It's not that hard to open a hospital in another world, right?

Chapter 175 Mechanical intestinal obstruction (two in one chapter)

What's wrong with that girl?

The old magician and the girl lying on the bed looked at Elder Wood with both eyes full of expectation.On the other hand, the female knight Selina stood aside with her sword pressed, her emerald green eyes flickering slightly, she looked at Elder Wood, then at Gretel, and in the end, she still fell more on Gretel.

Gretel glanced at her, and Selina gave him a slight nod, a smile in her eyes.Then, pointing to the girl on the bed, silently made a mouth shape.A pair of beautiful eyes are full of desire to flow, obviously asking: What is the disease?do you know?
This... Gretel looked at Elder Wood, and took a step towards the female knight with his right foot unobtrusively.Before the left foot could keep up, the elder had already turned around and looked at Gretel with a smile:
"What do you think, little Gretel?"

"I..." Gretel opened his mouth and was about to answer.When the words came to his mouth, he paused:
"I have some guesses, but I have to check to be sure whether I'm right or not."

"Then check it out." Elder Wood raised his hand with a smile.Gretel jumped up immediately:
"Wait a minute, I'm going to get a pen and paper!"

inquiry!

Check up!

Write a medical record!
He hugged a thick notebook and sat down in front of the girl. When he opened it, he saw that the front was packed with half of the notebook.He flicked to the latest page, looked at the girl on the bed, and gave a smile first:
"Girl, may I ask your last name?"

"Mainlan." The girl's face was drooping, and she pulled the blanket tightly, her ears turning red.Gretel coughed, immersed himself in writing, and continued to ask:

"age?"

"17 is old."

"Where is it uncomfortable?"

"The belly... the belly is getting bigger..."

"How long?"

"..."

"How long has it been since your belly started getting bigger?"

"Three, three or four months..."

"Is it that big from the beginning?"

"of course not!"

"Does your stomach hurt?"

"A little..."

"Does it hurt all the time or just for a while?"

"For a while..."

"Is it bloated?"

"Yes, a little..."

"Do you feel like vomiting? How is your stool? Do you have it every day? How much? Do you fart?"

"You...you man! Why do you ask everything!"

The girl's ears were red, she turned her head inward, and ignored him.Gretel raised his head helplessly, spread his hands to Elder Wood, and continued to write furiously:

"03.12
Iris Mainlander, female, 17 years old.

The abdomen is distended, progressively aggravated for 3 to 4 months, until the size of the sixth month of pregnancy.

Paroxysmal abdominal pain, abdominal distension, and sometimes vomiting. "

Uh... I can't write any more.He took out another piece of paper, scribbled down a lot of questions, looked around, and waved to the female knight.Selina took the paper from his hand, swept it up, and was taken aback on the spot:
"All these questions?"

"Ask them all."

"Do you really want to ask?" The female knight pointed at the paper with her slender fingers, "What have you taken? What medicine have you taken in the past few months? Have you been here..." Her cheeks turned red, "You have to ask? "

"You must ask!" Gretel put down his pen, clasped his hands together, and bowed to her:

"Sister, please help me! It's not convenient for me to ask these questions. You are a girl, and she is willing to talk to you...Really, the more accurate and detailed the answer, the more accurate I can judge the condition..."

"...All right." Selina pulled the paper away, with a half-smile, and pointed to the outside of the curtain.Gretel quickly picked up the stool and rolled up, consciously avoiding the outside of the curtain, and waved to call out the two elders together.He sat down with his notebook close to the curtain, pricked up his ears, and listened to the conversation between the two girls and tried to record:
"Loss of appetite, weight loss, constipation, and a small amount of gas. Five days ago, he was treated with a magic spell, but there was no improvement. What kind of bloody medical record is this? If you wear it back, you will be laughed to death!"

Tucao belongs to Tucao, and records should still be recorded.Thank goodness it was an outpatient clinic—Great took it upon himself to classify patients as outpatient clinics—and didn't have to write a medical record in the format of an inpatient.Otherwise, two or three sheets of paper would not be enough to write the admission record alone.

And behind the hospital admission records, there are medical course records, consent forms, various record documents and report sheets, each of which can have a thick stack, adding up, it must be as thick as the notebook in his hand...

After whispering in the curtain for a while, the female knight lifted the curtain and came out, her cheeks flushed slightly, and she threw the paper into his hand.Gretel hastily scanned and saw that the record was similar to what he had dictated. He only added a few sentences before closing the book and walking up to the old magician:

"Miss's situation, I've finished asking all the questions I need to ask. Next, I need to do some tests on her body—excuse me, can I touch her body?"

