Come on, Dr. Wu

Chapter 427 Poor parents in the world
A two-month-old baby with liver tumor, no wonder he is called that.

Today is New Year's Eve. The other wards are basically all on second-line duty, and the first-line staff are all gone. Of course, it was also because they knew that Wu Xiaofu would be on duty this year, so they left with peace of mind. After all, hepatobiliary surgery is a whole. If there is really a need for surgery, Wu Xiaofu can solve it.

While listening to Zhu Yun reporting the medical history of the sick baby, Wu Xiaofu went to the emergency room to check on the baby's condition.

Because the baby was in respiratory distress, the first thing Wu Xiaofu looked at was the baby's blood oxygen. The blood oxygen saturation without oxygen was 88%, which was actually okay. The baby was conscious and had mental response, but his face was pale, which was understandable given the influence of the liver mass. The baby's current condition was all thanks to the strong support of the maternal and child health care department.

The baby's development is normal, nutrition is average, and skin elasticity is acceptable. After Zhu Yun's diagnosis and treatment, the baby's breathing has stabilized, the three-depression sign is negative, and there is no cyanosis around the mouth.

There is no rash on the skin, no deformity of the head, and the tension of the anterior fontanelle is not high. It seems that there should be no problem with the brain.

Auscultation revealed coarse breath sounds in both lungs and moist rales, which seemed to be signs of upper respiratory tract infection.

The heart rhythm is regular, the heart sounds are strong, and no obvious murmurs are heard, so it seems that the heart problem is not serious.

The baby's abdomen was swollen, and he was crying loudly, perhaps because he was in discomfort. Wu Xiaofu took the opportunity to perform an abdominal examination and found that lumps could be seen in the baby's navel and bilateral groins without touching them. They could be pushed back.

After a round of examination, Wu Xiaofu had an idea. He took over the examination of the baby from the maternal and child health hospital and asked as he looked at it.

"Have you checked the blood pressure?"

"I checked it out, and the results have been sent over. The blood test showed white blood cells 5.7×10^9/L, lymphocyte ratio 48%, neutrophil ratio 38%, hemoglobin 67g/L, platelets 139×10^9/L, C-reactive protein 82mg/L, and respiratory pathogens: seven items were negative."

This doesn't seem like an ordinary cold!
After listening to the data, Wu Xiaofu realized that the inflammation was not serious and the baby should not suffer from respiratory distress. So the maternity and child health hospital sent the baby to the hospital on New Year's Eve.

After arriving at the hospital, Zhu Yun urgently checked a chest X-ray: the texture of both lungs was coarse and the heart shadow was full.

Gastrointestinal tract and right lower abdominal ultrasound showed no obvious abnormalities.

Color Doppler ultrasonography of the brain: no signs of intracranial hemorrhage were found.

In fact, color Doppler ultrasound of the brain is rarely performed, unless it is to check the brain blood flow. The infant is not an adult and cannot describe his or her condition, so we can only rule out one item at a time to make sure that the infant does not have intracranial hemorrhage. In this case, color Doppler ultrasound of the brain is very appropriate.

The abdominal examinations were all brought by the maternity and child health department.

Ultrasound of liver, gallbladder, pancreas and spleen: The lesion in the right lobe of the liver was 12*8.0cm.

Enhanced CT: A huge round-like mass shadow was seen in the right lobe of the liver, with a CT value of approximately 23.1-40.1HU, and dense dot-line shadows were seen inside. After enhancement, the lesion was unevenly enhanced, and the range of enhancement increased with time. The edge was still clear, and the size was approximately 106.9*80.4*119.5mm; multiple irregular dense shadows were seen in the liver; no obvious abnormal enhancement was seen in the remaining left lobe of the liver.

MR: A huge irregular space-occupying lesion was found in the right lobe of the liver, measuring approximately 74×108x120mm (left to right×front to back×up to down). The lesion boundary was clear, T1WI showed uneven low signal, T2WI showed mixed high and low signals, DWI sequence showed local high signal, and ADC value decreased.

From this perspective, the child's biggest problem is still the liver tumor.

"Director Wu, look."

At this time, the child had another episode of shortness of breath and repeated cyanosis.

Respiratory distress again!

"Quick, put on the non-invasive ventilator."

Seeing this, Zhu Yun did not dare to delay and hurriedly asked the nurse to use a non-invasive ventilator to assist ventilation. However, after the non-invasive ventilator was used, the child's breathing did not seem to improve much.

Wu Xiaofu couldn't help but shook his head when he saw this. It was indeed not just a breathing problem, it was also a liver problem.

"Intubate directly, notify the interventional department, and prepare for surgery."

