"He just said that his stomach hurts and he is shivering, we took his temperature, and it was 40 °C!"

The nurse hurriedly told Lin Yi about the situation.

"What?!"

In the office, Lin Yi and several people exclaimed in unison.

"Is this the patient with acute pancreatitis who has another accident?"

"No, isn't it already cured?"

"Yes, he was still talking and laughing vigorously in the morning, why is it suddenly like this now!"

"Is that just an illusion, in fact, there is still some disease hidden in his body, which has not been cured at all?"

When the sailors in the live broadcast room saw this sudden situation, they couldn't help but send a barrage to discuss.

"How can there be such a high body temperature, his pancreas is obviously fine, how can this be? It shouldn't be! ”

Lin Yi frowned and asked,

"Could it be that pancreatitis has suddenly worsened?"

Wu Jiang on the side also frowned and said:

"In his case, did he have complications, such as fluid accumulation around the pancreas, pancreatic pseudocysts, necrotic accumulation, and encapsulated necrosis?"

Lin Yi shook his head and said:

"It's really hard to say, let's go, you come with me to the ward to have a look!"

After speaking, Lin Yi and Wu Jiang immediately came to the ward, in front of the patient's bed.

"Doctor, you're here, he'......... He didn't know what was wrong, he was uncomfortable! ”

After the patient's wife saw Lin Yi, she immediately said to him anxiously.

"Don't worry, I'll see."

After Lin Yi finished speaking, his hand pressed lightly on the patient's abdomen.

"Does it hurt here?"

"It doesn't hurt, it hurts on top."

"What about here?"

"It hurts, it hurts!"

After Lin Yi read it, he couldn't help but say suspiciously:

"It's weird, he's now with obvious tenderness in his right upper quadrant, which is different from when he was admitted to the hospital."

"When he was admitted to the hospital, he had a pronounced pain in his abdomen, but now the focus is on the right upper quadrant, and the situation is different."

"The right upper quadrant is tender, which should be a problem with the liver and gallbladder, such as acute cholecystitis, acute hepatitis, liver abscess, etc., but the CT hepatobiliary scans done before have not found any problems!"

"And there are no gallstones in the gallbladder, but why does it suddenly hurt here?"

After speaking, Lin Yi immediately said to Wu Jiang:

"Hurry up and give him a follow-up check to see if the blood amylase level is elevated."

"Good!"

Wu Jiang agreed, and began to act.

The patient's wife pulled Lin Yi aside uneasily, and asked Lin Yi in a panic:

"Doctor, isn't it all right in the morning? Now why is it wrong again! Such a high fever! ”

The woman is now emotionally broken!

Because she just saw hope in the morning, her husband was discharged from the hospital, and now it is undoubtedly pulling her to the bottom all of a sudden, how can she accept it in her heart!

Lin Yi can also understand her current mood.

So he said to her:

"Ma'am, don't be in a hurry, aren't we checking the reason?"

Lin Yi couldn't say what the reason was now, so he could only appease her emotions.

"Oops, what's going on!"

The woman clutched her head in both hands and shouted.

After a while, Wu Jiang returned to the ward in a hurry with the report.

"Brother Yi, the results of the inspection are out!"

"How? Hurry up! ”

Lin Yi immediately said to him.

"The level of amylase in the blood is not high, and it is not a problem with the pancreas."

Wu Jiang said directly.

"Sure enough, there's a new problem........."

After Lin Yi listened, he said.

"But the white blood cell count was higher than ever, reaching 28x10E9/L (normal 3-9)! There must still be an infection, and I have already arranged for blood to be drawn and sent for culture. ”

Immediately afterwards, Lin Yi continued.

"Hmm."

Lin Yi nodded slightly, thought and said,

"The patient now has obvious pain in the right upper abdomen, and the cause is unknown, so he still needs to go for abdominal CT."

The patient's wife on the side couldn't help but be a little anxious, looked at Lin Yi and said:

"Doctor, why do you have to do a CT again? Since my husband was admitted to the hospital, he has had three CT scans! It's not an idea to do this all the time! ”

"Isn't this CT scan very radiating to the body? Is there no other way to diagnose it? Do you have to do a CT?! ”

After listening to this, Lin Yi immediately patiently explained to her:

"Ma'am, I understand that you have this question, but this CT scan is really what needs to be done! Because your husband's condition is constantly changing, it may have changed a lot from a CT done in the morning to a CT done in the afternoon. ”

"When we diagnose your husband, we pay attention to evidence, not speculation."

"Judging from his current situation, it is most likely a problem with the liver and gallbladder, and the most likely is the infection and inflammation of the liver and gallbladder."

"I'm sure, but what if not? Therefore, CT scans are needed to get accurate results. ”

After Lin Yi patiently explained, the woman's emotions also eased, and after thinking about it, this was indeed the case.

So he nodded and said:

"Alright then, doctor, I'll listen to you."