"Must it be like this?" Elder Wood rushed to ask.Gretel nodded helplessly:

"It must be like this. I have to verify something—not relying on seeing with my eyes, hearing with my ears, or relying on the detection of magic or magic, but by touching and pressing with my hands."

This is the case with female patients... Palpation and so on, the most normal means of medical diagnosis and treatment, must first seek the consent of the parents and patients.Gretel sighed secretly. If he could, he didn't want to cause such trouble—but the patient was right in front of him, and it was impossible for him to give up the diagnosis and treatment.

"Can you cure it?" Master Tolga pondered for a moment, did not answer, but asked Elder Wood.The elder bowed his head and thought for a while:

"I'm not very sure. I treated someone with a stomach smaller than hers before. I thought it was cured, but I don't know why she suddenly died of abdominal pain. Besides," he glanced sideways at Gretel:
"This child's treatment ideas and methods are different from my divine arts. Frankly speaking, I am also looking forward to his method."

Master Tolga looked at the still hanging curtain, then at Elder Wood, bowing his head in thought.Elder Wood avoided his gaze, and muttered softly as if talking to himself:
"It's not that I haven't touched it just now..."

"That's it!" The old magician immediately made up his mind.He threw back the curtain, pushed Gretel in, and brought him to his daughter himself:

"Iris, don't be afraid, let this pastor read it again! Just touch and press a few times with your hands, it doesn't matter, it doesn't hurt!"

"I..." The girl's snow-white cheeks were already flushed, and even the roots of her ears were red.She lowered her head, tightly clutching the blanket on her body, until her father pushed her two or three times before she let out a "hmm" sound like a mosquito.

Gretel: "..."

This can't work!Even if you are shy, you can't stop letting me see it for inspection!
"Miss, please raise your head a little bit so that I can see your face... well, I'll just look at your eyes..." No way, your face is so red that you can't even see if it's yellow or not!Thank goodness, the whites of my eyes didn't turn red...

Gretel tried his best to recall the skin he had seen before, and wrote: "The skin and sclera are not yellow." Very good, the liver lesions were roughly ruled out, and the pressure of treatment was reduced by more than half.Next, start palpating!
He beckoned the female knight to come out, lowered his voice, and whispered:
"You go to the bathroom with her first?"

He dragged the female knight in to accompany and testify, and spoke softly, explaining to the girl what she was going to do next.Then rub your hands to warm up, and lift the blanket——

Physical examination, start!
Gretel tried his best to control his expression, keeping his expression upright and serious, yet gentle and kind.He lifted the blanket from the girl's abdomen, first carefully observed and measured the circumference of her abdomen, and then—

"Miss, sit up and let me have a look. Slowly, just sit upright. Okay - lie down."

"Why did you let her sit and lie down?"

Elder Wood asked questions from behind.Gretel simply handed him the pen and paper:
"Elder, please help me record it. Note: The abdomen is distended and spherical, and the shape does not change significantly when moving the body."

Elder Wood frowned and wrote slowly.In just one sentence, there are two words that he is not very familiar with, so he has to think about how to write it.Gretel's explanation has caught up:
"Sitting up and lying down, the shape of the bulging part of the stomach does not change significantly, which means that the bulging thing is hard, not soft, especially not water - if it is water, it will flow to both sides when you lie down, becoming Come on, exhale, inhale, exhale, inhale again—remember, the bulge did not move with the breath. It is not the cause of the viscera or mass under the diaphragm.”

Every time the patient was asked to make a movement, he explained the reason, and Iris's face turned pale and then red, red and white again.The female knight pressed her friend's shoulder and said in a low voice:

"There are so many considerations—"

"Isn't it just so much to think about?" Gretel smiled faintly.

An enlarged belly — medically known as abdominal distention — can be divided into full abdominal distension and partial distension.Just the whole abdomen is distended, and there are three reasons for peritoneal effusion (ascites), pneumoperitoneum, and huge mass.For ascites, there are already three major categories and fifteen subcategories, with at least seventy or eighty causes.

Even if the cause of the disease is finally determined, a large number of auxiliary examinations must be relied on. Before prescribing these examinations, there must be a doctor's physical examination to guide the initial direction.

"There are no varicose veins in the abdominal wall, and no abnormality in the abdominal skin." Great, the possibility of intestinal strangulation is a little smaller!
Possibility of surgery↓↓

"Is it over?"

The old magician asked anxiously.Gretel took a deep breath: "Hurry up. Elder, come and see. On her belly—around the navel, there are strips of protrusions, don't they? Bending down, you can see them very clearly from the side. Alright, Give it a pat..."

