309 Sinkhole Syndrome And Minions (1/4)

Chapter 309 Sinkhole Syndrome and Minions (14)

"Let's take a look at the patient after TIPS." Zheng Ren smiled warmly, "Which room is it?"

Director Xia didn't continue his ward rounds, but brought Zheng Ren to the emergency room himself.

The patient can already sit up. Although he still looks haggard and anemic, the blackness on his face has subsided a lot. (Note 1)

"From last night to now, I have vomited blood three times. The volume is not large. There is about 150ml in total. It is considered to be old blood accumulated in the stomach." Director Xia introduced the patient's condition. The function is slightly worse, the blood ammonia is 63, and the physical examination has no typical characteristics of hepatic encephalopathy."

Because of the two stents, the pressure of the varicose veins in the patient's stomach was relieved, but not completely relieved.

As long as the bleeding is reduced, for the rest, the condition can be stabilized with hemostatic drugs and oral positive kidney ice saline.

Zheng Ren was concerned about the situation of hepatic encephalopathy.

After the operation, the patient is particularly prone to hepatic encephalopathy because part of the venous blood does not pass through the liver, and the liver metabolism process is missing.

This is also the main reason for leaving two stents to reduce the inner diameter of the outflow channel.

When the patient gets used to it, 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 topic.

If the patient has mild symptoms of hepatic encephalopathy, it is quite difficult to do this kind of questions.

But for math problems, you can only add one or two times.

Add too much, the average doctor can't understand it.

The patient's condition is still very good. Zheng Ren is going to observe for another two days. If the blood ammonia does not continue to rise, the second stent can be taken out.

After leaving the ward, Zheng Ren could see Director Xia with a sincere smile on his face.

After all, it is a pro-classmate, or the kind she can sign. It is undoubtedly a happy thing to survive without leaving too much sequelae.

After seeing the patient, Zheng Ren was going to drop by the ICU to take a look at the female patient who jumped off the building. Adenomyosis, there is another task for this matter, Zheng Ren will occasionally think about it.

He doesn't have obsessive-compulsive disorder, and if he wants to improve his skills, he only needs to do TIPS surgery. The skill points gained by a high-level surgery are equivalent to completing 3-5 tasks.

Of course, the experience points given by the task can be used for emergency, 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 another patient here, can you help me take a look?"

"Oh? Are you still a patient who needs TIPS surgery?" Zheng Ren asked.

"No, it's an intractable disease. The diagnosis and differential diagnosis are not clear, and the patient's condition is not good." Director Xia was a little embarrassed.

After all, it takes a lot of courage to say such words about an old director who has been diagnosed for many years.

This means that Zheng Ren performed a floating gallbladder and a TIPS operation in the past two days, which helped Director Xia a lot. If it were another person, Director Xia would rather transfer the patient to another hospital than seek help from a hospital chief from another department.

"What's the situation?" Zheng Ren also felt a little strange and asked.

"A 62-year-old female patient. The main clinical manifestation is severe sepsis, accompanied by abdominal pain and jaundice." Director Xia took Zheng Ren to the patient's ward and said, "A plain CT scan of the abdomen can show that the patient has liver abscess. And biliary gas. The area of ​​the liver abscess is about 5.2×4.2 cm.”

Liver abscess and jaundice, this is a fatal disease.

Hearing this, Zheng Ren hurried a little.

"MRCP (magnetic resonance cholangiopancreatography) results showed that the biliary-intestinal communication between the proximal duodenum and the common bile duct was visible, and there were low-intensity filling defects with unclear outlines in the intrahepatic and external bile ducts." Director Xia also quickened his pace, and continued: "Please consult with the general surgery department. The general surgery department said that the operation is not sure, because the patient's condition is not good, and the preoperative diagnosis is not clear. The possibility of failure is too high for laparotomy."

"What about past history?" Zheng Ren asked.

"It is said that a cholecystectomy was performed twenty-four years ago."

Is it just a cholecystectomy? Zheng Ren had doubts in his heart. If it was cholecystectomy, it should not be directly related to this disease.

With that said, several people came to the ward.

The junior physicians of the Department of Gastroenterology stood quietly in two rows in the corridor, holding the folders of medical records in their hands, behaved well.

"Boss, look at his little doctor, he is very upright." Su Yun whispered beside Zheng Ren.

"If we were like this, you would be the first person to be asked to stand." Zheng Ren anxiously looked at the patient, and squirted back.

Su Yun thinks about it, it is indeed the truth.

Several people entered the ward, and Zheng Ren looked directly at the system panel at the top right of his field of vision.

An unfamiliar diagnosis appeared before Zheng Ren's eyes - cesspool syndrome.

Sinkhole syndrome is also known as blind end syndrome and blind pit syndrome. It is an uncommon complication after surgical common bile duct and duodenum lateral resection and anastomosis.

The most likely reason is that food residues, stones, etc. accumulated in the blind bag formed from the biliary-enteric anastomosis to the ampulla of Vater, which caused a series of clinical symptoms.

The whole body of the patient is yellow and looks like a little yellow man.

The overall condition was very poor. Zheng Ren rubbed his hands together to make his hands warmer. The difference in body temperature from the patient's was too great.

As soon as the fingers touched the patient's body, they felt hot.

The patient's body temperature was at least 39 degrees Celsius, which should be caused by a serious infection.

The right upper quadrant, near the duodenum, had obvious tenderness, accompanied by rebound tenderness and muscle tension. Percussion was dull, with typical gastrointestinal symptoms.

"Director Xia, I need a bedside ultrasound." Zheng Ren frowned and thought.

Since the patient's self-reported history of cholecystectomy did not match the predisposing factors of common bile duct and duodenotomy, Zheng Ren still cautiously wanted to do other tests to clarify.

Although the big pig's hoof of the system has always been stable and reliable, doctors...especially doctors in tertiary hospitals pay attention to evidence.

Otherwise, after the operation is completed, the family members of the patient will turn around and sue you for a fraudulent medical practice, and you will have to walk around if you can't afford it.

This kind of thing happened often, and Zheng Ren felt very helpless.

But helplessness is helplessness, the operation should be done, and the cure should be saved.

Ten minutes later, the doctor in the B-ultrasound room came to the ward with an emergency B-ultrasound cart.

After closing the curtains and plugging in the power, the doctor in the B-ultrasound room had just squeezed gel into the patient's abdomen, when Zheng Ren suddenly asked, "Let me take a look first, okay?"

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Note 1: The complexion of patients with liver disease is mostly black. It's not a master's article, so explain it here.