decompensated cirrhosis, portal hypertension, hypoproteinemia, ion disturbances, ascites, pleural effusion......

The barrage of diagnoses is dizzying.

It seems that another patient with hepatitis B progresses to cirrhosis, splenomegaly, portal hypertension, and then leads to refractory ascites.

The diagnosis and progression of the disease in the early stage were similar.

There are two fatal diseases in the decompensated phase of cirrhosis – hematemesis and ascites.

Once ascites reaches the stubborn stage, ordinary diuretic and other means are not effective. Low protein leads to fluid exudation, resulting in ascites and continued increase in protein.

The common clinical treatment for hypoproteinemia is intravenous infusion of human blood albumin.

However, in the face of stubborn ascites, human blood albumin is useless no matter how much it is in, and it will soon become ascites oozing.

This complication is not the same as hematemesis, and although refractory ascites may not seem as acute as hematemesis, hematemesis due to portal hypertension can still be surgically surged.

Refractory ascites can only wait for death before TIPS surgery appears. At present, because of the extremely high difficulty of TIPS surgery, the hospitals carried out are limited to large tertiary hospitals above the provincial capital city.

If you have this disease, if you don't have tips surgery, it is equivalent to Ling Chi.

The patient is in extreme pain, and his life is slowly tormented towards the end.

Zheng Ren had a simple physical examination, and asked about the patient's relevant condition and laboratory test report.

The resident doctors who followed Director Xia answered one by one and were well-trained. The diagnosis in gastroenterology is similar to that in the system panel, and there is not much difference.

There are no absolute preoperative contraindications for patients and surgical treatment is possible.

Zheng Rendao: "Director Xia, the patient will do an MRI of the liver today, plus diffusion. I'm on the bill and I'm going to have surgery tomorrow. ”

"MRI diffusion?" Director Xia was stunned for a moment.

The full name of magnetic magnetic diffusion is magnetic resonance diffusion-weighted imaging.

Unlike conventional magnetic resonance imaging (RI), MRI diffusion is based on the movement of water molecules, which can provide clinical information based on the physiological state of the brain.

It is mainly used for the treatment of neurology.

It has a sensitivity of 94 and a specificity of 100 for the diagnosis of acute cerebral infarction, and can reliably distinguish arachnoid cysts from epidermoid cysts, subdural empyema from effusions, and abscesses from tumor necrosis.

For TIPS surgery, what does Zheng Ren want MRI diffusion to do?

Director Xia had heard that experts from the imperial capital and the magic capital used liver MRI diffusion to see tumors. But this is not a tumor, it is a refractory ascites in the advanced stage of cirrhosis.

Xiao Zheng: This is ......

Director Xia groaned.

Zheng Ren didn't explain much to Director Xia. This is a preoperative diagnosis and positioning method of TIPS that he has honed in the system operating room, which is used to judge the location of the portal vein and hepatic vein and improve the probability of successful puncture.

If you start from the beginning, I'm afraid a few days will not be enough.

There are other things, Zheng Ren is also lazy trouble.

After explaining this, Zheng Ren and Director Xia said goodbye and went to the ICU.

After changing clothes and entering the ICU ward, Zheng Ren felt the oppressive atmosphere in the entire ICU.

The head of the medical service is also sitting here, frowning.

Su Yun sat on the edge of Yang Lili's bed, with black hair fluttering on his forehead, looking down at the test sheet in his hand.

"What's wrong?" Zheng Ren came to Su Yun's side and asked in a low voice.

"Boss, something is wrong. Su Yun said, "This morning, the tranquilizer was stopped, and the patient developed mental symptoms. ”

Psychiatric symptoms?

Zheng Ren was also stunned.

In the diagnosis on the system panel, there are no psychiatric symptoms.

"The blood routine was generally normal, the intraoperative disinfection was done well, and there was no clear infection. Biochemical sugars 1549 ol/l, sodium 134 ol/l, potassium 415 ol/l, blood gas analysis pH 746, oxygen partial pressure 61 hg, bicarbonate 38 ol/l, alkali remaining 3 ol/l, urine ketone. Su Yun didn't look at the list in his hand, and casually said the results of this morning's emergency inspection report.

"What are Yang Lili's mental symptoms?" Zheng Ren asked with a frown.

"Fear, serious fear. Su Yun said, "It's like seeing a ghost, it's so restless that I can't tie my hand strap." The heart rate soared, and after stopping the tranquilizer, the heart rate went straight up from 95 beats per minute to 156 beats per minute. ”

"Strange. Zheng Ren recalled that Su Yun said that the test results were not bad on the whole, but the blood sugar was slightly high, and there were urine sugar and ketone bodies, which was considered to be the body's transient stress reaction to severe trauma.

And hell......

It's hard to explain.

Was it because she was violently frightened that day, which left a shadow on her heart?

There is such a possibility, but psychological treatment is considered a new discipline in the country, and Zheng Ren doesn't know who is the specialty.

And the most important thing is that in Yang Lili's current condition, psychologists have no way to do psychological counseling.

If you delay for a few days, you will have a tracheotomy. When the time comes, complications such as lung infections will appear......

Zheng Ren was also helpless.

No wonder the atmosphere in the ICU is so oppressive, and the patients who look good on the lab tests have strange complications.

In particular, this patient is the focus of the city's attention, and it is said that the patient's condition is reported directly to the director of the health bureau and the deputy mayor in charge of culture, education and health every day.

What does today's report say? Is it necessary to say that the patient's tranquilizer is stopped, and he will see a ghost?

Zheng Ren's brows tightened, pondering the various diagnoses given in the system panel.

After reapplying the tranquilizer, Yang Lili's heart rate was still very fast.

The patient has only a low-grade fever and no obvious abnormalities, so it is unlikely that there will be a serious infection.

Pulmonary embolism causes respiratory distress, chest pain, and increased heart rate?

Zheng Ren picked up the stethoscope and listened to Yang Lili's breath sounds on both sides. Not a pulmonary embolism......

There is no need to do a CTA examination of the pulmonary blood vessels, Zheng Ren can be sure.

Physical examination and systematic diagnosis are combined into one, which can be basically qualitative.

Could it be cardiac insufficiency caused by a large amount of fluid replacement after surgery? Zheng Ren pondered and asked, "How much is the amount of intake and output?"

Su Yun shook his head, it was obvious that he had also taken this into account.

"There was a lot more intake than outflow after surgery, and on the first day after surgery, the gap decreased. Yesterday, the amount of inflow and outflow was basically the same. ”

The large amount of postoperative intake is due to Yang Lili's massive bleeding.

It only took 2 days to recover, which can be said to be the result of the joint efforts of Su Yun and the medical staff of the ICU, plus Yang Lili is young and has good physical fitness.

Moreover, Yang Lili has no history of cardiovascular disease, nor does she have a similar family history, so the manifestations of cardiac insufficiency are not considered for the time being.

This also precludes ...... And then what?

Finally, diabetic ketoacidosis can only be considered.

Because Yang Lili had positive urine ketones, elevated blood sugar, and acidosis, but oxybutyrate was normal, the ICU doctor temporarily gave the patient a low dose of insulin.

Ketoacidosis, either.

It can't really be a mental illness...... Zheng Ren had a headache.

Looking carefully at the diagnostics in the system panel one by one, Zheng Ren's eyes suddenly lit up!

Is this it?

。