"I'm here to take a look at the patient after the TIPS surgery." Zheng Ren smiled warmly. "Which room?"
Chief Xia did not continue her ward rounds but personally brought Zheng Ren to the resuscitation room.
The patient was already able to sit up. Although he still looked haggard and anemic, the layer of darkness on his face had subsided significantly. (Note 1)
"Since last night, he has vomited blood three times. The volume is not large, about 150ml in total. It's thought to be old blood accumulated in the stomach." Chief Xia explained the patient's condition. "According to the test results this morning, hemoglobin has returned to 79g, coagulation is slightly poor, blood ammonia is 63, and there are no signs of hepatic encephalopathy."
Because of the two stents, the pressure on the patient's gastric varicose veins had been alleviated, but not completely.
As long as the bleeding was reduced, the patient's condition could be stabilized with hemostatic drugs and oral cold kidney saline.
Zheng Ren was concerned about hepatic encephalopathy.
After the surgery, the patient was particularly prone to hepatic encephalopathy because part of the venous blood did not pass through the liver and was not metabolized by the liver.
This was also the main reason why two stents were left to reduce the diameter of the outflow tract.
When the patient adapted, the second stent could be removed and the possibility of vomiting blood in the future would plummet.
Zheng Ren inquired about the patient's condition and asked him to do a few simple math problems, such as 74 + 7 + 7 + 7 =? Questions like that.
If the patient had mild symptoms of hepatic encephalopathy, it would still be quite difficult to solve such problems.
However, math problems could only be added once or twice.
Normal doctors would not be able to understand if he added more.
The patient's condition was still very good. Zheng Ren planned to observe him for another two days. If the blood ammonia did not continue to rise, he could remove the second stent.
When he left the ward, Zheng Ren could see the sincere smile on Chief Xia's face.
After all, he was a classmate of hers, the kind that she could sign for. Being able to survive without too many sequelae was undoubtedly something to be happy about.
After seeing the patient, Zheng Ren planned to go to the ICU to check on the female patient who had jumped off the building. Adenomyosis. There was still a mission that Zheng Ren occasionally remembered.
He did not have obsessive-compulsive disorder. If he wanted to improve his skills, he only needed to perform TIPS surgery. The skill points gained from a high-level surgery were equivalent to completing three to five missions.
Of course, the experience points from the mission could be used for emergencies, so this detail was not considered.
Just as she was about to leave, Chief Xia's expression darkened. She seemed to have made an important decision.
She then said, "Little Zheng, I have another patient here. Can you help me take a look?"
"Oh? Are they still patients who need TIPS surgery? "Zheng Ren asked.
"No, it's a difficult-to-treat disease. The diagnosis and differential diagnosis are not clear, and the patient's condition is not good." Chief Xia was a little embarrassed.
After all, it took a lot of courage for an old chief to say that the diagnosis was unclear.
This was also because Zheng Ren had performed a floating gallbladder and a TIPS surgery in the past two days, which had helped Chief Xia a lot. If it were someone else, Chief Xia would probably rather transfer the patient to another hospital than ask for help from a chief resident 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, abdominal pain, and jaundice, "Chief Xia said as she led Zheng Ren to the patient's ward." Abdominal pain.
Plain scan revealed liver abscess and biliary tract pneumatosis. The liver abscess is about 5.2 by 4.2 inches.
cm。”
Liver abscess complicated with jaundice, these were fatal illnesses.
Zheng Ren's footsteps quickened when he heard this.
"MRCP (magnetic resonance cholangiopancreatography) results showed biliary and intestinal communication between the proximal duodenum and the common bile duct. There are unclear contours of low-signal filling defects in the intrahepatic and extrahepatic bile ducts." Chief Xia also quickened her pace and continued, "We asked the general surgery department for a consultation, but they said the surgery is not confident because the patient's condition is not good, and the preoperative diagnosis is not clear. The probability of failure is too high if we perform an exploratory laparotomy. "
"What about the past history?" Zheng Ren asked.
"It's said that she had a cholecystectomy twenty-four years ago."
Was it just a cholecystectomy? Zheng Ren had doubts in his heart. If it was a cholecystectomy, it should not be directly related to this disease.
As they spoke, they arrived at the ward.
The junior doctors from the Department of Digestive Medicine stood quietly in two rows in the corridor. They held medical record folders in their hands, and they were well-behaved.
"Boss, look at the junior doctor. He's so straight," Su Yun whispered to Zheng Ren.
"If we do this, you'll be the first one to be asked to stand straight," Zheng Ren retorted anxiously as he looked at the patient.
Su Yun thought about it and agreed that it made sense.
They entered the ward and Zheng Ren looked at the System panel on the upper right corner of his vision.
An unfamiliar diagnosis appeared in front of Zheng Ren's eyes — pool syndrome.
Pool syndrome was also known as blind end syndrome or blind pit syndrome. It was a rare complication after choledocholedochoduodenal lateral resection and anastomosis.
It was most likely due to the accumulation of food residues and stones in the choledochoduodenal anastomosis.
Formed a blind pit in the ampulla, which caused a series of clinical symptoms.
The patient's entire body was yellow, and he looked like a Minion.
His overall condition was very poor. Zheng Ren rubbed his hands to warm them up, not too far away from the patient's body temperature.
As soon as his fingers touched the patient's body, he felt a burning sensation.
The patient's body temperature was at least 39 degrees Celsius, probably caused by a serious infection.
The right upper abdomen, near the duodenum, had obvious tenderness, rebound pain, and muscle tension. Percussion was a muffled sound, typical of gastrointestinal symptoms.
"Chief Xia, I want a bedside ultrasound," Zheng Ren said with a frown.
Since the patient's history of cholecystectomy did not match the triggering factor of choledochoduodenal lateral resection and anastomosis, Zheng Ren was cautious and wanted to do other tests to clarify.
Although the System had always been stable and reliable, doctors, especially those from Class Three Grade A hospitals, were particular about evidence.
Otherwise, the patient's family would turn around and sue them for medical fraud after the surgery was done.
This was a common occurrence, and Zheng Ren felt helpless.
However, even though he felt helpless, he still had to perform surgeries, and he had to treat and save people.
Ten minutes later, the doctor from the ultrasound room pushed an emergency ultrasound trolley into the ward.
He pulled the curtains and plugged it in. The doctor had just squeezed a coupling agent on the patient's abdomen when Zheng Ren suddenly said, "Let me take a look first, okay?"
…
…
Note 1: Most patients with liver disease have a black complexion. This was not a physiognomy, so it was explained here.
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