Krafft's Anomaly Notes

Chapter 32 Acute abdomen

"Name?"

"Gris."

"No, I mean the child's name. How old is it?" Kraft quickly filled in the name of Gris in the column of family members, indicating the patient's father.

They were sitting in an empty classroom, and Lucius had been sent to find two blankets, the patient's hard benches were bound to be uncomfortable.The students who followed were stopped behind, giving enough space.

The paper in his hand was drawn from the copy paper, and the second volume of "Human Body Structure" was placed under it. The student next to him handed him an ink bottle with a wink.The tip of the pen draws quickly on the paper, and the written words are connected into a string.

Although Kraft's handwriting is indeed good, his interview records are always crooked, and I don't know if it is affected by some mysterious power.

"Liss, her name is Liss." Gris was a little apprehensive, and answered Kraft's question in a low voice and quickly, as if Kraft would let him go if he was too slow, "I'm three years old this year."

A large group of people in black robes gave him a lot of pressure.They had been asked to step back a bit, but there was still something eerie about the brightly lit classroom.

"Where is the discomfort?" Kraft asked while turning his head to look at the child lying on the chair.It's really hard to tell the gender of a child of this age. If you think about it carefully, you will sometimes see this child in the tavern, but a set of clothes with no special characteristics makes him always think it is a boy.

Gris looked close to tears when the subject came up, his eyes flushed, but he held back his emotions and described what he knew in as clear a manner as possible.

"She seemed to have eaten something two days ago, and she kept having diarrhea. She thought she would get better in a few days, but she didn't expect her stomach to hurt even more this morning, and she couldn't speak a few words because of the pain.

I took her to church and asked for some holy water, and I visited the clinic and drank herbal soup, but it didn't help. "

"What herbs?" Kraft pressed.He knew that the holy water was purified water that had undergone some strange rituals. It was not that he had never drank it when he was a child. As a placebo, it was at least harmless.

Herbal medicine is hard to say.Few of the doctors who run clinics outside are college graduates, all kinds of folk remedies are rampant, and they dare to add anything to the medicine soup.

This is not the method of traditional Chinese medicine that uses syndrome differentiation and treatment. The treatment methods of Wendenggang amateur doctors are not so much for human use, as it is more similar to some green skin things that grow out of the ground. The main guiding ideology is " I wonder."

"Sorry, I don't know..." Gris was at a loss, "The priest said it was because I didn't believe in the Lord wholeheartedly, so I shouldn't let her drink those herbs?"

This man, who was nearly middle-aged, scratched his head in pain, almost tearing off his hair.In his eyes, this is a precursor to death, and he may lose his only child.

"I didn't mean that." Kraft pressed his shoulders, trying to calm him down, "It's okay if you don't remember, I have other questions to ask you."

……

……

I have to say that Gris belongs to the kind of parents that doctors like most.In the panic and fear of his daughter's illness, he was quite calm, allowing Kraft to quickly ask for relatively complete information.

The affected child is Gris's three-year-old daughter, Lise. Two days ago, she suddenly developed symptoms of fever and diarrhea, and her feces were as thin as water.

This is not a rare thing. It is quite normal for a child of this age to have a bad stomach for no reason. Most of the time, parents don't care too much.

As a father who pays more attention to his children, Gris even took time to go to church to pray and brought her back some holy water.

But after drinking the holy water for a day, Xiao Lisi's condition did not improve, so Gris, who was worried, took her to a nearby clinic and asked the doctor to prescribe a herbal soup.

Looking at the decoction with an unusual color, Gris still planned to let Lise try it, but died after trying it.Early this morning, Liz's abdominal pain, which was not serious at first, quickly intensified, and the feces she passed were not much, but they were bloody.

Anxious Gris carried Liz to the church and clinic, but the priest just said that in this situation, he could only pray sincerely and wait for God's will.The doctors in the clinic had no choice but to try to remove themselves.

As a person who has been running a tavern next to the college for a long time, the last thing Gris can think of is to ask someone he knows in the college for help, otherwise he can only wait for Liz to heal herself miraculously.

"I need to have an examination, is that okay?" Kraft finished writing down the history of present illness and basic information on the paper.There are only a few items in the past history and family history. I only know that Liz's mother also died of a sudden illness, and Gris couldn't tell what the illness was, but Liz was born without any serious illness.

"Okay, thank you." Gris nodded quickly. He didn't understand why he had to ask him for instructions, but Kraft's attitude should be to take over.

