Chapter 309： Sewage Pool Syndrome and Xiao Huangren (1/4)
"Look at the patients after TIPS." Zheng Ren smiled, warm and awkward, "Where is it?"
Director Xia did not continue to round up the house, but personally took Zheng Ren to the rescue room.
The patient is already able to sit up, although the look is still awkward, anemia, but the layer of black gas on the face has faded a lot. (Note 1)
"Last night, to the present, vomiting blood 3 times, the amount is not large, a total of about 150ml, consider the old blood accumulated in the stomach." Director Xia introduced the patient's condition, "In the morning test, the hemoglobin has recovered to 79g, coagulation The function is slightly worse, blood ammonia 63, the physical examination has no typical hepatic encephalopathy."
Because of the two stents, the pressure on the patient's gastric varices was alleviated, but not completely relieved.
As long as the bleeding is reduced, the rest, with the hemostatic drugs plus oral Zhengshen ice brine can stabilize the condition.
Zheng Ren is concerned about the condition of hepatic encephalopathy.
After the patient, hepatic encephalopathy is particularly prone to occur because part of the venous blood does not pass through the liver and the process of liver metabolism is reduced.
This is also the main reason for leaving two brackets to reduce the inner diameter of the outflow channel.
When the patient adapts, the second stent can be removed, and the likelihood of the patient vomiting blood will drop.
Zheng Ren went to ask about the patient's condition and asked the patient to do a few simple math problems, such as 74+7+7+7=? This type of topic.
If the patient has mild hepatic encephalopathy, this type of problem can still be quite difficult to do.
But math problems can only be added once or twice.
Adding more, the average doctor does not understand.
The patient's condition is still very good, Zheng Ren is ready to observe for another two days, if the blood ammonia does not continue to rise, the second stent can be taken out.
Out of the ward, Zheng Ren can see Director Xia with a sincere smile on his face.
After all, it is a pro-classmate, or the kind that she can give a signature, can survive, and does not leave too much aftereffects, which is undoubtedly a happy thing.
After reading the patient, Zheng Ren is ready to drop to the ICU and take a look at the female patient who jumped off the building. Adenomyosis, there is still a task in this matter, Zheng Ren will occasionally think of it.
He has no obsessive-compulsive disorder and wants to improve his skills. It is enough to do TIPS surgery. A high-level surgical skill point is equivalent to completing 3-5 tasks.
Of course, the experience value given by the task can be used for emergency, and this detail is not considered.
Just about to leave, Director Xia’s expression was a little heavy and seemed to make a crucial decision.
She then said: "Xiao Zheng, I have a patient here, do you have a look at the palm?"
"Oh? Still need a patient with TIPS surgery?" Zheng Ren asked.
"No, it is a difficult disease, the diagnosis and differential diagnosis are not clear, and the patient is in a bad state." Director Xia is a little embarrassed.
After all, the old director of many years, the diagnosis is unknown, this kind of saying that exporting requires a lot of courage.
This is why Zheng Ren has made a floating gallbladder in the past two days, and also done a TIPS operation, helping the director Xia busy. If it is to change individuals, Director Xia is more likely to give the patient a referral, and will not ask for the total hospitalization of a other department.
"What is the situation?" Zheng Ren also felt a little strange, asked.
"62-year-old female patient. The main clinical manifestations are severe sepsis with abdominal pain and jaundice." Director Xia took Zheng Ren to the patient's ward and said: "Abdomen CT scan can see patients with liver abscess. And biliary tract gas. The area of liver abscess is about 5.2 × 4.2cm."
Liver abscess, complicated by jaundice, this is a terrible disease.
Hearing here, Zheng Ren’s footsteps were anxious.
"MRCP (magnetic resonance cholangiopancreatography) results show that there is a communication between the proximal duodenum and the common bile duct, and there is a low signal filling defect in the liver and the outer bile duct." Director Xia also stepped up and continued. "Please consult the general surgery department. It is said that the operation is not very good, because the patient's condition is not good, and the preoperative diagnosis is not clear. If the laparotomy is performed, the possibility of failure is too high."
"What is the past history?" Zheng Ren asked.
"It is said that a cholecystectomy was performed twenty-four years ago."
Is it just a cholecystectomy? Zheng Ren has doubts in his heart. If it is a cholecystectomy, it should not be directly related to this disease.
Said, a few people came to the ward.
The lower-level physicians in the Department of Gastroenterology quietly stood in two rows in the hallway, holding medical records in their hands, and being well-behaved.
