Come on, Dr. Wu

Chapter 94 Gastrointestinal bleeding?

Pancreatitis actually has too many differential diagnoses. Intestinal perforation, intestinal obstruction, cholecystitis, etc. all need to be diagnosed.

This is also a major advantage of the development of modern auxiliary examinations. Without these auxiliary examinations, doctors can only make empirical diagnoses, empirically administer drugs, and treat diseases based on the 90% possibility. By the way, the condition will slowly recover. If it is not done correctly, there may be delays in disease progression, and the patient may even die because the real disease cannot be treated.

Therefore, the development of medicine is ultimately a good thing.

"How about it?"

Qiu Ying also came over after finishing the patients in her hands. She looked at the examination in her hand and knew what she was doing.

"Although intestinal perforation and obstruction can also cause amylase elevation, it rarely exceeds 500. Moreover, there are no signs of intestinal obstruction or intestinal perforation on CT. The pancreatic leakage is obvious. It should be pancreatitis. Yes, there are stones in the gallbladder. Now we have to see if it is pancreatitis caused by the gallstones."

In domestic patients, pancreatitis is basically accompanied by gallbladder and bile duct stones. If the stones fall into the pancreatic duct and become stuck, pancreatitis will occur.

This is the main cause of pancreatitis in China. Of course, the reason for this is that there are too many patients with gallstones in China.

Isn't there a saying that if the appendix is ​​removed before 20 and the gallbladder is removed before 40, the number of people who can retain the gallbladder and appendix when they are old is basically rare.

"Teacher, the general surgery and gastroenterology departments will be here soon."

Qu Ying had already placed the consultation order and made a phone call.

In the emergency department, you must always remember to seek consultation. The patient in front of you has pancreatitis and gallbladder stones, and specific plans will be discussed.

Since there are gallbladder stones, even if the pancreatitis condition is stabilized this time, the patient will still not be able to escape the fate of pancreatitis if the stone falls next time. This is the root cause of the disease, and it is best to remove it as soon as possible, but the patient's CT scan this time There are no stones blocking the pancreatic duct. It is most likely not caused by gallbladder stones but is related to drinking. Conservative treatment can also be considered to resolve the pancreatitis first.

As for whether the gallbladder stones will fall off later, it will definitely happen. It just depends on sooner or later. When the stones fall off and pancreatitis develops, you can cut the gallbladder again.

In other words, the pancreatitis can be resolved by hospitalization first, and the gallbladder can be treated at an elective date.

There are still many options, and the specific ones require medical and surgical consultation and soliciting the patient’s opinions.

"The Ranson score is okay. The disease is still mild at the moment and can be treated conservatively. What do you think of the surgery? Should I have surgery now?"

The female doctor from the Department of Gastroenterology came over and said directly that the doctor who comes for consultation will usually go through the patient's auxiliary examinations and medical records in the department to determine the seriousness of the condition before proceeding, and then make a detailed assessment based on the patient's own condition. As for mild cases, there are options for surgery or not.

Qiu Ying is already busy with other patients. Her meaning is obvious. It doesn't matter whether she is in the general surgery department or the gastroenterology department, she only needs to take people in.

It's not severe pancreatitis. If it were severe, I would have to ask the ICU to clean my butt.

"Now it's just gallbladder stones, and there is no inflammation in the gallbladder. It's better to wait until the pancreatitis situation stabilizes before elective gallbladder surgery depends on the patient's willingness."

After such an exchange, things became simple. The general surgery department's intention was obvious. No surgery was needed. You, the gastroenterology department, should take over first.

The female doctor in the Department of Gastroenterology also nodded. As usual, it was accepted by their department. This cannot be pushed out. However, what should be explained should still be explained. It is mild now, but it is not unreasonable to turn into severe disease during the treatment process. Perhaps, it is not that the treatment is not in place, but that the progress of pancreatitis can be fast or slow. The specific situation, no matter how small the risk, cannot be ignored.

"By the way, there are no beds in the Department of Gastroenterology. Let's put the patient in the emergency room for now. If there is a bed, I'll call."

I know this is the case, but I can also understand that in gastroenterology, it is normal not to have a bed, but it is strange to have a bed.