Ah!
Hearing Wu Xiaofu's words, Zhu Yun couldn't help but be stunned. Whether it was tracheal intubation or surgery, in Zhu Yun's opinion, it was a little hard to accept. The baby was only two months old, and tracheal intubation was too dangerous. As for surgery, Zhu Yun still couldn't figure out what was going on with the baby.

To be honest, normal people rarely suffer from respiratory distress due to liver problems.

However, this is a sick baby. Excluding other possibilities, there is only one possibility.

After a moment's hesitation, Zhu Yun asked someone to notify the interventional department and the anesthesia department. The interventional department prepared for the operation, and the anesthesia department was responsible for tracheal intubation. Zhu Yun could certainly perform tracheal intubation, but he had only intubated adults before. As for children, even Zhu Yun had never done that and felt too unsure.

"It's too late. Let me do it."

Wu Xiaofu said something and took the tracheal intubation tool directly from the nurse. The baby's condition obviously did not allow them to wait for the anesthesiology department to come.

Zhu Yun originally wanted to stop it, but seeing that Wu Xiaofu had already started, he could only step forward to help.

Every profession has its own expertise. Tracheal intubation looks easy, but it depends on the situation. The physiological structure of children is very different from that of adults, and they are also more fragile.

However, it turned out that he was overthinking it. Wu Xiaofu moved quickly and completed it in just a few moves.

With tracheal intubation and invasive ventilator-assisted ventilation, the child's condition improved.

"Are the family members here?"

"Yes, just outside the emergency room."

Zhu Yun brought Wu Xiaofu to the outside of the emergency room. At this time, the parents of the sick baby were hugging each other and crying. Both of them looked not very good. They were probably not getting a good night's sleep since the baby was born.

"I suspect the child's current condition is caused by liver problems, so I want to perform an interventional surgery on the child. If it is really a liver problem, it must be resolved quickly. Otherwise, given the child's condition, I'm afraid he won't survive tonight."

After hearing what Wu Xiaofu said, the mother of the sick baby cried even harder, and the father of the sick baby turned even paler. However, he was still rational and nodded quickly, "Director, I will listen to you. You must save my child..."

Seeing that the baby's father agreed, Wu Xiaofu did not delay any longer. He asked Zhu Yun to sign quickly and took the baby directly to the interventional department.

The most important thing now is to see what the baby's liver tumor is like. In fact, the baby is only two months old, and the internal organs are not fully developed yet, and the boundaries are not so clear. If one organ has a problem, other organs are likely to be affected. Especially after the liver tumor is formed, the liver function will be affected. One of the main functions of the liver is to detoxify. When the liver tumor is formed and the liver function is damaged, toxins will accumulate in the baby's body, affecting the heart, lungs and other functions.

After excluding other possibilities, the infant's respiratory distress was most likely caused by liver tumors.

As to whether it is true or not, that is also simple.

In the interventional room, two nurses looked at Wu Xiaofu with resentment. They were called here at short notice. It was New Year's Eve and they were preparing to eat dumplings, but they were pulled here. However, they were just a little resentful and didn't say anything.

After working for so many years, I have long been accustomed to the nature of my job. Let alone New Year's Eve, even if I am being intimate with my husband in the second half of the night and at a critical moment, I have to go to work if I receive a phone call.

"I'll try to fix it as quickly as possible."

Wu Xiaofu smiled and said to everyone that although he and his assistant were the only ones who could enter the interventional room, other work still required a lot of medical cooperation, and they could not leave until the operation was over.

After hearing Wu Xiaofu's words, everyone nodded. They still agreed with Wu Xiaofu's speed. After all, everyone knew that Wu Xiaofu was a quick shooter in the operating room.

The main purpose of this operation is to clarify the condition of the infant's liver tumor and then to see the condition of the blood vessels around the tumor. It would be best if the tumor can be cut off through interventional surgery.

As for the surgical operation, it is not an easy thing to do since the baby is only two months old.

The contrast agent was created and the guide wire was passed through the blood vessels to the liver. According to the results of CT and MRI, the tumor in the baby's liver had reached a distance of seven to ten centimeters. It should be noted that the baby's liver itself was not very large. This volume of tumor almost occupied more than half of the baby's liver.

Under angiography, Wu Xiaofu judged the condition of the tumor and was a little shocked. This tumor was undoubtedly growing. It might have started when the fetus was conceived. It has grown to this size in more than a year. In fact, this growth rate is already amazing.

Fortunately, except for the liver, there was no infiltration or invasion in other parts of the body. However, with such a fast growth rate, it is very likely to be a malignant tumor. As for what kind of tumor it is, it is still a question at this point.