"Boss, you see the little doctor of the family, many boards are right." Su Yun whispered around Zheng Ren.
"If we do this, the first board that is required to stand is you." Zheng Ren was anxious to see the patient, and spit back.
Su Yun thinks, this is indeed the truth.
A few people entered the ward, and Zheng Ren looked directly at the system panel at the top right of the field of view.
An unfamiliar diagnosis appeared in front of Zheng Ren's septic tank syndrome.
The septic tank syndrome has also become blind end syndrome and blind socket syndrome. It is an uncommon complication after surgical bile duct and duodenal lateral anastomosis.
The high probability is that food debris, stones, etc. accumulate in the biliary anastomosis to the blind pocket formed by the Vater ampulla, causing a series of clinical symptoms.
The patient was yellow and looked like a little yellow man.
The overall state is very poor, Zheng Ren smashed his hand, let his hand warmer, and the patient's temperature difference is not too big.
As soon as the finger touched the patient's body, it felt hot.
The patient's temperature is at least 39 degrees Celsius and should be caused by a serious infection.
In the right upper abdomen, close to the duodenal segment, tenderness is obvious, accompanied by rebound tenderness and muscle tension. Percussion is voiced and has typical gastrointestinal symptoms.
"Director Xia, I want a bedside B-super." Zheng Ren frowned.
Because the patient's history of spontaneous cholecystectomy and the common bile duct, duodenal lateral anastomosis is not consistent with this predisposing factor ~ www.novelhall.com ~ so Zheng Ren is cautious to do other checks to clear.
Although the system's big pig's hooves have been stable and reliable, doctors, especially doctors in the top three hospitals, are concerned with evidence.
Otherwise, the operation is done, the patient's family turns to tell you a fraudulent practice, can't eat and walk.
This kind of thing is often seen, Zheng Ren is also very helpless.
But helplessness is helpless, the surgery still has to be done, the treatment saves people, or is saved.
Ten minutes later, the doctor in the B-room went to the ward with an emergency B overtaking.
Pulling on the curtains and plugging in the power supply, the doctor in the B-chamber room just squeezed the coupling agent in the patient's abdomen. Zheng Ren suddenly asked: "I will take a look first, okay."
......
......
Note 1: The face of patients with liver disease is mostly black. Not a teacher, so explain it here.
Director Xia did not continue to round up the house, but personally took Zheng Ren to the rescue room.
The patient is already able to sit up, although the look is still awkward, anemia, but the layer of black gas on the face has faded a lot. (Note 1)
"Last night, to the present, vomiting blood 3 times, the amount is not large, a total of about 150ml, consider the old blood accumulated in the stomach." Director Xia introduced the patient's condition, "In the morning test, the hemoglobin has recovered to 79g, coagulation The function is slightly worse, blood ammonia 63, the physical examination has no typical hepatic encephalopathy."
Because of the two stents, the pressure on the patient's gastric varices was alleviated, but not completely relieved.
As long as the bleeding is reduced, the rest, with the hemostatic drugs plus oral Zhengshen ice brine can stabilize the condition.
Zheng Ren is concerned about the condition of hepatic encephalopathy.
After the patient, hepatic encephalopathy is particularly prone to occur because part of the venous blood does not pass through the liver and the process of liver metabolism is reduced.
This is also the main reason for leaving two brackets to reduce the inner diameter of the outflow channel.
When the patient adapts, the second stent can be removed, and the likelihood of the patient vomiting blood will drop.
Zheng Ren went to ask about the patient's condition and asked the patient to do a few simple math problems, such as 74+7+7+7=? This type of topic.
If the patient has mild hepatic encephalopathy, this type of problem can still be quite difficult to do.
But math problems can only be added once or twice.
Adding more, the average doctor does not understand.
The patient's condition is still very good, Zheng Ren is ready to observe for another two days, if the blood ammonia does not continue to rise, the second stent can be taken out.
Out of the ward, Zheng Ren can see Director Xia with a sincere smile on his face.
After all, it is a pro-classmate, or the kind that she can give a signature, can survive, and does not leave too much aftereffects, which is undoubtedly a happy thing.
After reading the patient, Zheng Ren is ready to drop to the ICU and take a look at the female patient who jumped off the building. Adenomyosis, there is still a task in this matter, Zheng Ren will occasionally think of it.
He has no obsessive-compulsive disorder and wants to improve his skills. It is enough to do TIPS surgery. A high-level surgical skill point is equivalent to completing 3-5 tasks.
