Decompensated cirrhosis, portal hypertension, hypoalbuminemia, ionic disorder, ascites, hydrothorax …
The series of diagnoses was dizzying.
It looked like another patient with hepatitis B that progressed to cirrhosis, splenomegaly, portal hypertension, and refractory ascites.
The diagnosis and progression were similar.
Decompensated cirrhosis had two fatal symptoms — hematemesis and ascites.
Once the ascites reached the refractory stage, normal diuretic methods would not work. Low protein caused fluid to seep out, causing ascites and increased protein levels.
The most common clinical treatment for hypoalbuminemia was intravenous infusion of human albumin.
However, in the face of refractory ascites, no matter how much human albumin was injected, it would quickly turn into ascites and ooze out.
This complication was different from hematemesis. Although refractory ascites was not as acute as hematemesis, hematemesis caused by portal hypertension could still be surgically performed.
Before the advent of TIPS surgery, refractory ascites could only wait for death. Due to the high difficulty of TIPS surgery, only Class Three Grade A hospitals in provincial cities and above could carry out TIPS surgery.
Without TIPS surgery, this disease was equivalent to death by a thousand cuts.
The patient was in extreme pain, his life slowly coming to an end.
Zheng Ren did a simple physical examination and asked about the patient's condition and test results.
The resident doctor beside Chief Xia answered each question one by one. He was well-trained. The gastroenterology department's diagnosis was similar to the System's. There was not much difference.
The patient did not have any preoperative contraindications and could be treated with surgery.
Zheng Ren said, "Chief Xia, the patient will do an MRI of the liver today with diffusion. I'll prepare for tomorrow's surgery. "
"Nuclear magnetic resonance imaging?" Chief Xia was stunned.
The full name of MRI was diffusion weighted magnetic resonance imaging.
Unlike conventional magnetic resonance imaging (MRI), MRI was based on the movement of water molecules and could provide clinical information based on the physiological state of the brain.
It was mainly used for neurological treatment.
Its sensitivity in the diagnosis of acute cerebral infarction was
, specificity was
At the same time, it could reliably distinguish arachnoid cysts from epidermoid cysts, subdural empyema from effusion, abscess from tumor necrosis.
Why did Zheng Ren need a diffusion-weighted magnetic resonance for TIPS surgery?
Chief Xia had heard of experts in Imperial Capital and Sorcery Capital who used MRI to look for tumors. However, this was not a tumor. It was refractory ascites in the late stage of cirrhosis.
Little Zheng …
Chief Xia pondered.
Zheng Ren did not explain much to Chief Xia. This was a diagnostic and positioning method that he had honed in the operating theater of the System. It was used to determine the location of the portal vein and hepatic vein to increase the success rate of the puncture.
If he were to start from the very beginning, he might not even have enough time for a few days.
There were other things that Zheng Ren could not be bothered with.
After that, he bade Chief Xia farewell and went to the ICU.
After changing his clothes and entering the ICU ward, Zheng Ren could feel the depressing atmosphere in the entire ICU.
The chief of the medical administration division was also there, frowning.
Su Yun sat by Yang Lili's bed. His fringe fluttered as he looked down at the lab report in his hand.
"What's wrong?" Zheng Ren came to Su Yun's side and whispered.
"Boss, there's something wrong with the situation," Su Yun said. "This morning, the tranquilizer was stopped, and the patient showed signs of mental illness."
Mental symptoms?
Zheng Ren was also stunned.
There were no mental symptoms in the System's diagnosis.
"The blood test is generally normal, and the intraoperative disinfection was done well. There is no clear infection. Biochemical sugar
Ol/l, sodium
Ol/l, potassium
Blood Gas Analysis Acidity Alkalinity
746, oxygen partial pressure
Hg, bicarbonate
Ol/l, alkali remaining
Ol/l, ketone urine. " Su Yun did not even look at the list in his hand, and casually told him the results of this morning's urgent investigation report.
"What are Yang Lili's mental symptoms?" Zheng Ren asked with a frown.
"Fear, very serious fear," Su Yun said. "It's as if she's seen a ghost. She's very agitated, and the straps on her hands can barely hold her down. Her heart rate has skyrocketed. After the tranquilizer was stopped, her heart rate went from 95 beats per minute to 156 beats per minute. "
"That's strange." Zheng Ren recalled the results from Su Yun's report. Overall, the patient's blood sugar was slightly high, and there were signs of urine sugar and ketone body. It was considered a transient stress reaction to a serious injury.
What the hell …
It was hard to explain.
Was it because of the trauma that day, and it had left a shadow in her heart?
That was a possibility, but psychological treatment was an emerging field in the country. Zheng Ren did not know anyone who specialized in it.
Most importantly, Yang Lili's current condition was not something a psychiatrist could do for her.
A few days of delay would result in a tracheotomy. If complications such as lung infection occurred …
Zheng Ren felt helpless.
No wonder the atmosphere in the ICU was so depressing. A patient who had looked fine on the test results had developed a strange complication.
This was especially so since the patient was the focus of attention in the city. It was said that the director of the health bureau and the deputy mayor in charge of public health had to report the patient's condition every day.
What should he say about today's report? Was he supposed to say that the patient had seen a ghost after the tranquilizer was stopped?
Zheng Ren frowned as he pondered the various diagnoses on the System's panel.
Yang Lili's heart rate was still racing even after the tranquilizer was reapplied.
Postoperative infection? The patient only had a low fever.
There were no obvious abnormalities, so the possibility of a serious infection was low.
Pulmonary embolism? Respiratory distress, chest pain, and increased heart rate?
Zheng Ren picked up the stethoscope and listened to Yang Lili's breathing. It was not a pulmonary embolism …
Zheng Ren could confirm it without a CTA examination of the pulmonary arteries.
The combination of physical examination and the System's diagnosis could basically determine the cause.
Could it be a heart failure caused by excessive fluid replacement after surgery? Zheng Ren pondered and asked, "What's the blood volume?"
Su Yun shook his head. Obviously, he had considered this point as well.
"The blood volume after surgery was much higher than the blood volume. On the first day after surgery, the difference decreased. Yesterday, the blood volume was basically the same. "
The high blood volume after surgery was due to Yang Lili's massive hemorrhage.
She had recovered in only two days, which was the result of the combined efforts of Su Yun and the ICU medical staff. In addition, Yang Lili was young and in good physical condition.
Moreover, Yang Lili had no history of cardiovascular disease or any similar family history, so cardiac dysfunction could not be considered for the time being.
That was ruled out as well … Then what?
In the end, he could only consider diabetic ketoacidosis.
Since Yang Lili had positive urine ketones, high blood sugar, and acidosis, but normal hydroxybutyric acid, the ICU's doctors had recommended that the patient be given a low dose of insulin for the time being.
Ketoacidosis was also not the case.
Could it really be a mental illness … Zheng Ren's head hurt.
As he read the diagnoses on the System's panel, his eyes suddenly lit up!
Could it be this?
。
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