"I'm talking about a comprehensive examination, touching the entire stomach, including the thighs." Kraft glanced at the group of students behind him, and felt that he should explain first, "I don't think this is suitable for too many people watching. Mr. Guys, can you avoid it for a while? You can take this time to review why I asked so many questions. "

"Well... no problem." Gris agreed after hesitating for a while, and was going to go out with the students.Perhaps it was Kraft's serious attitude that gained his trust, and he didn't raise any doubts.

"Come back, Gris. I'm talking about them. The family members will stay with you and help comfort the child." The students quickly left the venue, and Kraft pulled Gris to the side of the child, and began the inspection.

Kraft brushed back his hair and touched Liz's forehead, the temperature was not high.The child's face was full of tears, and if he didn't cry, he probably had been crying for a long time, and now he couldn't cry anymore.

In fact, he already knew something in his heart. This kind of thing belongs to the favorite thing to talk about in diagnostics-acute abdomen. In layman's terms, it means "doctor, I have a stomachache".Even without giving Kraft an extraordinary memory, he can use its content skillfully.

The 3-year-old child had diarrhea and fever for two days. It should be a digestive tract infection caused by some pathogen. It is very common in Wendeng Port, where seafood is everywhere.

But today's situation is probably not caused by aggravated infection.The sudden decrease in defecation and blood is probably due to an obstruction.

Kraft touched the seemingly normal abdominal wall, and felt no obvious tension and stiffness when he pressed down.

This made him a little relieved. It seemed that it wasn't serious enough for the oozing fluid to irritate the peritoneum. Maybe it wasn't serious.

Following a fixed direction, he quickly found evidence to support his point of view, which was a mass in the lower right abdomen, which felt a bit like a sausage.

The situation is okay, and the heart that Carat is carrying is completely relieved. It should be intussusception. This position can be boldly guessed to be ileocecal intussusception.

At the junction of the small intestine and the large intestine, a section of ileum in the ileocecal part was inserted into the large intestine, and one wall changed into several layers, and it was blocked on the spot.It is not uncommon for children with intestinal disorders, and it is one of the most commonly treated acute abdomens in pediatric surgery.

The hapless boy may have had viral diarrhea, itself a risk factor for intussusception, and then drank some weird herbal decoction and had intussusception of course.

The diagnosis process was quite smooth, allowing Kraft to find a little bit of the feeling of responding to the teacher's questions in the case discussion class, and give the answer confidently after finding all the evidence.

Logically speaking, the next step is to confirm the diagnosis by imaging examination, but it is a pity that there is no B-ultrasound here, and abdominal upright radiographs cannot be done, so don't think about a 100% diagnosis.

He re-covered the child's clothes, picked up a pen and paper, and separated the item "Preliminary Diagnosis" at the end of the page, combined the words "intestine" and "insertion" in Norse, and reserved a line below space.

When he has free time, he has to add a line of explanation below. Since he became a lecturer, he has to leave blanks for noun explanations everywhere, which is almost an occupational disease.

He raised his head and explained to Gris: "You can understand that one part of her intestines was put into another part, and then it was blocked like that. Do you remember when she started to hurt?"

"Probably before the bell tower rang twice, I took her to the church. I can't remember the exact time."

That was about an hour and a half to two hours, the luck of the misfortunes.If it is discovered in time, even if you go to the church first, the time period has not yet reached the level of intestinal necrosis, and it can be resolved with non-surgical solutions.

So what's the non-surgical option?

"That's not right..." Kraft murmured, and the heart that had just let go immediately lifted up again, as if he was stuck at the last step of a smooth calculation in an advanced math problem, and found that everything was fine, but the amount of calculation was not enough. not come out.

"What's wrong?" Gris also became nervous. Obviously, Kraft had just explained the cause of the disease to him, and now things seem to be complicated again.At this time, the most feared thing is the doctor's expression of "the smile is gradually disappearing".

Kraft didn't answer him, a serious question lay before him, blocking the last way.

For the current situation, the standard answer he knows is air enema, which can easily solve most early acute intussusceptions like Liz's.

But this requires corresponding equipment. He didn't learn how to make it with a machine. He didn't understand how this thing could control the air pressure, and inflate the intestines back to their original position without perforating them.

Even if he knows how to make it, can he directly rub the machine out of thin air?Taking a step back, even if the god of the church appeared on the spot and conjured up a machine for him, how can he confirm the success of the reset without B-ultrasound, X-ray and other image inspections?
The air enema plan didn’t work, so there was only the traditional method left—Kraft had to go through surgery, let Xiao Lisi suffer a knife, and use a traumatic but more direct and effective method to get the intestines back.

But air enema is not good, so can surgery be performed under this condition?To perform an operation without anesthesia and sterile conditions, it would be better to pray to God to send an angel to send him an air enema machine.

(End of this chapter)