Of course, the experience value given by the task can be used for emergency, and this detail is not considered.
Just about to leave, Director Xia’s expression was a little heavy and seemed to make a crucial decision.
She then said: "Xiao Zheng, I have a patient here, do you have a look at the palm?"
"Oh? Still need a patient with TIPS surgery?" Zheng Ren asked.
"No, it is a difficult disease, the diagnosis and differential diagnosis are not clear, and the patient is in a bad state." Director Xia is a little embarrassed.
After all, the old director of many years, the diagnosis is unknown, this kind of saying that exporting requires a lot of courage.
This is why Zheng Ren has made a floating gallbladder in the past two days, and also done a TIPS operation, helping the director Xia busy. If it is to change individuals, Director Xia is more likely to give the patient a referral, and will not ask for the total hospitalization of a other department.
"What is the situation?" Zheng Ren also felt a little strange, asked.
"62-year-old female patient. The main clinical manifestations are severe sepsis with abdominal pain and jaundice." Director Xia took Zheng Ren to the patient's ward and said: "Abdomen CT scan can see patients with liver abscess. And biliary tract gas. The area of liver abscess is about 5.2 × 4.2cm."
Liver abscess, complicated by jaundice, this is a terrible disease.
Hearing here, Zheng Ren’s footsteps were anxious.
"MRCP (magnetic resonance cholangiopancreatography) results show that there is a communication between the proximal duodenum and the common bile duct, and there is a low signal filling defect in the liver and the outer bile duct." Director Xia also stepped up and continued. "Please consult the general surgery department. It is said that the operation is not very good, because the patient's condition is not good, and the preoperative diagnosis is not clear. If the laparotomy is performed, the possibility of failure is too high."
"What is the past history?" Zheng Ren asked.
"It is said that a cholecystectomy was performed twenty-four years ago."
Is it just a cholecystectomy? Zheng Ren has doubts in his heart. If it is a cholecystectomy, it should not be directly related to this disease.
Said, a few people came to the ward.
The lower-level physicians in the Department of Gastroenterology quietly stood in two rows in the hallway, holding medical records in their hands, and being well-behaved.
"Boss, you see the little doctor of the family, many boards are right." Su Yun whispered around Zheng Ren.
"If we do this, the first board that is required to stand is you." Zheng Ren was anxious to see the patient, and spit back.
Su Yun thinks, this is indeed the truth.
A few people entered the ward, and Zheng Ren looked directly at the system panel at the top right of the field of view.
An unfamiliar diagnosis appeared in front of Zheng Ren's septic tank syndrome.
The septic tank syndrome has also become blind end syndrome and blind socket syndrome. It is an uncommon complication after surgical bile duct and duodenal lateral anastomosis.
The high probability is that food debris, stones, etc. accumulate in the biliary anastomosis to the blind pocket formed by the Vater ampulla, causing a series of clinical symptoms.
The patient was yellow and looked like a little yellow man.
The overall state is very poor, Zheng Ren smashed his hand, let his hand warmer, and the patient's temperature difference is not too big.
As soon as the finger touched the patient's body, it felt hot.
The patient's temperature is at least 39 degrees Celsius and should be caused by a serious infection.
In the right upper abdomen, close to the duodenal segment, tenderness is obvious, accompanied by rebound tenderness and muscle tension. Percussion is voiced and has typical gastrointestinal symptoms.
"Director Xia, I want a bedside B-super." Zheng Ren frowned.
Because the patient's history of spontaneous cholecystectomy and the common bile duct, duodenal lateral anastomosis is not consistent with this predisposing factor ~ www.novelhall.com ~ so Zheng Ren is cautious to do other checks to clear.
Although the system's big pig's hooves have been stable and reliable, doctors, especially doctors in the top three hospitals, are concerned with evidence.
Otherwise, the operation is done, the patient's family turns to tell you a fraudulent practice, can't eat and walk.
This kind of thing is often seen, Zheng Ren is also very helpless.
But helplessness is helpless, the surgery still has to be done, the treatment saves people, or is saved.
Ten minutes later, the doctor in the B-room went to the ward with an emergency B overtaking.
Pulling on the curtains and plugging in the power supply, the doctor in the B-chamber room just squeezed the coupling agent in the patient's abdomen. Zheng Ren suddenly asked: "I will take a look first, okay."
......
......
Note 1: The face of patients with liver disease is mostly black. Not a teacher, so explain it here.
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