Decompensated liver cirrhosis, portal hypertension, hypoalbuminemia, ion disorders, ascites, pleural effusion…
The array of diagnoses is dizzying.
It seems that this is another patient whose hepatitis B has progressed to liver cirrhosis, splenomegaly, portal hypertension, and then led to refractory ascites.
The early diagnosis and disease progression are similar.
There are two fatal diseases in the decompensated stage of cirrhosis: hematemesis and ascites.
Once ascites reaches the stubborn stage, ordinary diuresis and other methods will not work. Ascites leads to low protein, which in turn causes body fluids to leak out, causing more severe ascites and a continuous decrease in protein.
This is an endless loop.
The common way to treat ascites and hypoalbuminemia clinically is diuresis + intravenous infusion of human albumin.
However, in the face of stubborn ascites, no matter how much human albumin is inserted, it will be useless, as it will soon turn into ascites and leak out.
This complication is different from hematemesis. Although it seems that stubborn ascites is not as urgent as hematemesis, hematemesis caused by portal hypertension can still be treated with surgery.
Stubborn ascites can only wait to die before tip surgery. Nowadays, because tip surgery is extremely difficult, the hospitals where it is performed are limited to large tertiary hospitals in provincial capital cities or above.
If you have this disease, without tips surgery, it is equivalent to Ling Chi.
The patient is in extreme pain, and his life is slowly suffering towards the end.
Zheng Ren conducted a simple physical examination and asked about the patient's condition and test results.
The resident doctor who followed Director Xia answered questions one by one and was well-trained. The diagnosis of gastroenterology is similar to that of the system panel, and there is not much difference.
The patient has no absolute preoperative contraindications and can be treated surgically.
Zheng Rendao: "Director Xia, the patient will undergo an MRI of the liver today with diffusion added. I will pick up the order and prepare for the surgery tomorrow."
"Nuclear magnetic dispersion?" Director Xia was stunned for a moment.
Diffusion nuclear magnetic resonance imaging, the full name is magnetic resonance diffusion weighted imaging.
Different from conventional magnetic resonance imaging (MRI), nuclear magnetic diffusion is based on the movement of water molecules, which can provide clinical information based on the physiological state of the brain.
Mainly used for neurological treatment.
The sensitivity for diagnosing acute cerebral infarction is 100%, and the specificity is 100%. It can also reliably identify arachnoid cysts and epidermoid cysts, subdural empyema and effusion, abscess and tumor necrosis.
For tips surgery, what does Zheng Ren need MRI diffusion for
Director Xia had heard that experts from the Imperial Capital and Magic Capital used liver MRI diffusion to detect tumors. But this is not a tumor, it is stubborn ascites in the late stage of cirrhosis.
Xiao Zheng, this is...
Director Xia pondered.
Zheng Ren didn't explain anything to Director Xia. This is a tip for diagnosis and positioning before surgery that he has honed in the system operating room. It is used to determine the location of the portal vein and hepatic vein and improve the chance of successful puncture.
If I were to start from the beginning, I am afraid that a few days would not be enough.
There are other things that Zheng Ren is too lazy to trouble.
After explaining this, Zheng Ren and Director Xia said goodbye and went to the ICU.
After changing clothes and entering the ICU ward, Zheng Ren felt the depressing atmosphere in the entire ICU.
The director of the medical department is also sitting here, frowning.
Su Yun was sitting beside Yang Lili's bed, her black hair fluttering in front of her forehead, and she lowered her head and looked at the test sheet in her hand.
"What's wrong?" Zheng Ren came to Su Yun and asked in a low voice.
"Boss, something is wrong." Su Yun said, "This morning, the sedative was stopped and the patient developed mental symptoms."
Psychiatric symptoms
Zheng Ren was also startled.
There are no mental symptoms in the diagnosis on the system panel.
"The blood routine was generally normal, intraoperative disinfection was done well, and there was no clear infection. Biochemical sugar was 15.49 mmol/l, sodium was 134 mmol/l, potassium was 4.15 mmol/l; blood gas analysis: pH 7.46, partial pressure of oxygen mmhg, bicarbonate mmol/l, alkali remaining 3 mmol/l; urinary ketones +++." Su Yun casually told the results of this morning's emergency report without looking at the list in his hand.
"What are Yang Lili's mental symptoms?" Zheng Ren asked, frowning.
"Fear, very serious fear." Su Yun said, "It was like seeing a ghost. I was so agitated that I almost couldn't tie my wristband. My heart rate soared even more. After I stopped the sedative, my heart rate dropped from 95 beats/ The score directly increased to 156 times/minute."
"Strange." Zheng Ren recalled the test results that Su Yun said. Overall, they were pretty good, except that the blood sugar was slightly high, and there were urine sugar and ketone bodies. It was considered to be the body's transient stress response to severe trauma.
And what the hell...
This is so hard to explain.
Was it because she was severely frightened that day, which left a shadow in her heart
It was possible, but psychological treatment was considered an emerging subject in the country, and Zheng Ren didn't know who was a professional.
And the most important thing is that with Yang Lili's current situation, the psychiatrist is unable to provide psychological counseling.
If delayed for a few days, the tracheotomy will occur. Once complications such as pulmonary infection occur...
Zheng Ren was also helpless.
No wonder the atmosphere in the ICU is so depressing. Patients who appear to be fine on laboratory tests develop strange complications.
In particular, this patient is a key target of the city's attention. It is said that the patient's condition is reported directly to the director of the Health Bureau and the deputy mayor in charge of culture, education and health every day.
What do you say about today's report? Could it be said that when the patient stopped sedating, he saw ghosts
Zheng Ren frowned tightly, pondering over the various diagnoses given in the system panel.
After re-applying the sedative, Yang Lili's heart rate was still very high.
Postoperative infection? The patient only has low-grade fever, and postoperative heat absorption is considered. There are no obvious abnormalities in crp, so serious infection is unlikely.
Pulmonary embolism? Caused respiratory distress, chest pain, increased heart rate
Zheng Ren picked up the stethoscope and listened to Yang Lili's breathing sounds on both sides. It's not pulmonary embolism...
Zheng Ren can be sure without doing a CTA examination of the pulmonary blood vessels.
Physical examination and systematic diagnosis are combined into one, which can basically determine the diagnosis.
Could it be cardiac insufficiency caused by massive fluid replenishment after surgery? Zheng Ren thought about it and asked, "How much is the input and output?"
Su Yun shook his head, obviously he had also considered this.
"The amount of input after surgery was much greater than the amount of output; on the first day after surgery, the difference was reduced. Yesterday, the amount of input and output was basically the same."
The large amount of blood taken after surgery was due to Yang Lili’s massive bleeding.
It only took 2 days to recover. It can be said that it is the result of the joint efforts of Su Yun and the ICU medical staff, plus Yang Lili is young and has good physical fitness.
Moreover, Yang Lili has no history of cardiovascular disease or similar family history, so symptoms of cardiac insufficiency are not considered for the time being.
This is also ruled out... So what then
In the end, diabetic ketoacidosis can only be considered.
Because Yang Lili had positive urine ketones, elevated blood sugar and acidosis, but normal hydroxybutyric acid, the ICU doctor's instructions temporarily gave the patient low-dose insulin treatment.
Ketoacidosis, neither.
It couldn't really be a mental illness... Zheng Ren had a headache.
Looking carefully at the diagnoses in the system panel one by one, Zheng Ren's eyes suddenly lit up!
Could it be this