"Let's take a look at the patients after tip surgery." Zheng Ren smiled warmly, "Which room are you in?"
Director Xia did not continue the ward rounds, but personally took Zheng Ren to the emergency room.
The patient can already sit up. Although he still looks a little haggard and anemic, the black air on his face has faded a lot. (Note 1)
"From last night to now, I vomited blood three times. The amount was not large, about 150ml in total. It is considered to be old blood accumulated in the stomach." Director Xia introduced the patient's condition. "In the test report this morning, the hemoglobin has returned to 79g, and the blood coagulation is His function was slightly poor, his blood ammonia was 63, and his physical examination showed no typical features of hepatic encephalopathy."
Because two stents were removed, the pressure on the patient's gastric varices was relieved, but not completely relieved.
As long as the bleeding is reduced, the remaining condition can be stabilized by using hemostatic drugs plus oral administration of kidney ice saline.
Zheng Ren is concerned about hepatic encephalopathy.
After surgery, patients are particularly prone to hepatic encephalopathy because part of the venous blood does not pass through the liver and lacks liver metabolism.
This is also the main reason for leaving two stents to reduce the inner diameter of the outflow tract.
When the patient adapts, the second stent can be removed, and the possibility of the patient vomiting blood in the future will plummet.
Zheng Ren went to inquire about the patient's condition and asked the patient to do a few simple math problems, such as 74+7+7+7=? This kind of questions.
If the patient has mild symptoms of hepatic encephalopathy, it will still be quite difficult to solve such questions.
But for math problems, you can only add one or two times.
If you add too much, most doctors won’t be able to understand it.
The patient's condition is still very good. Zheng Ren plans to observe it for two more days. If the blood ammonia does not continue to rise, the second stent can be removed.
After leaving the ward, Zheng Ren could see a sincere smile on Director Xia's face.
After all, he is a close classmate, the kind she can sign, and he can survive without leaving too many sequelae. This is undoubtedly a thing to be happy about.
After seeing the patients, Zheng Ren was going to drop by the ICU to take a look at the female patient who jumped off the building. Adenomyosis, this matter has another task, Zheng Ren occasionally thinks of it.
He has no obsessive-compulsive disorder. If he wants to improve his skills, all he needs to do is undergo tip surgery. The skill points gained from a high-level surgery are equivalent to completing 3-5 tasks.
Of course, the experience points given by the mission can be used for emergencies, so this detail will not be considered.
Just as he was about to leave, Director Xia's expression darkened slightly, as if he had made a crucial decision.
She then said: "Xiao Zheng, I have a patient here. Can you give me a hand?"
"Oh? Are you still a patient who needs tips surgery?" Zheng Ren asked.
"No, it's a complicated disease. The diagnosis and differential diagnosis are unclear, and the patient's condition is not good." Director Xia was a little embarrassed.
After all, it takes a lot of courage to say this to someone who has been a director for many years and whose diagnosis is unclear.
This is why Zheng Ren performed a floating gallbladder and a tip operation in the past two days, which helped Director Xia a lot. If it were anyone else, Director Xia would probably rather transfer the patient to another hospital than seek help from a resident general from another department.
"What's going on?" Zheng Ren also felt a little strange and asked.
"A 62-year-old female patient. The main clinical manifestations are severe sepsis, accompanied by abdominal pain and jaundice." Director Xia said while taking Zheng Ren to the patient's ward: "A plain scan of the abdomen can see that the patient has liver abscess and jaundice. Pneumobiliary disease. The area of the liver abscess is approximately 5.2x4.2 cm."
Liver abscess, complicated by jaundice, is a fatal disease.
Hearing this, Zheng Ren's steps became a little more hasty.
"The mrcp (magnetic resonance cholangiopancreatography) results showed that biliary-intestinal communication was visible between the proximal duodenum and the common bile duct, and there were ill-defined low-signal filling defects in the intrahepatic and extrahepatic bile ducts." Director Xia also quickened his pace and continued: "Please consult the general surgery department. The general surgery department said that there is no confidence in the operation because the patient's condition is not good and the preoperative diagnosis is not clear. If laparotomy is performed, the possibility of failure is too high."
"What about the past history?" Zheng Ren asked.
"It is said that he had a cholecystectomy twenty-four years ago."
Is it just a cholecystectomy? Zheng Ren had doubts in his heart. If it is a cholecystectomy, it should not be directly related to this disease.
With that said, several people came to the ward.
The junior doctors in the Department of Gastroenterology stood quietly in two rows in the corridor, holding medical record folders in their hands, behaved.
"Boss, look at how upright this young doctor is." Su Yun whispered beside Zheng Ren.
"If we do this, you will be the first person asked to stand on the spot." Zheng Ren looked at the patient anxiously and spat back.
Su Yun thought about it, it was indeed the truth.
Several people entered the ward, and Zheng Ren looked directly at the system panel on the upper right side of his field of vision.
A strange diagnosis appeared in front of Zheng Ren: cesspool syndrome.
Sewage pool syndrome is also known as blind end syndrome and blind den syndrome. It is a rare complication after surgical common bile duct and duodenum lateral incision and anastomosis.
It is most likely that food residues, stones, etc. accumulate in the blind bag formed from the bilioenteric anastomosis to the ampulla of Vater, causing a series of clinical symptoms.
The patient's body was yellow and looked like a minion.
The overall condition was very poor. Zheng Ren rubbed his hands to make his hands warmer so that they would not be too different from the patient's body temperature.
As soon as the fingers touched the patient's body, he felt hot.
The patient's body temperature is at least around 39 degrees Celsius, which should be caused by severe infection.
There was obvious tenderness in the right upper quadrant, near the duodenum, accompanied by rebound tenderness and muscle tension. There is dullness to percussion and typical gastrointestinal symptoms.
"Director Xia, I want a bedside ultrasound." Zheng Ren frowned in thought.
Because the patient's self-reported history of cholecystectomy was not consistent with the triggering factor of lateral incision and anastomosis of the common bile duct and duodenum, Zheng Ren was still cautious and wanted to do other tests to make it clear.
Although the big pig's hooves of the system have always been stable and reliable, doctors...especially doctors in tertiary hospitals, pay attention to having evidence.
Otherwise, after the operation is completed, the patient's family will turn around and sue you for a fraudulent medical practice, and you will have to walk away without food.
This kind of thing happens often, and Zheng Ren is helpless.
But we have no choice but to do the surgery. We still have to do the surgery. We still have to treat the disease and save the patient.
Ten minutes later, the doctor in the B-ultrasound room pushed the emergency B-ultrasound car to the ward.
After closing the curtains and plugging in the power, the doctor in the B-ultrasound room had just squeezed the coupling agent on the patient's abdomen. Zheng Ren suddenly asked, "I'll take a look first, okay?"
…
…
Note 1: The complexion of patients with liver disease is mostly black. This is not a fortune telling article, so I’ll explain it here.
-- Pull up to load the next chapter -->