In the ward.

No water, upper gastric tube, gastrointestinal decompression.

To be honest, people who have never had a gastric tube cannot understand the sour feeling of a gastric tube. Wu Xiaofu has never had one, but he has seen it many times. Patients are all afraid of it, and it is no different from being tortured.

Basically, after this routine is followed, there are very few people who dare to drink after being discharged from the hospital. Of course, there are still some brave people, and those are basically the frequent visitors to the hospital.

The medication is the same, inhibiting pancreatic enzyme secretion, relieving spasms and analgesics, protecting the gastrointestinal tract, etc.

"Let's go to eat?"

After hearing this, Qu Ying hesitated and nodded. Although she was angry when she saw Wu Xiaofu, she forgave him because he took the initiative to help and work with her.

Qu Ying really couldn't figure it out. Wu Xiaofu was not handsome in appearance, he was a bit tall, and he was a bit talented. Why were there so many girls jumping at him?

During the meal, Qu Ying didn't want to talk to Wu Xiaofu. However, who was Wu Xiaofu? He was offering his ultimate move and discussing the topic. Sure enough, Qu Ying was still concerned about his own performance. Even though everyone said he didn't want to compete with Wu Xiaofu. , but that’s what I’ve said before, and I’ve always said it smells really good.

However, the question this time was really unauthentic. It was one-on-one and one person said nothing.

They still have to go out to the clinic in the afternoon.

After changing his clothes, Wu Xiaofu heard someone in the ward saying that the patient with pancreatitis in the morning was getting worse.

After all, he had received the treatment himself, so Wu Xiaofu was also very concerned at this time.

The blood pressure is 80/40mmHg, and it continues to drop.

"what happened?"

"I told him not to eat or drink, but he still ate chocolate." Yeah!
  Wu Xiaofu was stunned when he heard this. What kind of operation is this? A young man in his twenties should have no problem with his understanding, but he is still a college student. The seriousness of the condition has been explained so clearly. Is this because he can't think about it and wants to commit suicide?

The condition is definitely progressing. The blood pressure of 80/60mmHg is already an indicator of shock. The patient is also irritable and has obvious mental symptoms.

Zhu Yun was in charge of the ward. When he saw Wu Xiaofu coming, he quickly pulled him to work together.

Low blood pressure means that the effective circulating blood volume is declining. Increase fluid replenishment and volume expansion, and the blood pressure must be brought back as soon as possible.

However, the process is like this, but the effect is not necessarily the same.

Dual-channel fluid replenishment was used, but the blood pressure not only failed to rise, but also continued to drop. The patient's breathing and heart rate were very unstable, and the assisted breathing could not keep up. If this continued, he was afraid that he would need to be put on a ventilator.

"Teacher, even if it's severe pancreatitis, it shouldn't be like this. It's progressing too fast."

"What do you think?"

"Stop bleeding."

Hearing Wu Xiaofu's words, Zhu Yun also nodded. Pancreatitis bleeding is actually very common, and the biggest reason for the sharp drop in blood pressure is actually caused by excessive blood loss.

Even based on the doctor's experience, bleeding is the most likely possibility.

"This is an idea. Generally, in patients with severe pancreatitis, hypotension, skin and mucous membrane bleeding, or gastrointestinal bleeding are common complications. Hypotension is generally due to the secretion of kallikrein, which causes kinins and bradykinin in the blood. The increased amount of peptides causes blood vessels to dilate, causing patients to experience drops in blood pressure, irritability, and a very small number of patients may experience sudden shock or even sudden death.

The current patient's symptoms are quite consistent, but the blood pressure dropped too fast. I am more inclined to have gastrointestinal bleeding. Severe pancreatitis can lead to gastric mucosal lesions, multiple abscesses, pancreatic necrosis and other diseases. Gastrointestinal bleeding is also common. What's more, if the patient eats a piece of chocolate at noon, the risk of gastric acid secretion and gastrointestinal bleeding will also be greatly increased.

First draw blood and have someone do an ultrasound. "

The nurses hurriedly started drawing blood and performing ultrasound, while Wu Xiaofu looked at the helpless girl aside.

