"Take a look at the patients after TIPS. Zheng Ren smiled, warm and warm, "Where is it?"

Director Xia did not continue to make rounds, but personally took Zheng Ren to the rescue room.

The patient was able to sit up, although he still looked a little haggard and anemic, but the black aura on his face had subsided a lot. (Note 1)

"From last night to now, I have vomited blood 3 times, the amount is not large, a total of about 150ml, it is considered to be old blood accumulated in the stomach. Director Xia introduced the patient's condition, "In the laboratory report this morning, the hemoglobin has recovered to 79g, the coagulation function is slightly poor, the blood ammonia is 63, and there are no typical characteristics of hepatic encephalopathy on physical examination." ”

Because of the two stents, the pressure of the patient's gastric varicose veins was relieved, but not completely.

As long as the bleeding is reduced, the rest can be stabilized with hemostatic drugs and oral ice saline for the kidney.

Zheng Ren is concerned about hepatic encephalopathy.

After surgery, patients are particularly prone to hepatic encephalopathy because a part of the venous blood does not pass through the liver, which reduces the process of liver metabolism.

This is also the main reason for leaving two stents to reduce the inner diameter of the outflow channel.

When the patient gets used to it, the second stent can be removed, and the likelihood of the patient retching up blood in the future plummets.

Zheng Ren asked the patient about the situation and asked the patient to do a few simple math problems, such as 74+7+7+7=?.

If the patient has mild symptoms of hepatic encephalopathy, this kind of problem can be quite difficult to do.

But for math problems, you can only add them once or twice.

Add too much, and the average doctor doesn't understand.

The patient's condition is still very good, Zheng Ren is going to observe for another two days, if the blood ammonia does not continue to rise, the second stent can be removed.

Out of the ward, Zheng Ren could see Director Xia with a sincere smile on his face.

After all, it's a classmate, or the kind she can sign, she can survive, and she won't leave too many sequelae, which is undoubtedly a happy thing.

After seeing the patient, Zheng Ren was ready to stop by the ICU to take a look at the female patient who jumped off the building. Adenomyosis, there is still a task in this matter, Zheng Ren occasionally remembers.

He doesn't have obsessive-compulsive disorder, and if he wants to improve his skills, all he needs to do is have TIPS surgery. A high-level surgical gain skill points is equivalent to completing 3-5 tasks.

Of course, the experience points given by the mission can be used for emergencies, so this detail will not be considered.

Just as he was about to leave, Director Xia's expression sank slightly, as if he had made a crucial decision.

She then said, "Xiao Zheng, I still have a patient here, can you help me take a look?"

"Oh, are you still a patient who needs to have TIPS?" asked Jung-in.

"No, it is an incurable disease, the diagnosis and differential diagnosis are not clear, and the patient is not in good condition. Director Xia was a little embarrassed.

After all, the old director for many years, the diagnosis is unknown, and it takes a lot of courage to say this.

This means that Zheng Ren has done a floating gallbladder and a TIPS operation in the past two days, which has helped Director Xia a lot. If it were a different person, Director Xia estimated that he would rather transfer the patient to the hospital than ask for help from a general inpatient from another department.

"What's the situation?" Zheng Ren also felt a little strange and asked.

"A 62-year-old woman. The main clinical manifestations are severe sepsis, accompanied by abdominal pain and jaundice. Director Xia took Zheng Ren to the patient's ward and said, "A non-contrast abdominal CT scan can show that the patient has liver abscess and pneumocystis. The size of the liver abscess is about 5.2×4.2 cm. ”

Liver abscess, complicated by jaundice, this is a fatal disease.

Hearing this, Zheng Ren's footsteps were a little anxious.

"MRCP (magnetic resonance cholangiopancreatography) results showed biliary-intestinal communication between the proximal duodenum and the common bile duct, and there was a hypointense filling defect with ill-defined contours in the intrahepatic and external bile ducts. Director Xia also sped up his pace and continued: "Please consult the general surgery, and the general surgery is not very sure because the patient's condition is not good, and the preoperative diagnosis is not clear. In the case of exploratory laparotomy, the probability of failure is too high. ”

"What about the past history?" asked Zheng Ren.

"It is said that twenty-four years ago, a cholecystectomy was performed. ”

Is it just a cholecystectomy? Zheng Ren had doubts in his heart. In the case of cholecystectomy, there should be no direct connection to the disease.

With that, several people came to the ward.

The junior physicians of the Department of Gastroenterology stood quietly in two rows in the corridor, holding medical record clips in their hands, and behaved properly.

"Boss, look at the little doctor of the family, how upright. Su Yun whispered beside Zheng Ren.

"If that's the case, you'll be the first one to be asked to stand. Zheng Ren was anxious to see the patient, and squirted back.

Su Yun thought about it, this is indeed the truth.

Several people entered the ward, and Zheng Ren looked directly at the system panel in the upper right corner of the field of vision.

An unfamiliar diagnosis appeared in front of Jung-in's eyes - cesspool syndrome.

Cesspool syndrome is also known as blind end syndrome and blind fossa syndrome. It is a non-common complication after surgical common bile duct and duodenal anastomosis.

It is most likely because food debris, stones, etc. accumulate in the blind pocket formed from the biliary-intestinal anastomosis to the ampulla of Vater, thus causing a series of clinical symptoms.

The patient is yellow all over and looks like a minion.

The overall state was very poor, Zheng Ren rubbed his hands to make his hands warmer, and the difference between the patient's body temperature was not too big.

As soon as the fingers touched the patient's body, they felt a burst of heat.

The patient's temperature is at least around 39 degrees Celsius, which is likely to be the result of a severe infection.

Right upper quadrant, near the duodenal segment, is tender with rebound tenderness and muscle tension. Dullness to percussion is typical of gastrointestinal symptoms.

"Director Xia, I want a bedside ultrasound. Zheng Ren frowned and pondered.

Because the patient complained that the history of gallbladder resection did not match the predisposing factors of common bile duct and duodenal lateral anastomosis, Zheng Ren was still cautious and wanted to do other tests to clarify.

Although the system has been stable and reliable, the doctor ...... Especially the doctors in tertiary hospitals pay attention to evidence.

Otherwise, after the operation is done, the patient's family will turn around and accuse you of a fraudulent medical practice, and you will have to walk around if you can't eat.

This kind of thing is often seen, and Zheng Ren is also very helpless.

But helplessly, it is still necessary to do surgery, to treat and save people, or to be saved.

Ten minutes later, the doctor in the B-ultrasound room pushed the emergency B-ultrasound car to the ward.

Closing the curtains and plugging in the power supply, the doctor in the B-ultrasound room just squeezed the couplant in the patient's abdomen, and Zheng Ren suddenly asked, "I'll take a look first, okay." ”

……

……

Note 1: The complexion of patients with liver disease is mostly black. It's not a Xiangshi text, so let's explain it here.