However, if we consider the reason why it grows so fast, Wu Xiaofu can be almost sure of its origin.

Without blood vessel supply, it is impossible for the tumor to grow so fast and be confined to the liver. This shows that the liver tumor is likely to grow by relying on the liver blood vessels.

Therefore, Wu Xiaofu's biggest goal in this operation was actually to inhibit the growth of the tumor through vascular embolization.

Liver tumor angiography Looking at the tumor attached to the hepatic artery and vein, Wu Xiaofu frowned.

Hepatic hemangioendothelioma?

As Wu Xiaofu looked at the tumor, an idea flashed through his mind. It was precisely because the baby's tumor might be hepatic vascular endothelial flow that Wu Xiaofu frowned.

Hepatic hemangioendothelioma, also known as angiosarcoma, is a highly malignant liver tumor. It is relatively rare and mostly congenital. It is most likely to occur in infants. As for the cause, if it is a born baby, it may be related to the use of the contrast agent thorium dioxide or the ingestion of arsenic. Recently, it is also believed to be related to vinyl chloride.

But if an unborn fetus suffers from hepatic hemangioendothelioma, it may be related to the fact that the mother underwent such examinations and ingested harmful substances during pregnancy.

Unlike pregnant women in the last century, pregnant women in this century may be exposed to too many harmful substances, including harmful gases and substances in the working environment, electromagnetic radiation in life, and so on.

This is also the reason why hospitals do not recommend pregnant women to undergo X-ray, CT and other radiation examinations. Data shows that if pregnant women consume too many lines, they are likely to give birth to children with congenital diseases.

If the baby really has hepatic hemangioendothelioma, some of the baby's symptoms and signs can be easily explained.

Under angiography, the liver of the infant was obviously much larger than that of children of the same month. The medical records of the infant in the maternal and child health hospital also mentioned that the infant had abdominal distension, abdominal pain, anorexia and anemia. Now all the symptoms are correct.

Hepatic hemangioendothelioma is very dangerous. Not to mention the malignancy of the tumor itself, if the tumor ruptures and hematoabdomen occurs, it is very dangerous. If not treated in time, the baby may lose his life in a short time.

Moreover, hepatic hemangioendothelioma has the potential to form blood clots.

If this is the case, you should know that respiratory distress also has a great possibility of pulmonary embolism, which is the most dangerous.

While thinking, Wu Xiaofu had already started the operation. The blood vessels around the liver tumor were very complicated, but the nutrition blood vessels of the tumor were also clearly visible to Wu Xiaofu. What Wu Xiaofu had to do now was to embolize the nutrition blood vessels of the tumor and inhibit the growth of the tumor.

As for the tumor itself, if it is really hepatic hemangioendothelioma, the lesion is now confined to the liver, and the most ideal treatment method is actually surgery.

However, the baby's current physical condition is obviously not suitable.

The best time is to resolve the child's crisis first, stabilize the child's condition, and then perform surgery at a later date.

The interventional surgery went smoothly. If it was just a vascular embolism, it would be extremely simple for Wu Xiaofu. The baby was safely returned to the ward in half an hour. However, the baby had anemia and some blood vessels were embolized during the operation. Therefore, the baby needed symptomatic transfusion of blood products such as suspended red blood cells and fresh frozen plasma after the operation.

There are also potassium and calcium supplements given according to the symptoms, as well as some hormones and anti-inflammatory drugs.

Wu Xiaofu gave medical instructions and explained some specific circumstances to the nurse. It was definitely not suitable for babies to take medicine, let alone hormones and anti-inflammatory drugs. But there was no other way. In this situation, between damaging the body and saving lives, saving lives must be the priority.

Wu Xiaofu directly distributed the medical instructions, including methylprednisolone, sirolimus, and oral co-sulfamethoxazole to prevent lung cancer.

"Thank you, Director Wu, thank you, you saved our child's life, thank you."

When the child's parents saw that their child's condition had improved, they thanked Wu Xiaofu profusely. Wu Xiaofu felt a little sad in his heart. He thought that it was pitiful for all parents in the world. Now that the child is in such a condition, the ones who are actually suffering the most are the child's parents.

However, there are some things that they still have to face.

"I suspect the child has hepatic hemangioendothelioma, which is a highly malignant tumor. During this interventional surgery, I only stabilized the child's condition and temporarily saved his life. Later, I would recommend that the child undergo surgery to remove the tumor.

Fortunately, the child's tumor is now confined to the liver, and the prognosis after surgery should be good."

Still need surgery!

(End of this chapter)