Early the next morning, Yang Ping went to the ICU to round the ward again.

Nie Shun'e's vital signs are very stable, her blood pressure has risen a little more than last night, and her hemoglobin has risen slightly without blood transfusion, indicating that there is no obvious bleeding in her body.

Various biochemical indicators are also good, and the blood sugar is a little lower than last night's result, but it is still much higher, indicating that the remaining pancreas has not completed compensation so quickly.

The aminotransferases have dropped slightly, the bilirubin has dropped significantly, and the other indicators have not changed much.

ICU doctors have installed an insulin pump for Nie Shun'e to temporarily use insulin to lower blood sugar.

The function of the pancreas is still there, but it takes a certain amount of time to compensate, so the use of insulin pump needs to be slowly reduced, otherwise the function of the remaining pancreas will be inhibited, and the secretion function of residual pancreatic cells will eventually be destroyed.

In fact, Yang Ping's biggest concern is not the quality of his surgery, this is definitely no problem, it can be controlled by himself.

His biggest concern is that the remaining liver and pancreas are not compensatory enough to bear the physiological needs of the human body, because no one can make accurate estimates, and to some extent, it is uncontrollable.

Now, judging from the changes in the indicators of blood tests, there is not much of a problem, but the scale of the operation involving the ex vivo resection of tumors of eight organs and the autologous transplantation of five organs is too large, and it is also a blow to the human body, so it is better to stay in the ICU for a few more days.

The operation itself is a blow to the human body, and the bigger the operation, the greater the blow to the human body.

For example, in trauma surgery, there is the concept of a second blow, trauma is the first blow, and surgery is the second blow to the human body, so for severe multiple trauma, in order to reduce the destructiveness of the second blow, trauma surgery puts forward the concept of step-by-step treatment.

For Yang Ping's patients, whether it is an ordinary ICU, a trauma ICU, or a cardiovascular ICU, they are all very welcome, because they can not only learn things, but also good thesis materials.

Doctors want to be promoted, papers are necessary, many doctors worry about papers, which gives birth to the "thesis industry" and a larger "title industry", and many people rely on this to make a fortune.

The name of the Institute of Surgery is not called in vain, it is always studying the theories, surgical methods and new instruments of surgery, and innovating the old and bringing forth the new, which creates the best conditions for writing a thesis, in fact, in the Institute of Surgery, the thesis is only a by-product of the incident.

Song Zimo and Xu Zhiliang are the second authors of several of the 13 CNS articles because they follow Yang Ping, and they have also written many papers in top journals, so they can be promoted to the title soon.

Zhang Lin and Xiao Wu are not a big problem to be promoted, after all, with the team, so many scientific research resources, close to the water, the first month, any few heavyweight papers are enough to be promoted, not to mention the monograph "Surgical Retractor", which is full of dry goods.

The job title, if it is not a genius who walks sideways, ordinary people can't get around, they must follow the crowd, otherwise they will suffer, so what can't be changed, it's best to adapt, and you can only adapt.

Dr. Jin of the Department of Orthopedics is a maverick, he is honest in everything, he will not be flexible when he publishes papers, and it took a long time to hold back one paper, and now he has finally put together the papers, but when he was reviewed, he lacked a minimum of respect for relevant experts, so in the end, he is still an indicator.

"Professor Yang, we are going to write a paper on this patient, right?" Dr. Meng from the ICU said.

In fact, there is no overlap between the ICU paper and the surgical paper, the ICU mainly discusses the postoperative monitoring of the case, and the surgery is from the perspective of treatment surgery, so there will be no intersection between each other.

"It's okay, you can write whatever you want."

Dr. Meng was very happy to get Yang Ping's permission, this is a rare material.

After seeing Nie Shun'e, Yang Ping came out of the ICU and communicated with her husband in the family waiting room at the door to explain her condition.

Saying that Cao Cao Cao arrived, Yang Ping met Dr. Jin on the way back from the ICU, and Dr. Jin pulled Yang Ping to chat in the corner for a while.

"Professor Yang, do you still need someone over there?"

Dr. Jin asked directly, he felt too old and in his early forties, so he never mentioned this matter to Yang Ping.

Dr. Jin is actually very good in both character and technology, but he is too honest, so honest that he is not suitable for society, and he is so honest that the circle of life is limited to hospitals.

Most of his classmates are deputy chief physicians, some are already chief physicians, many have become department directors, and he is still an attending physician, in terms of level, he is better than the vast majority of chief physicians.

For a small foreign body removal operation, he can study the X-ray, CT and MRI of the foreign body in Sanbo Hospital, and then establish a geometric model, and use the geometric model combined with the image pictures to locate the foreign body.

Yang Ping actually appreciates this type of person very much, since Dr. Jin is willing to come, Yang Ping is also willing to accept, and now the Institute of Surgery is short of manpower, but Yang Ping has always adhered to the principle of preferring shortage to excess, and has been more cautious in recruiting people.