So Lin Yi didn't delay any longer, and said directly to Wu Jiang:

"Take the patient for an abdominal CT!"

"Good!"

…………

Soon, the CT report results came in.

"Brother Yi, look!"

Wu Jiang handed the CT film to Lin Yi.

After Lin Yi saw it, he couldn't help but be stunned!

From above, it can be seen that the patient's gallbladder is significantly enlarged and thickened, but there is no sign of stones in the gallbladder, and there is no obvious problem with the pancreas!

"This ...... What's going on? ”

Lin Yi couldn't help frowning and said, and then thought in his mind,

"Enlarged gallbladder and thickened gallbladder wall, which is obviously a manifestation of acute cholecystitis, but the patient does not have gallstones......... More than 90% of acute cholecystitis is caused by stones! ”

Wu Jiang also analyzed on the side:

"If it is acute cholecystitis, it can indeed explain the patient's sudden right upper quadrant pain, high fever and chills, and elevated infection indicators, but these CT CTs have not seen that the patient has gallstones!"

"In general, acute cholecystitis is unlikely without gallstones."

"Because inflammation is usually caused by stones irritating the gallbladder wall or stones blocking the opening of the gallbladder, causing increased pressure."

After a moment of silence, Lin Yi suddenly said:

"But if you don't have a gallstone, you don't have to have cholecystitis."

"There is a type of acute cholecystitis called acalculous acute cholecystitis. In other words, cholecystitis can be caused without gallstones, but this is rare, and less than 5% of cholecystitis will be the case. ”

"But......... Okay, why do patients develop acalculous acute cholecystitis? ”

After Lin Yi finished speaking, he couldn't help but shake his head suspiciously.

Wu Jiang also fell silent.

After a while, Lin Yi suddenly spoke:

"I've got some ideas."

"What is the reason?"

After hearing this, Wu Jiang immediately raised his head and looked at Lin Yi.

"His acute cholecystitis is likely to be caused by the previous fasting of water."

Lin Yi said directly.

As soon as he finished speaking, the patient's wife on the side became anxious.

"Caused by fasting water? Wasn't that what you made water fast? You're not saying that eating will put a strain on the pancreas! ”

"Why is this happening to my husband now, and you say it's caused by fasting water?"

"What the hell is going on!"

Lin Yi explained to her:

"Yes, I said that acute pancreatitis does require fasting from water, there is no doubt about that, but ......... There are two sides to everything. ”

"After the food enters the digestive tract, the gallbladder will start to contract, which helps digest the food by excreting bile, but if there is no food and water entering the body, the gallbladder will not work and will not contract."

"In this way, over time, excess bile will stagnate in the gallbladder, which may cause inflammation and even bacterial infection."

"So that's what happened, and there's no way around it."

Wu Jiang nodded and agreed:

"Well, that makes sense, that's how it should be."

Hearing this, the sailors in the live broadcast room couldn't help but discuss:

"I understand! That is to say, it is necessary to fast water for the treatment of pancreatitis, but fasting water will cause gallbladder disease! ”

"That's right, it's a dilemma!"

"The so-called success is also Xiao He, and defeat is also Xiao He!"

"This is really no way, if you don't drink water at that time, the patient's pancreas will be directly wasted, which is more dangerous!"

"Yes, you can't blame the water fasting for this situation."

"That's definitely going to be banned!"

"What should I do now? Does anyone know what you know? ”

"If you can't do this, you'll have to operate on your gallbladder!"

Then, Lin Yi sighed and said:

"Actually...... It is better for the patient to have a gallstone and his cholecystitis is caused by a gallstone. ”

"Because acalculous cholecystitis progresses faster and is more dangerous than calculous cholecystitis."

"If you don't do it well, there will be a risk of gallbladder gangrene and perforation at any time, and if it really comes to that point, it will be troublesome!"

As soon as Lin Yi said this, the patient's wife became even more anxious!

This finally came out of the ICU, it can be said that I escaped death, and I didn't have time to be excited for a long time, but I didn't expect that now I have stepped into the ghost gate with one foot!

It can be said that how much excitement there was in the morning, how great the loss is now!

Immediately afterwards, Wu Jiang asked Lin Yi:

"That......... Brother Yi, what do you think we should do now? ”

Lin Yi thought for a moment, and then said:

"In this case, either the gallbladder is removed directly, or minimally invasive surgery is performed using percutaneous transhepatic gallbladder puncture."

"And it can't be delayed, it must be settled quickly!"

"After all, the gallbladder is so big now, which means that the bile stagnation inside is very powerful, and if this stasis is not lifted in time, the gallbladder will break down at any time."

"At that time, the bile will spill all over the abdominal cavity, and sepsis will appear in minutes, and then there will be no ability to return to the sky."

"So you have to make a decision as early as possible whether to cut out the gallbladder directly or do minimally invasive surgery (percutaneous transhepatic gallbladder aspiration)."

