Guan Zheng squeezed left and touched right, but he looked very professional. After inquiring, the Guanzheng said, "Appendicitis, relax. Keeping your mind relaxed can alleviate the pain. The doctor will come right away."
Guan Zheng pulled the past nurse and said: "This patient has acute appendicitis and needs urgent surgery."
"Who are you?" The nurse ignored the administration.
Guan Zheng took the bandage from the nurse and said, "Leave this to me. You can go and see this patient. He is more serious."
The nurse insisted: "How can this work? If you make a mistake, who should I cry?"
"Don't worry about this, I have this." Guan took out a notebook from his pocket like a coup d'etat. The nurse took a look and said, "Forget it, I'll call the doctor to show him."
Xu Jiuyan asked curiously: "What did you show the nurse just now?"
Guan Zheng lay beside Xu Jiuyan's ear and said, "Nurse qualification certificate."
"You are perverted! Do you even have this?" Xu Jiuyan looked at Guan Zheng dumbfounded.
Guan Zheng smiled and said: "I took the exam in my sophomore year. Because the employment rate of bioengineering was too low, so I listened to Feng Yuan and went to the exam. I thought I would work in the hospital and be a fashionable male. Nurse or something."
"But I didn't expect to be a policeman by mistake?" Xu Jiuyan said.
Guanzheng nodded and said, "Before I met the Bureau of History, I never thought I would be a policeman."
Xu Jiuyan pouted and said, "No wonder you know so much about medical knowledge. I'm really curious, how many things are you hiding from me?"
Guan Zheng smiled and said, "I'm hiding it from you, it's because your IQ is low, OK. Think about it for yourself, I know so much clinical knowledge, do you fools?"
Xu Jiuyan flew over with a fist: "Despise my IQ again..."
Xu Jiuyan's hand moved for a while and said, "Hey, hey, what's wrong with him? Isn't it dysfunctional?"
Guan Zheng turned and looked over and saw that the patient had lost consciousness. Guan Zheng shouted a few times but did not respond. Seki said: "Call a doctor. Acute appendicitis causes intestinal perforation, hemorrhagic shock, and surgery must be done as soon as possible."
The doctor finally took time out and pushed the patient into the operating room with all his might.
Xu Jiuyan stood at the door of the operating room, looking at the light that was lit, and asked: "Is this appendicitis so dangerous?"
Sekisei said: "Is that right? Appendicitis is an inflammatory change caused by a variety of factors. It is a common disease in surgery. It is most common in young people. It is more common in men than women. Acute appendicitis is more common in all ages and pregnancy. Chronic appendicitis is rare in women. Chronic appendicitis is rare. There are many reasons for acute appendicitis. First, the obstructed appendix is a long and thin tube with only one end connected to the cecum. Once obstructed, the secretions in the lumen can accumulate, the internal pressure increases, and the appendix is compressed. The wall obstructs the distal blood supply. On this basis, bacteria in the lumen can invade the damaged mucosa and easily cause infection.
Secondly, the main factor of infection is direct infection caused by bacteria in the appendix cavity. If the appendix mucosa is slightly damaged, bacteria invade the tube wall and cause different degrees of infection. Other factors considered to be related to the disease include visceral nerve reflex caused by gastrointestinal dysfunction such as diarrhea and constipation, leading to appendix muscles and blood vessels**, resulting in appendix lumen stenosis, blood supply disorder, mucosal damage, and bacterial invasion And cause acute inflammation.
For chronic appendicitis, clinical disease can be roughly divided into two categories: recurrent appendicitis and chronic appendicitis. The former is mostly caused by the inability to completely remove residual infection from the lesion during the onset of acute appendicitis, and the disease is prolonged and unhealed. The latter has no history of acute appendicitis, the symptoms are vague, and the signs are often inaccurate. "
Xu Jiuyan nodded and asked: "Then how do you judge that he is appendicitis?"
Seki said in detail: "Typical acute appendicitis has pain in the upper middle abdomen or around the umbilical cord. A few hours later, the abdominal pain transfers and is fixed to the right lower abdomen. When the inflammation spreads to the serosal layer and parietal peritoneum, the pain is fixed to the right lower abdomen. Pain in the original upper abdomen or around the umbilical cord is reduced or disappeared. Therefore, the absence of a typical history of metastatic right lower abdominal pain cannot rule out acute appendicitis. Simple appendicitis often presents paroxysmal or persistent pain and dull pain with persistent acute Pain often indicates purulent or gangrenous appendicitis. Sustained severe pain spreads to the middle and lower abdomen or both sides of the lower abdomen, and is often a sign of appendix gangrene perforation. This is the case of this patient.
Gastrointestinal symptoms The gastrointestinal symptoms of simple appendicitis are not prominent. In the early stage, nausea and vomiting may occur due to reflex gastric cancer. Pelvic appendicitis or gangrene perforation of the appendix may increase the frequency of bowel movements. Fever is generally only low-grade fever, no chills, and purulent appendicitis generally does not exceed 38 degrees Celsius. High fever is more common in appendix gangrene, perforation, or peritonitis.
Tenderness and rebound pain. Abdominal tenderness is a manifestation of inflammation of the peritoneum. The tenderness point of the appendix is usually located at Mc’s point, which is the middle and outer third of the junction between the right anterior superior iliac spine and the umbilical cord. Rebound pain is also called the Blumberg sign. In patients with obesity or appendicitis in the posterior cecum, tenderness may be mild, but there is obvious rebound pain. Abdominal muscle tension and purulent appendix have this sign, especially when gangrene perforation complicated by peritonitis. However, elderly or obese patients have weak abdominal muscles, and the opposite abdominal muscles must be checked at the same time for comparison.
A small number of people also have skin hypersensitivity. Skin hyperesthesia in the early stage, especially when the appendix cavity is obstructed, the right lower abdominal skin hyperesthesia phenomenon can occur, the range is equivalent to the tenth to twelfth thoracic spinal cord innervation area, located at the highest point of the right iliac crest, right pubic crest and The triangle formed by the umbilicus is also called Sherren's triangle. It does not change due to the position of the appendix. If the appendix is perforated with gangrene, the skin hypersensitivity in this triangle will disappear.
The symptoms of chronic appendicitis are also similar. Abdominal pain is pain in the right lower abdomen, which is characterized by intermittent dull pain or distending pain, which is heavy and light, and the location is relatively fixed. Most patients induce abdominal pain after eating, exercising, fatigue, cold and standing for a long time. Patients with gastrointestinal reactions often have varying degrees of indigestion and decreased appetite. Those with a longer course may suffer weight loss and weight loss. Generally, there is no nausea, vomiting, or abdominal distension, but elderly patients may be accompanied by constipation. Tenderness in the abdomen is the only physical sign, which is mainly located in the lower right abdomen, usually in a small area and a constant position. It can only appear when there is heavy pressure. No muscle tension and rebound pain, generally no abdominal mass. "
Xu Jiuyan felt that she had gained knowledge in an instant, and asked, "What about appendix surgery? A while ago, I heard the news that appendix surgery can kill people, so I really want to know if it is true or fake? Such a small operation can also be required. Human life?" (End of this chapter)