"Xiaoyu, it was me who caused you trouble. You must not let anything happen to you. I am still waiting for you to marry me..."

After gathering everyone's fragments of words, Wu Xiaofu also got a rough idea. This girl should be the patient's girlfriend. In the morning, he received a call from the patient's colleague and started to rush there. The patient's home was not in Donghai, and his parents I can't come for a while, so my girlfriend can only take care of me.

After the gastric tube was inserted, the patient's condition actually improved.

However, fasting water, decompressing the gastrointestinal tract, and giving fluids can supplement the patient's energy needs, but the hunger in the stomach is still very uncomfortable. The patient's girlfriend heard the patient complain and He took out a chocolate from his bag. The patient’s girlfriend suffered from hypoglycemia and kept chocolates with her.

Neither of them took it seriously. It was just a small piece of chocolate. What big impact could it have? After all, the patient felt much better now, and his stomach pain was no longer so painful. He could not be discharged from the hospital soon and could continue to work. .

After the chocolate entered his stomach, the patient began to suffer from pain soon after, and his blood pressure and heart rate also began to change on the monitor.

Shaking his head, he suddenly thought of the story Bian Que and King Wen of Wei told about their three brothers.

Bian Que and King Wen of Wei said that among their three brothers, the eldest brother had the best medical skills, and the second brother was the worst. King Wei Wen still didn't believe it. After all, he had never even heard the names of Bian Que's two brothers, and Bian Que's reputation , has spread throughout the country, and even other countries know the name of Bian Que's miracle doctor.

Bian Que's answer was that the eldest brother cured the patient before he got sick, and the second brother cured the patient when the disease was just beginning and at its mildest. Who can know and write about these two situations? Ah, he is the only one who treats the most serious and difficult diseases, so he is famous.

In fact, the current medical environment is like this. Doctors all play the role of Bian Que. On the contrary, the work of popularizing medical science is somewhat unsatisfactory.

The two people in front of me are still college students, and they don't even have this bit of common sense.

When I was watching short videos in the past, every time I watched those videos that complained about how expensive and difficult it is to get medical care, or how careless human life was, some people would discuss that everyone should hold a medical book in their hands and learn medical skills, so they don’t have to be here. Complained.

In fact, it’s not unreasonable. You don’t really need to see a doctor for yourself, but at least you can increase some medical knowledge.

Eating healthily, living a healthy life, and preventing diseases before they occur is probably much easier than seeking medical attention in an emergency.

After the color ultrasound was pushed over, Zhu Yun started to operate and check the conditions of the heart and abdomen. However, he didn’t know whether to say he was lucky or unlucky. The color ultrasound of the heart and abdomen did not detect any problems. Hemorrhage in the gastrointestinal tract. Sometimes, the color ultrasound room was used to really It's hard to see the problem, but at least some rare bleeding possibilities have been ruled out.

For example, pancreatitis can cause spleen rupture.

Patients with severe pancreatitis have another terrible complication, which is hemorrhage of the skin and mucous membranes. The occurrence of pancreatitis will lead to local blood circulation disorders, followed by symptoms such as blood hypercoagulation, thrombosis, and disseminated intravascular coagulation, which can easily Cause bleeding of skin and mucous membranes.

This is about blood clots. Everyone knows how terrible blood clots are.

This thing is famous for blocking whoever is unlucky. If it blocks the blood vessels in the brain, it will be a cerebral infarction. If it blocks the pulmonary blood vessels, it will be a pulmonary infarction. If it blocks the cardiovascular vessels, it will be a myocardial infarction. They are all fatal diseases.

If a thrombus blocks the splenic artery, hemorrhage and necrosis of the spleen may also cause problems. If the necrosis falls off, it means splenic artery rupture and bleeding.

In the same way, hepatic artery, cystic artery, etc. are also possible, but they may be relatively small.

Now that there is no blood visible in the abdominal cavity, this situation should be ruled out.

"Hemoglobin is over seventy!"

When the blood test came out, Zhu Yun stared blankly after seeing it. Hemoglobin was the hemoglobin in the routine blood test. With a hemoglobin of more than 70, except for the hematology department, which could keep calm, other departments had to worry.

(End of this chapter)