"Cutting out the gallbladder directly is equivalent to uprooting, and the problem can be solved once and for all."

"It's just......... After all, the patient does not have gallstones, and it would be a pity if the gallbladder was cut out directly. ”

"The percutaneous transhepatic gallbladder puncture action is much smaller, but the effect may not be immediate, and it is possible that the bile is too viscous to be extracted."

"Of course, if you can pull it out and decompress the gallbladder in time, it will avoid the operation of cutting off the gallbladder, and the advantages are also outstanding."

After Lin Yi finished speaking, he looked at the patient's wife and asked her:

"Ma'am, do you understand what I just said, which treatment do you prefer?"

The woman nodded and said:

"Well, I can roughly understand what you mean."

"I think it's better to try the puncture you said first, and don't remove the gallbladder first."

Lin Yi had already guessed that she would choose this way.

So Lin Yi nodded and said:

"Okay, in that case, let's do a gallbladder puncture first!"

So he said to Wu Jiang:

"Ready to perform percutaneous transhepatic gallbladder puncture and drainage for the patient!"

Then he turned to the woman and said:

"But I still have to tell you in advance that this puncture was done under B-ultrasound positioning, and it is generally safer."

"But after all, it's not done with the naked eye, a needle pierces through the skin, first through the liver, and then reaches the gallbladder, which may puncture the blood vessels along the way and cause massive bleeding, so there is still a certain risk."

"Of course, I'm also telling you about the possible risks in advance."

"Oh, that's right........."

After listening to Lin Yi's words, the woman's face was obviously a little pale.

She clenched her hands into fists and bit her lip lightly, her heart constantly tangled.

After a while, she finally made up her mind, nodded vigorously and said to Lin Yi:

"Okay, doctor, I see, just do it!"

"Okay, then we'll arrange it now!"

After finishing speaking, Lin Yi immediately arranged it.

The piercing was carried out successfully and there were no surprises!

When this news came out, I couldn't help but breathe a sigh of relief to the patient's wife, who was waiting for the results.

Outside the clinic, Lin Yi said to Wu Jiang:

"The bile just now is indeed very thick, and a lot of black-brown and dark green bile is drained out."

"A part of it is going to be tested to see what bacteria are in it."

"There must be bacteria in this, otherwise it wouldn't have caused such an obvious high fever, chills and an increase in infection indicators!"

"Okay, I'll go now!"

Wu Jiang nodded after hearing this, and then immediately took action!

After a while, the results of the blood culture came out!

There's E. coli in it!

After a while, Wu Jiang hurriedly ran over and said to Lin Yi:

"Brother Yi! The results of the bile test are also out!

"There's E. coli in there, too."

After Wu Jiang finished speaking, Lin Yi did not show much surprise, but nodded slightly and said:

"Now it seems, the evidence is conclusive! The patient is cholecystitis caused by bile stasis, and due to the high pressure in the gallbladder, some bacteria enter the blood circulation, causing sepsis, so the patient will have symptoms of high fever and chills! ”

"Brother Shen!"

"Hmm!"

Shen Changqing walked on the road, and when he met someone he knew well, he would say hello to each other or nod his head.

But it doesn't matter who it is.

There was no superfluous expression on everyone's face, as if they were very indifferent to everything.

on this.

Shen Changqing is used to it.

Because this is the Demon Suppression Division, it is an institution that maintains the stability of Great Qin, and its main responsibility is to kill demons and monsters, and of course there are some other side jobs.

Arguably.

In the Demon Suppression Division, everyone has a lot of blood on their hands.

When a person is accustomed to seeing life and death, then he will become indifferent to many things.

When he first came to this world, Shen Changqing was a little uncomfortable, but over time he got used to it.

The Demon Suppression Division is huge.

The people who can stay in the Demon Suppression Division are all powerful masters, or people who have the potential to become masters.

Shen Changqing belongs to the latter.

Among them, the Demon Suppression Division is divided into two professions, one is the town guard and the other is the demon exterminator.

Anyone who enters the Demon Suppression Division starts with the lowest level of demon slayer.

Then step by step, he is expected to become a town guard.

Shen Changqing's predecessor was a trainee demon slayer in the Demon Suppression Division, and he was also the lowest level of the demon slayer envoys.

Have memories of the predecessor.

He is also very familiar with the environment of the Demon Suppression Division.

It didn't take long for Shen Changqing to stop in front of an attic.

Unlike other places full of slaughter, the attic here seems to stand out from the crowd, and in the bloody Demon Suppression Division, it presents a different tranquility.

At this time, the attic door is open, and there are occasional people entering and exiting.

Shen Changqing only hesitated for a moment, and then stepped in.

Access to the attic.

The environment has changed in vain.

A burst of ink fragrance mixed with the faint smell of blood came to his face, making his brow furrow instinctively, but quickly stretched.

The smell of blood on everyone's body in the Demon Suppression Division is almost impossible to clean.