After the pat, the long strip-shaped protrusions on the snow-white, high-protruded belly kept wriggling, rising and falling one after another.Some are forward, some are backward, in different directions.Iris moaned softly: "It hurts—"

"It's almost over, bear with me." Gretel comforted softly.The old magician said in surprise behind him:

"what is this?!"

"This is the intestines—or rather, this is what is stuck in the young lady's intestines and makes her stomach swell so much."

Gretel explained with confidence.He looked back at Elder Wood, gestured with both hands:
"Remember, you can see the multi-layered trapezoidal bowel shape and peristaltic waves—elder, do you have a long empty tube here? I want to listen to bowel sounds!" Hell, the stethoscope was not brought...

"I'll send someone to look for it." Elder Wood put down the pen and paper, got up and was about to go out.Master Tolga grabbed him: "Where is the need for such trouble? I will come!"

He stretched out his hands and pulled them in the air.Immediately, a straight round tube appeared in the air, hollow, translucent, and as thick as a hand.Gretel let out an "ah":
magic trick!It's voidshaping with magic tricks!How could he not have thought of this before!That's right, although he can't make a stethoscope, he can still make one with a round tube!The magic trick is also an apprentice-level magic. You can throw dozens of them a day, and the consumption is almost negligible!
He thanked him, took the stethoscope, and stuck it to his ear.With one head pressed against Iris' abdomen, her face immediately became serious, she breathed evenly, and listened attentively.Bend the five fingers of the empty left hand, counting one by one:
"Remember, abdominal pain is accompanied by high-pitched bowel sounds, which are metallic..." Bowel sounds can reach more than 10 times per minute, and the sound is loud, "Bowel sounds are hyperactive."

At this point in the physical examination, the symptoms have been basically confirmed.Gretel still didn't dare to be careless, and carefully pressed down from the liver and spleen to make sure that there were no other lesions before getting up and washing his hands.The old magician hurriedly asked beside him:
"It's because her intestines are blocked, right? Give her some laxatives, and it will be fine if she can open it up?"

"It's not that easy..."

Gretel gave him a speechless look.Mechanical intestinal obstruction is confirmed, where is the obstruction?Is it complete intestinal obstruction or partial obstruction?Simple or strangulated?Is there any volvulus?intussusception?Intestinal perforation?
Besides, intestinal obstruction is not necessarily caused by constipation, it can be cured by taking some laxatives... What if it is a foreign body?Is it a gallstone?Is it a tumor?It's useless to take laxatives!

He stretched out his hand to Elder Wood: "Elder, lend me your oak stick."

"Are you going to use [Detect Magic] again?" Elder Wood handed over the oak stick with a smile, moved behind Gretel, released the spell, and opened the vision of meditation.Soon, he frowned, his eyes full of confusion:
"What are you looking at?"

The old magician frowned even more than the elders.Gretel shrugged: I definitely don't understand it, I don't understand the structure of the human body, I haven't studied medical imaging, and I don't know what to look at when the film is in front of me.

Not to mention laymen, even novice doctors have to study for a year or two and watch hundreds of thousands of films to understand it!
He turned over the page, and sketched the picture he saw in his meditation vision.The flat film was done in the lying position first, and then Iris was asked to stand up, and the [Detection Magic] was activated for the second time, and then the plain film was drawn in the standing position.Relying on the accumulated skills of drawing and explaining to patients for many years, the outline of the body, bones, organs, intestines, etc., will soon come to life on the paper.

The advantage of magic is that what you see is what you get. A healer can handle everything from examination to treatment by himself, and there is no need for patients to queue up for X-rays.The downside is that once the magic is over, the image in the meditation field of vision disappears immediately, and there is no way to save the image except to draw it on the spot——

Hey, if conditions permit, we still have to get an X-ray machine!
After drawing two plain X-ray films—let’s count them as X-rays—then draw B-ultrasound images.When it was all done, Gretel spread out the three pictures and explained to the patient and the patient's family:

"Look, this is a flat film in the lying position. You can see the intestine—is it thicker than the one next to it? This is where the intestine is blocked. Here, here, the place with different brightness is gas in the small intestine. Looking at the standing position again, one ring after another, arranged upwards like a ladder, this is the liquid-gas plane..."

"There are some clumped images here. The clumps are very large, exceeding..." Gretel gestured with his hand: "10 cm in diameter. Combined with what the elder said before, I feel a lot of messy life breath, I think... ..."

The two old men stared at the mosquito coils.Elder Wood is still trying to identify, memorize, and recite. Master Tolga has already grabbed him with one hand and Gretel with the other. His forehead is steaming, almost smoking:

"Then how to cure it!"

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(End of this chapter)