Doctor of Healing

Chapter 668 Must win!

Ji Xiang changed his clothes, returned to the ward, and saw Lu Gang sitting angrily in front of the computer and looking at the medical records.

"Director Lu, what's the matter?" Ji Xiang asked.

"Acute abdomen, the f*ck gastrointestinal, liver and gallbladder gangsters are not willing to have surgery." Lu Gang said angrily, "Although I also think that surgery is not possible, it doesn't look like intestinal perforation, but the patient's condition is not right."

It was obvious that Lu Gang was a little anxious and confused, so he spoke in a mess, as if he hadn't thought about it, and he expressed his anxiety by instinct.

Especially after scolding the liver and gallbladder, stomach and intestines, on the other hand, if he said that he didn't think he could perform surgery, Zhao Zhe almost didn't laugh out loud.

Ji Xiang leaned over and glanced at the laboratory report.

The emergency abdominal color Doppler ultrasound showed that the liver echo was thick, the gallbladder wall was thickened and rough, and a small amount of peritoneal effusion.

Blood gas analysis: oxygen partial pressure 53.8mmHg, oxygen saturation 84.6%.

Serum potassium 2.4mmol/L; renal function: urea nitrogen 22.08mmol/L, creatinine 352μmol/L, uric acid 428μmol/L.

Emergency amylase 137U/L; blood routine: white blood cells 9.3×109/L, neutrophils 0.787, hemoglobin 105g/L.

Acute renal failure, accompanied by hypokalemia, these are nothing in the face of acute abdomen, which can be treated by drugs.

"Director Lu, how is the physical examination?"

"Blood pressure 210/148mmHg, respiration 23 times/min, oxygen saturation 99%, T36.8 ℃, heart rate 105 beats/min. Breath sounds in both lungs are coarse, right lung can smell moist rales, no wheeze, heart rate 105 Beats/min, regular, no pathological murmurs.

Abdominal muscle tension, full abdomen tenderness, rebound tenderness, flat abdomen, bowel sounds disappear, face and limbs are not swollen. "

"It's a typical acute abdomen. Does the upright peritoneal dialysis support gastrointestinal perforation?" Ji Xiang asked again.

This question was close to the point, and Lu Gang nodded uneasy.

Lin Jiuze suddenly became interested. Based on his knowledge of Ji Xiang, he knew that Ji Xiang would follow Director Lu Gang to attend the consultation.

This time, I must not lose!
He opened the drawer, took out his small notebook, and held it tightly with his hands.

His palms were a little wet, but Lin Jiu didn't notice. He subconsciously wiped the sweat from his palms on the white clothes.

I have a basic understanding of the patient's condition, and it seems that there is no doubt about the acute abdomen. If it is an ordinary hospital, the surgeon will definitely push it to the stage to open it to see where there is a problem.

But Director Lu has been hesitating.

There is a problem, and Lu Gang doesn't know where the problem is.

Some things are hard to explain, and they are all a kind of "sixth sense" formed by seeing patients too much.

As for the "clinical manifestations", it is like Lu Gang's current appearance.

Lin Jiu knew that when encountering difficult and miscellaneous diseases, doctors rely on years of clinical experience to make judgments. If they really want to say one, two, three, four, five, they can't do it.

"When will the hospital consultation start? Have you seen the patient, Director Lu?" Ji Xiang asked.

"I took a look at it yesterday, and I will go to see it together later." Lu Gang replied naturally.

Jixiang re-examined the medical records of the Department of Gastroenterology, "Does the patient have family depression?"

"Well, when I saw the patient, I didn't think everyone in the family had depression. The diagnosis of this disease, hey." Lu Gang didn't continue, just heyed.

Lin Jiu captured this detail, and various diagnoses about depression causing abdominal pain popped up in his mind.

Depression itself does not cause abdominal pain, but long-term diseases such as abdominal epilepsy, and there is no definitive diagnosis, will cause patients to enter a state of anxiety and depression over time.

The cause and effect are just the opposite, but the two appear together clinically, so they are also within the scope of consideration.

Abdominal epilepsy is also possible.

Lin Jiuze went all out this time, he was no longer as lazy as before, his eyes were shining, his hands were tightly gripping the notebook, and the ballpoint pen was rattling.

It's just that he didn't realize it.

Even the harmless expressions of humans and animals disappeared, and Lin Jiu was full of fighting spirit at this moment.

fighting!

fighting! !
Must win! ! !

When they came to the Department of Gastroenterology, Lu Gang and Ji Xiang had their physical examinations, while Lin Jiu stood in the corner and observed their every move as well as the patient's face and body language.

After Lu Gang and Ji Xiang left, Lin Jiu began to write and draw in his notebook.

When you write something, look up and observe; then lower your head to write, and then look up again.

Soon, Lin Jiu fell into deep confusion.

He took this patient very seriously, much more seriously than he did at Massachusetts General Hospital.

The belly case had already been laid out. In a short period of time, Lin Jiu wrote at least ten diagnoses, but none of the diagnoses was correct. He even had deep doubts about the knowledge he had learned.

Abdominal pain and acute abdomen are not organ problems, nor abdominal epilepsy, nor are they common diseases such as volvulus and intestinal spasm.

What else could it be?
Lin Jiu racked his brains thinking.

At the same time, Ji Xiang was chatting with the patient's family about his condition, and Lu Gang began to preside over the consultation of the whole hospital.

"The situation this time is different from before. The patient's plate-shaped abdomen is particularly obvious, accompanied by tenderness and rebound pain. The acute abdomen can be clearly diagnosed. Although there is no crescent syndrome in the upright peritoneal dialysis, it may be intestinal perforation and gas leakage. Not many."

The gastroenterologist said after briefly introducing the patient's situation.

"I remember that this patient has already been consulted for the third time. The first two times..." said the deputy director of the gastrointestinal surgery department. "The most outrageous thing is the second time. The patient said that the pain was relieved when he submitted the order for surgery."

"I have also considered this point. Is it acute cholecystitis? Although cholecystitis is not serious on the B-ultrasound, it will also cause severe pain and acute abdomen. Every time you are hospitalized, you must have intravenous antibiotics. Under the action of antibiotics, the gallbladder It's normal for Yan to be suppressed."

"I don't think it's that simple. Generally speaking, cholecystitis will cause upper abdominal pain. Except for gallbladder perforation and bile flow all over the stomach, there will be no signs of a flat abdomen."

Many doctors have their own opinions, and there is no unified answer.

Lu Gang's hair drooped, and he didn't care about it at all. It seemed that his mind was running rapidly, trying to figure out what was going on with the patient.

There was a knock on the door.

Ji Xiang then pushed open the door and tiptoed in.

"I don't think surgery is possible," said the surgeon. "The patient's pain was relieved before the operation the first two times. If the problem is not found after the operation, or the gallbladder can only be removed after searching for a long time, the pain still persists after surgery. What shall we do?"

"The acute abdomen is already obvious, and this is a typical sign of laparotomy!" The gastroenterologist insisted, "There is no surgery, so what else can be done?"

The two sides insisted on their own words and started arguing.

The more they talked, the more intense it became, and there were even signs of slapping the table and scolding mothers.

"Keep your voice down!" Lu Gang raised his voice to suppress the quarrels of the crowd, "Can't you say good things? What are you talking about?"

Several doctors held back their words in dissatisfaction.

(End of this chapter)