Gou is practicing medicine in the clinic

There are even some typical cases of aortic dissection in which the blood pressure on the right side is high and the blood pressure on the left side is low.

"His blood pressure is relatively high, with systolic blood pressure of 149mmhg and diastolic blood pressure of 102mmhg. According to family members and him, his blood pressure has always been high because of the high academic pressure in high school and his liking for eating heavy-flavored food."

Sister Juan, the nurse, was talking about the patient's condition.

You already have high blood pressure and you like heavy-flavored foods, which can easily aggravate the symptoms of high blood pressure.

A diet heavy in salt, oil, and sugar is very harmful to the body.

If you eat it once in a while, it might not be a big problem.

If you eat it every day, your body will easily collapse.

This young patient has long-term hypertension, which may lead to atherosclerosis over time.

Hypertension and atherosclerosis are important causes of aortic dissection.

Li Jingsheng had reason to suspect that the patient's cause might be aortic dissection.

"Have you done an electrocardiogram on him?"

"I did it. I did an electrocardiogram when I sent him to the emergency room, which can preliminarily rule out the possibility of aortic dissection."

Xiao Linlin showed the patient's electrocardiogram to Li Jingsheng for review.

After taking it, Li Jingsheng looked at it carefully.

"The electrocardiogram shows atrial fibrillation and a certain degree of heart failure!"

This is a very bad sign.

Simple abdominal pain is generally difficult to cause atrial fibrillation or heart failure.

The most common cause of abdominal pain is problems with the digestive tract. For example, enteritis, or eating raw, cold, or spicy food can cause irritation to the gastrointestinal mucosa. Stomach pain may occur at this time.

But Li Jingsheng had never heard of heart failure and atrial fibrillation caused by enteritis.

Maybe he is ignorant!
  So what disease does this patient have?
  He tried taking the stethoscope and auscultating the patient's bowel sounds.

normal.

A soft abdomen, insignificant tenderness, and normal bowel sounds can basically rule out a variety of lower gastrointestinal diseases.

At this time, the patient again vomited due to severe pain.

"vomit……"

What the patient vomited this time was actually dark red blood.

In an instant, everyone's nerves were tense.

If it is just an ordinary digestive tract disease, it is impossible to vomit blood.

Moreover, the vomited blood is dark red, indicating that the bleeding has occurred for a long time.

Because the fresh blood is bright red.

Li Jingsheng realized that the patient's condition was critical and urgent, and the real cause must be diagnosed as soon as possible.

The same goes for the Second Hospital. Although the hospital's strength is average, it still insists on occupying the entire area south of the city.

This also resulted in the ambulance pulling back some patients who were very difficult to diagnose and treat, and it was difficult for the hospital to handle them well.

It is definitely unfriendly to patients.

The patient who could have survived through rescue was ultimately unable to be saved and died.

Who is responsible for this?
  The hospital cannot be held responsible. According to medical procedures, as long as the hospital fulfills its rescue obligations, it is generally not responsible.

"Have you had an ultrasound on him?"

Li Jingsheng asked.

"Took an abdominal B-ultrasound."

Among some routine examinations, B-ultrasound and X-ray are probably the two most frequently used examination methods.

Now some hospitals have begun to pursue higher efficiency.

Because after the B-ultrasound is done and the problem is discovered, it is likely that a CT scan or even an MRI will be required.

The hospital began to encourage some experienced doctors to conduct unconventional examinations such as CT directly after fully communicating with patients and obtaining consent.

This is of great benefit, especially when facing some acute illnesses.

It can significantly shorten the patient’s queuing time for examination.

The cause of the disease can be identified in the shortest time and treatment can be carried out promptly and accurately.

This greatly improves the success rate of rescuing acutely ill patients.

Li Jingsheng took the patient's other examination information and looked at it.

There are many diseases that can cause a patient to have excruciating abdominal pain. Appendicitis, gallstones, kidney stones and other diseases that are more suitable for this patient include.

Appendicitis has been preliminarily ruled out, and gallstones and kidney stones can basically be ruled out.

Abdominal aortic dissection was also ruled out.

"Have you checked his cardiac enzymes?"

Li Jingsheng felt that atrial fibrillation and heart failure meant there must be cardiovascular problems.

Aortic dissection is ruled out, what about acute myocardial infarction?

Judging from the electrocardiogram response, it doesn't look like myocardial infarction.

Where does the blood come from when the patient vomits?

Basically, it can be ruled out that the blood comes from the stomach.

The possibility of bleeding in the lungs, bronchi, and trachea can basically be ruled out. Because these places bleed, the vomited blood is usually foamy.

He believed that the blood was most likely coming from the digestive tract.

Then we can only search down the stomach.

The duodenum, jejunum, and ileum are all possible. The blood was dark red, and there was no blood in the vomiting at first.

Based on Li Jingsheng's diagnostic experience, it can be basically concluded that the bleeding site is likely to come from the small intestine.

And it is most likely the ileum segment of the small intestine.

Is it oozing blood or intestinal bleeding?

He needs to sort out these issues one by one.

"Myocardial enzymes have been checked and there are abnormal increases."

Xiao Linlin replied.

During their consultation, the patient's condition progressed very rapidly, his face became extremely pale, and he also developed symptoms such as cyanosis of the lips. The patient's consciousness also seemed to gradually become unclear.

