Doctor of Healing

Chapter 669 Abdominal pain caused by high blood pressure
"Director Lu, we do not recommend surgery." Consulting experts from hepatobiliary surgery and gastrointestinal surgery said in unison.

They looked at each other, and at the same time looked at Lu Gang.

The opinion is very clear, the surgeon thinks this is a scapegoat, so they don't want to bear it.

Similar examples have appeared clinically, although not very frequently.

For acute abdomen, if you open the abdomen and see that there is nothing wrong with it, whoever opens the abdomen will be embarrassed.

What should I do if I can't find the problem?Is it closed?

After going down, the patient still hurts, how to explain clearly to the patient's family?
So in this case, we can only organize on-stage consultations.

In the face of patients with open stomachs, doctors are helpless in the operating room.You can't really put a zipper on the patient's stomach as the joke says, and just unzip it when you want to see it.

But if you don't open it and take a look, the existing various checks don't support medical diseases.

Here lies the source of the disagreement.

Lu Gang frowned, and he sighed, "I'll call Director Bai and ask the leader for advice."

The meaning of this is already very clear. If you want to take a look on the stage, the medical department must take the blame, so that the clinical surgeons can rest assured.

"Director Lu, teachers, the patient has a detail that I don't know if everyone has noticed." Ji Xiang suddenly broke the awkward silence.

"What details." Lu Gang had already taken out his mobile phone, ready to call Director Bai.As he asked, he looked for Director Bai's phone number.

Although Ji Xiang began to speak forcefully, he did not stop Lu Gang from moving.

"In the first two hospitalizations, the patient recovered on his own. One time he almost missed the operation. Before the operation, the patient refused the operation because of the relief of abdominal pain. Later, he was discharged automatically after a complete recovery."

"I know, I just said it." Lu Gang started to press the buttons on the mobile phone to call Director Bai.

"Every time he was hospitalized, the patient's blood pressure was very high, and the antihypertensive drugs were pumped in with a micropump. The patient had a history of hypertension for 2 years, and he did not take oral antihypertensive drugs during the 2 years. The only measure to lower blood pressure was hospitalization. The medicine pumped in during the period."

Just as Lu pressed the last button, his fingers stopped in mid-air.

"High blood pressure has nothing to do with abdominal pain. If it's an abdominal aortic dissection, the patient's grave is probably already tall," said the gastroenterologist.

"I think it's related. It's almost time to pump the antihypertensive drugs this time, and I just asked, and the patient reported a slight relief of abdominal pain."

"Maybe it's numbness?" the gastroenterologist said.

He looked down on Jixiang very much.

Director Lu is obviously ready to ask Director Bai of the Medical Affairs Department for instructions, which proves that Director Lu is partial to surgical operations and laparotomy.

Ji Xiang suddenly jumped out to stop him, leaving the troublesome patient to himself, whether it was looking for trouble or something.

He looked at Ji Xiang coldly, no matter what Ji Xiang said, he thought it was wrong.

Although his tone was not kind, Ji Xiang didn't care, but smiled slightly, "According to the dosage of the medicine, the blood pressure can drop to about 150 in half an hour, and the pain should also be relieved by then. "

"Xiaoji, don't talk nonsense." Lu Gang said in a low voice, "Acute abdomen caused by blood pressure, do you think your diagnosis is logical?"

"Director Lu, yes." Ji Xiang also lowered his voice, as if whispering to Lu Gang.

It's just that the office is quite quiet, and you can still hear what they are saying if you listen carefully.

High blood pressure, abdominal pain, is there a connection?

If Ji Xiang was just an ordinary training doctor, he might have been kicked to the Science and Education Department by his department, and the training certificate would not be issued.

"What logic! Just kidding." Lu Gang was a little unhappy, but he didn't directly mock like other doctors.

"The sympathetic nervous system is hyperactive and the release of vasoconstrictor active substances, such as renin and angiotensin II, etc. is increased, blood pressure rises sharply, small blood vessels spasm throughout the body, and the circulating blood volume decreases, which reflexively causes the activation of vasoconstrictor active substances to further vasoconstriction , the production of inflammatory factors."

"At the same time, elevated blood pressure leads to damage to the vascular endothelium. The above-mentioned combined effects lead to a significant increase in tissue exudation, and peritoneal effusion and perirenal effusion appear. With the effective control of blood pressure, the effusion in multiple serous cavities disappears, and abdominal signs Disappeared, and diagnostic treatment ruled out surgical disease of the abdominal viscera."

"Anyway, the blood pressure is too high during surgery and there is no way to anesthetize. The anesthesiology department has to wait for the blood pressure to drop a bit before talking about it. Wait."

Ji Xiang said very relaxed and freehand.

The door was pushed open at some point, and Lin Jiuze walked in and stood in the corner, staring at Ji Xiang in a daze.

What Ji Xiang said is reasonable, but Lin Jiu has been working in the clinic for about ten years, and has never encountered a similar case.

This logic seems clear, but in fact it only exists in theory.

It cannot be said to be unreasonable, it can only be said to be too idealistic.

However, Ji Xiang's last sentence was right - the patient's blood pressure was too high, and the anesthesiology department had to wait until the blood pressure was under control before going on stage.

suddenly!

A thought popped into Lin Jiuze's mind - the patient retreated after being hospitalized for the second time, and was about to go to the operating room for surgery, and the pain suddenly eased.

Could it be that the patient's blood pressure dropped and the stomach pain stopped?

Although Jixiang's judgment was unfounded and seemed "untenable", there was a sense of a close connection with the actual situation of the patient.

"Huh? Wait and see?" Lu Gang asked.

"I guess acute renal failure is also related to high blood pressure, but fortunately the patient did not have complications such as aortic dissection due to malignant hypertension." Ji Xiang smiled, "Wait a minute, the anesthesiology department has not arrived yet, They won’t pick up patients when they arrive.”

That's right.

Under Ji Xiang's "harmony", the medical and surgical departments have reached the most basic consensus-lower blood pressure first.

Regardless of surgery or not, lowering blood pressure is a must.

Lin Jiu was puzzled, he looked at Ji Xiang silently, and repeated what Ji Xiang said in his heart.

These words... It seemed like a joke, like making love, but it didn't look like treating a disease at all.

But Lin Jiuze had a feeling that maybe the patient's stomach really didn't hurt after the blood pressure dropped.

time flies.

Four or ten minutes later, everyone came to the ward together.

The patient's blood pressure is 155/80 mm Hg, and the plate-shaped abdomen has shown signs of relief, and it no longer feels hard like a board.

Moreover, the patient reported that his symptoms were relieved. Like the last hospitalization, he expressed obvious dissatisfaction with the operation.

From the patient's point of view, the problem can be solved with a little medicine, so why open the belly?

Seeing the patient's condition, he checked the body carefully, and after calling all the checks that could be done at the bedside, Lu Gang smoothed back the strand of hair that had fallen out.

"No surgery, go back to the office."

(End of this chapter)