The business of the Institute of Surgery is quite complicated now, and I don't know if Dr. Jin likes it or not, and whether he can adapt to it.

On the orthopedic side, Director Han has already recommended the article, which is about the spine, and the conditions are good.

Dr. Jin is a trauma orthopedic specialist, and the surgical institute is actually not suitable for ordinary people, because the business is complicated, it is easy to distract energy, but for people with strong learning ability, it is not scattered, but has a wide range of contacts, and each department is integrated with each other.

"There is a shortage of manpower, I don't know if you can adapt to it?" Yang Ping is not secretive.

"If you don't dislike me for being an old master, let me go over there to help."

"No problem."

Dr. Jin no longer has any hope for the promotion of the title, in fact, he also has connections, his mentor and his classmates are the biggest contacts, but he didn't go to anyone at all, and always disdained to do this, even if he just opened his mouth to say a word, he was sure that this matter could be solved, but he just didn't open his mouth, and he was bored and focused on clinical practice.

In fact, some colleagues introduced Dr. Jin to the boss of the agency, but Dr. Jin was indifferent, he really didn't want to do this.

After chatting with Dr. Jin for a while, when I returned to the department, Song Zimo and Xu Zhiliang had already gone for surgery.

The brothers of the department recently set up a website for the Institute of Surgery, and there is a forum on the website, the purpose of this forum is mainly to seek medical treatment for some patients with high-difficulty cases, and to radiate the strength of the Institute of Surgery to the world through the Internet.

The forum on the site has just opened, and no one has spoken on it.

Just sat down for a while, Director Fang, a strategic partner, called: "Professor Yang, I am in the Department of Gastroenterology, a patient with pseudointestinal obstruction, but I have not been able to find the cause, can you help to see." ”

Now Director Fang is nervous, as long as he can't figure it out, he thinks of the Institute of Surgery, thinks of Yang Ping, and wants to get rid of poverty and become well-off.

Yang Ping looked at the time, it's okay to go to the operating room late, Song Zimo and Xu Zhiliang will call themselves even if they encounter difficulties, it is better to go and see what is going on, Lao Fang still has some eyesight.

Nie Shun'e was discovered by him, and if he hadn't referred him, Nie Shun'e would still be seeking medical treatment everywhere now.

Yang Ping came to the internal medicine building from the Institute of Surgery, and when he came out, he saw many signboards hanging at the gate, and he wanted to laugh.

When I arrived at the Department of Gastroenterology, Director Fang had not yet left, and was chatting with Dr. Chen Feiyu from the Department of Gastroenterology in the office. ”

The chair was ready, and Dr. Chen beckoned Yang Ping to sit down.

Dr. Chen and Yang Ping are familiar with each other, the previous emergency department of the "auto-brewing syndrome" patient, Yang Ping was diagnosed by Dr. Chen was handed over to Dr. Chen for allogeneic fecal transplantation treatment, in order to thank Yang Ping for providing this rare case, Dr. Chen reciprocated the favor and allocated several fecal donation places to the Institute of Surgery, so far there are graduate students who enjoy this benefit and easily get a subsidy of several thousand yuan per month.

Yang Ping sat down on the chair next to him, and Dr. Chen introduced the condition and said: "Female, 25 years old, repeated abdominal distension and abdominal pain and diarrhea for 7 years, aggravated for 3 months, now at least three times a day, sometimes seven or eight times a day, diagnosed as pseudo-intestinal obstruction in many hospitals, after each symptomatic treatment, abdominal distension and abdominal pain can be relieved a lot, but the diarrhea is still the same, not improved at all, as time goes by, the symptoms have become more and more severe in the past three months, especially in these days, I can't get out of bed at all, let alone eat now, Even after drinking a sip of water, his stomach was swollen and very uncomfortable, and he was given an enema after coming in, and now it is a little easier, but as long as he eats again, he can only rely on parenteral nutrition support. ”

"Colonoscopy was done too, right?" Yang Ping asked.

Dr. Chen smiled and nodded: "I did the colonoscopy six times, and I didn't find any abnormalities, and I also did a colonoscopy in the outpatient clinic of our hospital, and I didn't find anything." ”

Yang Ping looked at the patient's case, a 25-year-old girl, unmarried, had no special medical history in the past, after the appearance of symptoms, eating less and less, especially in the last three months, nutrition could not keep up, so the weight decreased significantly, lost more than 20 pounds in three months, 1.65 meters tall, and now only 60 pounds, the diagnosis given by the hospital I have seen before is pseudointestinal obstruction.

Intestinal obstruction, in fact, is the intestinal tract as a transport channel is not smooth, medically refers to the intestinal contents caused by various reasons can not run, can not pass through the intestine. It is divided into mechanical, motil, and hematovascular.