Everything indicates that the patient is quickly heading towards death.

"Director Xiao, I initially suspect the possibility of oozing or bleeding in his intestines. Can we do a CT or color Doppler ultrasound immediately to check the blood supply?"

Li Jingsheng still prefers color Doppler ultrasound.

The price is cheap and the color Doppler ultrasound is particularly effective in checking blood flow conditions.

"Does Dr. Li also think that his vomiting blood came from the intestines?"

"Yes, I doubt it. And it's probably the small intestine. Personally, I'm more inclined to think there's something wrong with the ileum."

In this situation, Li Jingsheng did not hide anything and directly revealed his diagnosis results.

"Then let's do a CT scan on him!"

Xiao Linlin was worried that the patient would die, so she decided not to check the color Doppler ultrasound, but directly checked the CT scan.

In terms of accuracy, CT has more advantages.

"Dr. Li, please come to my office first. The patient's test results should be available soon."

In fact, there are many inspections that cannot be done at night.

Because the doctor is off duty.

Although the Second Hospital was not rated as a tertiary hospital, it is still a large tertiary hospital. Not to mention how good the emergency room construction is, at least it is quite satisfactory.

There is also a doctor on duty in the CT room at night.

After all, no one can guarantee what kind of patients the emergency department will receive. Sometimes, a CT examination can even save a life.

Many emergency patients cannot wait until the next day.

Not long after, the young patient’s CT examination results came out.

There is a truncation sign of sudden disappearance of the intestinal artery lumen.

The intestinal wall is edematous and thickened, and the intestinal tube is dilated.

Intestinal wall strengthening is reduced.

Generally speaking, the cause of weakened intestinal wall enhancement is basically ischemia in the lesion.

Then contact the previous vascular cavity and suddenly disappear.

Li Jingsheng realized almost immediately that there was probably a problem with the patient's intestinal arteries.

"Director Xiao, is this site the superior mesenteric artery?"

"Correct!"

"This patient is likely to have a blocked mesenteric artery. This series of symptoms will only occur if the mesenteric artery is blocked. In this way, the patient's vomiting of dark red blood can be explained."

Li Jingsheng believed that Xiao Linlin also had this diagnosis.

"Then have you ever thought about why the patient's artery was blocked?"

As expected, Xiao Linlin already had the same diagnosis as Li Jingsheng.

In the office, there were not only Li Jingsheng and Xiao Linlin, but also three gastroenterology doctors.

They basically had no business interrupting.

But even if you just listen to it, you can still gain a lot.

You can see how top gastroenterologists like Director Xiao and Li Jingsheng diagnose diseases.

Then you can also learn their diagnostic ideas for diagnosing this disease.

Just like answering a big question, the idea is very important.

Different ideas will lead to different solutions to the problem.

"Considering that the patient usually likes to eat heavy-flavored foods, and the electrocardiogram shows signs of heart failure and atrial fibrillation, I am more inclined to think that the thrombus may have detached and blocked the superior mesenteric artery."

Li Jingsheng’s diagnosis was mesenteric artery embolism.

The best way to diagnose this disease is to do arterial angiography.

Currently, arterial angiography is considered the gold standard for diagnosing this disease.

"What's your diagnosis?"

Xiao Linlin looked at the doctors under her.

She now has a strong heart and wants to make the Department of Gastroenterology bigger and stronger, and has significantly increased her efforts in training her doctors.

In the past, she basically didn't care much about her doctors.

"I support the diagnostic conclusion of intestinal artery obstruction mentioned by Director Xiao and Dr. Li. As for whether it is arterial embolism, this requires arterial angiography to confirm."

"The cause of this patient's disease was relatively complicated at the beginning. But after the CT scan, I feel that the cause is very clear, and it is undoubtedly mesenteric artery embolism. Although arteriography has not been done to confirm the diagnosis, it is basically certain that it is this disease.

Since this disease has a very high mortality rate and is a very dangerous disease, thrombolytic treatment should be given immediately. "

Xiao Linlin herself is not bad. After several years of training as the director of the department, she appears to be very decisive in dealing with such critical and severe patients.

Thrombolysis is not difficult.

Thrombolysis is performed by continuously injecting alkali, urokinase and other drugs directly through arterial catheterization.

I dare not say that this treatment will be effective, at least it is a symptomatic treatment.

Thrombolysis is only the first step, because the time from the onset of the disease to the diagnosis is already quite long.

It is estimated that the area of ​​intestinal necrosis should not be small.

You will definitely need to contact the general surgery department to perform laparotomy to remove the necrotic intestine. If necessary, you may even need to perform an arterial bypass.

Li Jingsheng saw that he had helped diagnose the cause of the disease, and he would naturally not care about the subsequent treatment.

It's very late now.

He took a taxi home.

There are still a lot of things to deal with when I return to the clinic. Sure enough, the more money people make, the busier they will be.

He really wishes he could have a clone now.

The patient with mesenteric artery embolism should have a treatment result tomorrow morning. The mortality rate of this disease is quite high. If it is not diagnosed in time, the mortality rate can be as high as over 80%.

If the thrombolysis effect is good, the next step is to see how long the necrotic intestinal segment is.

Some patients' lives were saved after rescue.

However, more than 70% of the small intestine was removed, and he could only rely on intravenous nutrition and infusion for the rest of his life. I have to say, this is really a fatal disease. (End of chapter)