Chapter 351 Postoperative Mental Illness?

Decompensated liver cirrhosis, portal hypertension, hypoproteinemia, ion disorder, ascites, pleural effusion...

The barrage of diagnoses is dizzying.

From the looks of it, it was another patient who progressed from hepatitis B to cirrhosis, splenomegaly, portal hypertension, and then led to intractable ascites.

Early diagnosis and disease progression were similar.

There are two fatal diseases in the decompensated stage of cirrhosis-hematemesis and ascites.

Once the ascites reaches the intractable stage, the usual diuretic measures are not effective. Ascites leads to low protein, which in turn leads to exudation of body fluids, resulting in more severe ascites, while the protein continues to decrease.

It's an endless loop.

The common way to treat ascites and hypoproteinemia clinically is diuresis + intravenous infusion of human serum albumin.

But in the face of stubborn ascites, no matter how much human serum albumin is put in, it is useless, and it will soon turn into ascites and ooze out.

This complication is different from hematemesis. Although it seems that refractory ascites is not as urgent as hematemesis, hematemesis caused by portal hypertension can still be treated surgically.

Intractable ascites, before TIPS surgery, can only wait for death. Now TIPS surgery is extremely difficult, and the hospitals that carry out it are limited to large tertiary hospitals above the provincial capital city.

With this disease, if there is no TIPS operation, it is equivalent to Lingchi.

The patient is in extreme pain, and his life is going to the end in slow suffering.

Zheng Ren did a simple physical examination, and asked about the patient's condition and test results.

The resident doctor who was with Director Xia answered each item one by one, and was well-trained. The diagnosis of gastroenterology is similar to the diagnosis of the system panel, and there is not much difference.

Patients have no absolute preoperative contraindications and can be treated surgically.

Zheng Rendao: "Director Xia, the patient will have an MRI of the liver today, plus diffusion. I will bring up the list and prepare for surgery tomorrow."

"Nuclear magnetic dispersion?" Director Xia was taken aback for a moment.

Magnetic resonance diffusion, the full name is called magnetic resonance diffusion weighted imaging.

Different from conventional magnetic resonance imaging (MRI), the basis of nuclear magnetic resonance imaging is the movement of water molecules, which can provide clinical information based on the physiological state of the brain.

It is mainly used in the treatment of neurology.

It has a sensitivity of 94 % and a specificity of 100 % for the diagnosis of acute cerebral infarction and can reliably differentiate arachnoid cysts from epidermoid cysts, subdural empyema from effusion, abscess from tumor necrosis.

What does Zheng Ren need MRI for TIPS surgery?

Director Xia has heard that experts in the Imperial Capital and Shanghai Metropolitan City use liver MRI diffusion to look at tumors. But this is not a tumor, but stubborn ascites in the late stage of liver cirrhosis.

Xiao Zheng, this is...

Director Xia pondered.

Zheng Ren didn't explain anything to Director Xia. This is a pre-TIPS diagnosis and positioning method that he has honed over time in the operating room of the system. It is used to judge the position of the portal vein and hepatic vein and improve the probability of successful puncture.

If we start from the beginning, I am afraid that a few days will not be enough.

There are other things that Zheng Ren is too lazy to trouble.

After explaining this, Zheng Ren and Director Xia left and went to the ICU.

After changing clothes and entering the ICU ward, Zheng Ren felt the oppressive atmosphere in the entire ICU.

The chief of the medical department is also sitting here, frowning.

Su Yun was sitting beside Yang Lili's bed, with black hair fluttering on his forehead, looking down at the test sheet in his hand.

"What's wrong?" Zheng Ren came to Su Yun's side 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."

Mental symptoms?

Zheng Ren was also taken aback.

In the diagnosis on the system panel, there are no mental symptoms.

"Blood routine is generally normal, intraoperative disinfection is good, and there is no clear infection. Biochemical sugar 15.49 mmol/L, sodium 134 mmol/L, potassium 4.15 mmol/L; blood gas analysis: pH 7.46, partial pressure of oxygen 61 mmHg, bicarbonate 38 mmol/L, alkali remaining 3 mmol/L; urine ketone body +++." The results of the report are all stated.

"What are Yang Lili's mental symptoms?" Zheng Ren asked, frowning.

"Fear, very serious fear." Su Yundao, "It's like seeing a ghost. The agitation is so strong that you can hardly tie the wristband. The heart rate soars. After the sedative is stopped, the heart rate directly rises from 95 beats per minute to 156 beats per minute."

"Strange." Zheng Ren recalled Su Yun's test results. Overall, they were not bad, but the blood sugar was slightly high, and there were sugar in urine and ketones. It was considered to be a transient stress response of the body to severe trauma.

And hell...

This is so hard to explain.

Is it because of the severe fright that day, which left a shadow in her heart?

There is such a possibility, but psychological treatment is a new discipline in the whole country, and Zheng Ren doesn't know who it is specialized in.

And most importantly, with Yang Lili's current situation, the psychiatrist has no way to provide psychological counseling.

After a few days of delay, the trachea will be cut. At that time, once complications such as pulmonary infection appear...

Zheng Ren was also very helpless.

No wonder the atmosphere in the ICU is so oppressive. The patients who looked fine in laboratory tests had strange complications.

In particular, this patient is the focus of attention in the city. 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.

How about today's report? Do you want to say that the patient will see a ghost after the sedative is stopped?

Zheng Ren frowned tightly, thinking about the various diagnoses given on the system panel.

The sedative was reapplied, but Yang Lili's heart rate was still fast.

postoperative infection? The patient had only low-grade fever, and postoperative absorption of heat was considered. CRP is also not significantly abnormal, so a serious infection is unlikely.

pulmonary embolism? Resulting respiratory distress, chest pain, rapid heart rate?

Zheng Ren picked up the stethoscope and listened to Yang Lili's breathing sounds on both sides. Not a pulmonary embolism...

There is no need for a CTA examination of the pulmonary vessels, Zheng Ren can be sure.

Physical examination and system diagnosis are combined into one, which can basically be qualitative.

Could it be the cardiac insufficiency caused by a large amount of fluid infusion after the operation? Zheng Ren thought about it and asked, "How much is the amount?"

Su Yun shook his head, obviously he had considered this point.

"The postoperative intake is much more than the output; on the first day after the operation, the gap decreased. Yesterday, the intake and output were basically the same."

The large postoperative intake 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 medical staff in the ICU, and Yang Lili is young and has good physical fitness.

Moreover, Yang Lili has no history of cardiovascular disease, nor does she have a similar family history, so the performance of cardiac insufficiency is not considered for the time being.

That also rules out... so what then?

Finally, only diabetic ketoacidosis can be considered.

Because Yang Lili had positive urine ketones, elevated blood sugar, and acidosis, but the oxybutyric acid was normal, the doctor's order in the ICU temporarily gave the patient low-dose insulin therapy.

Ketoacidosis, neither.

It can't really be a mental illness... Zheng Ren has a headache.

Looking carefully at the diagnostics on the system panel one by one, Zheng Ren's eyes suddenly lit up!

Could it be this?