Mechanical intestinal obstruction is a physical narrowing or obstruction of the intestine, and dynamic intestinal obstruction is the absence of physical narrowing or obstruction of the intestinal tube, but the motility of intestinal peristalsis is insufficient or missing, and food or food debris cannot pass smoothly through the intestine.

The contents of the intestines are able to pass through the intestines smoothly because of the force of intestinal peristalsis, which pushes them to form a squeeze from far to near, so that they are squeezed out step by step.

There is also a type of blood circulation intestinal obstruction, that is, there is a problem with the blood supply to the intestines, peristalsis is weakened or disappears, any organ needs blood supply, and ischemia will cause the organ to strike, just like a car cannot be driven without refueling.

Pseudo-intestinal obstruction, as the name suggests, is false, not the three conditions mentioned above, neither mechanical obstruction, nor motility disorder, nor blood vascularization disorder, but it is manifested as a symptom of intestinal obstruction.

The presence of symptoms without an associated cause is a common feature of diseases that are medically named "pseudo-sexual".

Blood routine, biochemistry, liver and kidney function, and various tumor markers have been examined, and there was a water and electrolyte imbalance at the beginning of admission, such as low potassium, which has now been corrected, which should be caused by low intake, diarrhea, and pseudointestinal obstruction.

Low potassium itself can also cause a weakening of muscle contraction, which can cause intestinal paralysis, that is, insufficient peristaltic motility of the intestines, resulting in intestinal obstruction, which is a dynamic intestinal obstruction.

There is a disease called periodic hypokalemic paralysis, which can also cause muscle weakness, but generally it is muscle weakness of the limbs, the lower limbs are heavier than the upper limbs, and the symptoms are relieved after potassium supplementation, this patient does not have muscle weakness in the limbs, through potassium supplementation, it is now normal for a few days, and the symptoms have not been relieved at all, Dr. Chen has ruled out this diagnosis.

Surgeons are weaker at diagnosis than physicians, and internists are more adept at diagnosing.

Intestinal adhesions can also be caused by this condition, but Dr. Chen is also confused now, the patient has not had surgery before, has not developed digestive tuberculosis, peritonitis and other diseases, and the possibility of intestinal adhesions is extremely small.

This disease is indeed a bit strange, intractable abdominal distension and abdominal pain, pseudointestinal obstruction, Yang Ping recalled these key words in his mind.

"When we did colonoscopy in the outpatient clinic, we had taken more intestinal mucosa for pathological examination, and no abnormalities were found, which is really strange."

Dr. Chen really can't think of any other diseases like this, and Dr. Chen also considers some relatively rare diseases, but they are all ruled out one by one.

"We've done research on microbiota analysis, and our lab is doing gut microbiota research, so we're paying special attention to that."

"Let's look at the patient first."

Yang Ping didn't see any clues from the case.

"What does a patient do?" Yang Ping asked more.

Dr. Chen said: "Live streaming brings goods. ”

It seems to be quite popular now, Yang Ping heard that Qin Xiaowei, who is freehand rock climbing, is now also engaged in live broadcasting, selling goods related to outdoor sports, which is very popular and makes a lot of money.

"What do you sell?" Yang Ping asked more carefully.

"Slimming products!"

"Weight loss products?"

"It should have nothing to do with this, she said that she didn't touch this product at all, let alone eat, and she has only been involved in the live broadcast of weight loss products in recent months, this girl is very smart, she found that she is very thin, especially in recent months, so she wants to use her special situation to promote weight loss products, there is a boss who takes a fancy to her, let her live broadcast the goods, she estimates that she is eloquent, and has affinity, plus this skinny image, the performance is very good." Dr. Chan explained.

The doctor in charge of the bed next to her immediately added: "She said that after discovering her special situation, she regarded her thinness as an advantage, because her appearance was okay, and while seeking medical treatment, she was looking for an interview with some weight loss product companies. ”

"I don't even have to do special effects, I just use her as a model, and let everyone see what is called skinny in front of the camera."

"This is also a chance, the boss originally found a few girls to demonstrate the process of weight loss, said to reduce the backbone shape, in order to achieve the effect, the boss asked the fitness coach to train these girls, strictly limit the amount of food per day, but the effect is still not good, seeing that the cowhide is going to be blown up, the boss is in a hurry, he gave a few girls laxatives, may be too diarrheal, there is a girl who is actually dehydrated and sent to the hospital for rescue, the boss lost a lot of money."

"I was so scared that the boss didn't dare to do this anymore, so he could only find a ready-made look."

"After changing to her, she didn't have to do anything, she actually lost thirty pounds in three months, and suddenly brought the boss's goods to the fire, but the boss saw that she suddenly lost weight so fast, and she was afraid that something would happen, so let her rest for a while to recuperate."

"Actually, she can't stand it herself, so she needs to see a doctor."

"No, she is hospitalized and the boss of weight loss products has asked her to cooperate."

After the doctor in charge of the bed finished speaking, Dr. Chen led the way: "Let's go see the patient together." ”

The first is the latest.