Dean Guo and the others were not in a hurry, drinking tea and chatting while waiting for the big medical records to be delivered.

About half an hour later, Zhang Jun knocked on the door and came in, holding a large medical record that he had just finished writing in his hand.

When Qi Damin saw Zhang Jun coming in, he asked, "Have you finished writing?"

"I'm reporting to Section Chief Qi that I have written down my medical history and the course of my first diagnosis and asked several teachers to review it."

Qi Damin took the iron clip and handed it to Dean Guo who was sitting in the middle.

Dean Guo was not polite. He opened the medical record and looked through it. After all, he was a college student. His handwriting was standardized, clear and organized. He indeed had two brushes.

Dean Guo nodded while flipping through the pages. When he reached the diagnosis page, his hands and eyes stopped.

"Classmate Xiao Zhang, your diagnosis is cholangiocarcinoma, right?"

Zhang Jun swallowed nervously: "Yes, Dean Guo."

"Oh, then tell me what is the basis for your diagnosis?"

"My main diagnostic basis is based on B-ultrasound alone. The patient has intrahepatic bile duct dilation, gallbladder emptiness, and soft tissue shadows in the upper common bile duct, but the caliber of the extrahepatic bile duct is normal. This can basically be judged as hilar cholangiocarcinoma, and it has already

It’s the middle to late stage.”

Dean Guo smiled and said nothing. Instead, he handed the medical record to Qi Damin next to him and motioned for everyone to circulate it.

Just when Jin Peilin was the last to read the medical record and before he could praise Zhang Jun, Chen Qi also knocked on the door and came in.

"Dean Guo, Section Chief Qi, Director Zhu, Director Jin, my medical record has been written."

Qi Damin nodded: "You sit next to me for a while."

When Dean Guo got Chen Qi's medical records, the first thing he noticed was the beautiful pen calligraphy. The pen was strong and powerful, which made him nod his head after reading it.

The entire medical record is written down in more detail than Zhang Jun's, but when it comes to scoring, the two people's scores are almost the same. However, Zhang Jun is a college student and Chen Qi is a technical secondary school student. If the two have the same score, Zhang Jun actually loses first.

.

Dean Guo did not express any opinion, but directly turned to the diagnosis page, and then his eyes lit up:

"Classmate Xiao Chen, are you diagnosed with hilar bile duct stenosis and cholangitis?"

As soon as these words came out, they immediately aroused the interest of everyone in the office. Everyone's originally dull mood suddenly became lively.

Because the diagnoses of Chen Qi and Zhang Jun are completely different, it means that this game is definitely not a draw. One of them must lose completely, and then there will be a good show.

Zhang Jun was a little surprised when he heard Chen Qi’s diagnosis:

"Chen Qi, didn't you see on the B-ultrasound sheet that there was a soft tissue shadow in the upper part of the common bile duct? It's such an obvious tumor."

Dean Guo handed the medical records to Qi Damin next to him and asked with a smile:

"Yes, why did you eliminate such a big thing when it was there? Let me show you two more test reports. These were done by the patient in the outpatient clinic in the morning, and the results have just been sent."

Dean Guo handed over two pieces of paper,

One is a B-ultrasound report, which shows that the lumen at the bifurcation of the left and right hepatic ducts is narrowed, and a 2.7cm*1.4cm mass can be seen in the common hepatic duct after contrast agent injection.

The other is an X-ray report, which shows that the hilar bile duct is severely stenotic, the intrahepatic bile duct is widely dilated, and the common bile duct and pancreatic duct have no stenosis or dilation.

Zhang Jun looked even more proud after reading it, feeling that his diagnosis was stable.

After reading it, Chen Qi just gently placed the two report sheets on the table without any frustrated expression on his face.

Dean Guo looked at Chen Qi with a playful expression and asked with a smile:

"How about it? After seeing these two reports, do the two students need to modify their initial diagnosis?"

Zhang Jun shook his head firmly: "These two report sheets further confirm that my diagnosis is correct and there is no need to change it."

Chen Qi smiled: "Yes, these two report sheets also made me more determined to rule out the diagnosis of malignant tumors."

Dean Guo leaned back on his chair, looked at the many doctors in the room and asked, "Come on, tell me, which diagnosis do you agree more with?"

Li Jun was the first to stand up: "Dean Guo, I agree with Zhang Jun's diagnosis. This is a very obvious space-occupying tumor, and it is still at the liver hilus, so the possibility of malignant tumor is the highest."

Several other young doctors also nodded, obviously everyone agreed with Zhang Jun's diagnosis.

Dean Guo then looked at several senior doctors: "Lao Qi, Lao Zhu, and Director Jin, please tell us. Today will be a big case discussion in the department."

Qi Damin was trained in internal medicine. After reading several report sheets and physical examination results in the medical records, he tended to be cholangiocarcinoma.

Zhu Huoyan carefully looked at several report sheets and then glanced at Chen Qi. Obviously, he was leaning towards Chen Qi's diagnosis, but because Chen Qi had not yet given a detailed basis for his diagnosis, he did not speak out to support it.<

/p>

Jin Peilin remained silent. With the big bosses around, he, the head of a small department, shouldn't be overly expressive.

When Dean Guo saw that everyone in the office was leaning towards Zhang Jun, he said with a smile:

"Xiao Chen, you see, everyone's diagnosis is that cholangiocarcinoma is highly likely. If you want to say it is common cholangitis, then please tell me the basis for your diagnosis. Be careful, don't talk nonsense, we doctors must hold it in

A pragmatic attitude."

Chen Qi let out a breath. As a hepatobiliary surgeon in his previous life, he was confident that his diagnosis would not be wrong. After all, he had dealt with too many bile duct cancers before.

"Dean Guo, several teachers, I judge from these perspectives.

One is that the patient's clinical manifestations are inconsistent. He does not have jaundice. Neither the test results nor his face indicate jaundice. In addition, the patient has no symptoms such as itchy skin, weight loss, indigestion, and upper abdominal discomfort."

Chen Qi began to explain the basis of his diagnosis, and the office quickly became quiet.

We are all professional doctors. Although we have inner tendencies, we also understand the principle of listening and listening.

Zhang Jun deliberately objected, saying that not every cholangiocarcinoma would have the above clinical manifestations, but he held back. If he interrupted others when reporting their condition, whether it was right or wrong, it would leave a bad impression on the leader.<

/p>

Chen Qi ignored everyone's thoughts and continued following his own train of thought:

"In addition, the two lists given by Dean Guo just now indicate that if it is cancer, there are no intrahepatic metastases and accompanying lesions, no vascular invasion, and no enlargement of the portal lymph nodes, so inflammatory lesions

It cannot be ruled out.

Another basis is the tumor indicator on the physical examination sheet. As you can see, carbohydrate antigen 19-9 is normal. So just a bile duct stricture and a soft tissue shadow can be said to be a malignant tumor. I think it is unlikely.

”
Chapter completed!