Ji Xiang changed his clothes, returned to the ward, and saw Lu Gang sitting in front of the computer in a huffing breath and looking at the medical records.

"Director Lu, what's the matter?" Ji Xiang asked.

"Acute abdomen, especially gastrointestinal, hepatobiliary and gallbladder are reluctant to operate." Lu Gang said angrily, "Although I also think that I can't do surgery, it doesn't look like intestinal perforation, but the patient's condition is wrong." ”

It was obvious that Lu Gang was a little anxious and a little confused, so he spoke in a mess, as if he had no brain, and relied on instinct to express his anxiety.

Especially if he just finished scolding the liver and gallbladder and stomach and intestines, and on the other hand, he didn't think he could do the surgery, so he almost didn't make Zhao Zhe laugh.

Ji Xiang leaned over and glanced at the test report.

Abdominal ultrasound in the emergency department showed coarse hepatic echo, thickened and rough gallbladder wall, and a small amount of fluid in the abdominal cavity.

Blood gas analysis: partial pressure of oxygen 53.8mmHg, oxygen saturation 84.6%.

serum potassium 2.4mmol/L; Renal function: urea nitrogen 22.08mmol/L, creatinine 352μmol/L, uric acid 428μmol/L.

emergency amylase 137U/L; Complete blood count: leukocytes 9.3×109/L, neutrophils 0.787, hemoglobin 105g/L.

Acute renal failure, accompanied by hypokalemia, is nothing in the face of an acute abdomen and can be treated with medication.

"Director Lu, how is the physical examination?"

"Blood pressure 210/148 mmHg, respiration 23 breaths per minute, oxygen saturation 99%, T36.8 °C, heart rate 105 beats per minute. Coarse breath sounds in both lungs, crackles in the right lung, no wheezing, heart rate 105 beats per minute, rhythm, no pathological murmur.

Abdominal muscle tension, tenderness in the whole abdomen, rebound tenderness, plate-like abdomen, loss of bowel sounds, and lack of swelling of the face and limbs. ”

"Quite a typical acute abdomen, upright dialysis does not support gastrointestinal perforation?" Ji Xiang asked again.

This sentence was close to the point, and Lu Gang nodded uneasily.

Lin Jiu became interested all of a sudden, and with his understanding of Ji Xiang, he knew that Ji Xiang should follow Director Lu Gang and Lu to participate in the consultation.

This time, you can't afford to lose!

He opened the drawer, took out his small notebook, and held it tightly with his hand.

The palms of his hands were a little wet, but Lin Jiu didn't notice it, he subconsciously wiped the sweat stains on his palms on the white clothes.

The patient's condition is basically understood, and it seems that there is no doubt about an acute abdomen, and if it were a general hospital, it would definitely be directly pushed to the stage by the surgeon to see where the problem was.

But Director Lu has been hesitating.

There is a problem, and Lu Gang doesn't know what the problem is.

Some things can't be said clearly, but they are all a kind of "sixth sense" formed by seeing the patient see too much.

As for the "clinical manifestation", it is like what Lu Gang is now.

Lin Jiu knows that many times when encountering incurable diseases, doctors rely on years of clinical experience to judge, and if they really want to say one, two, three, four, five, they can't do it.

"When does the hospital-wide consultation start?" Have you seen the patient, Director Lu? Ji Xiang asked.

"I took one look yesterday, and we'll look at it later." Lu Gang replied naturally.

Ji Xiang re-examined the medical records of the Department of Gastroenterology, "Does the patient have family depression? ”

"Well, I don't feel like I have depression at home when I see patients. The diagnosis of this disease, hey. Lu Gang didn't continue, just heyed.

Lin Jiu captured this detail, and various diagnoses about depression causing abdominal pain popped up in his mind.

Depression itself does not cause abdominal pain, but if a condition such as abdominal epilepsy does not heal over time and there is no confirmed diagnosis, it can cause the patient to enter a state of anxiety and depression over time.

Antecedents and consequences are opposite, but clinically the two occur together, so they are also considered.

Abdominal epilepsy is also possible.

Lin Jiu went all out this time, he was no longer as lazy as before, his eyes were shining, his hand was holding the notebook tightly, and the ballpoint pen was pinched and gurgling.

It's just that he didn't realize it himself.

Even the harmless expressions of humans and animals were gone, and Lin Jiu at this moment was full of fighting spirit.

Fight!

Fight!!

Gotta win!!

When they came to the Department of Gastroenterology, Lu Gang and Ji Xiang examined their bodies, while Lin Jiu stood in the corner to observe their every move and the patient's face and body language.

After Lu Gang and Ji Xiang left, Lin Jiu began to write and draw in his notebook.

Write, look up; Then I lowered my head to write, and then I looked up to observe.

Soon, Lin Jiu fell into a deep confusion.

He took this patient very seriously, much more seriously than he did when he was at Massachusetts General Hospital.

The abdominal case had already been done, and in a short period of time, Lin Jiu had written at least ten diagnoses, but none of them were correct in so many diagnoses, and he even had deep doubts about the knowledge he had learned.

Abdominal pain and acute abdomen are not organ problems, nor abdominal epilepsy, nor are they common diseases such as volvulus and intestinal spasm.

What else could that be?

Lin Jiu racked his brains and was thinking.

At the same time, Ji Xiang was chatting with the patient's family about his condition, and Lu Gang began to preside over the hospital-wide consultation.

"This time the situation is different from before, the patient's plate-like abdomen is particularly obvious, accompanied by tenderness and rebound tenderness. Acute abdomen can be definitively diagnosed, and although upright peritoneal dialysis is not crescent, it may be a perforation of the intestine and not much gas leakage. ”

The gastroenterologist said after a brief introduction to the patient.

"I remember that this patient was already the third consultation, the first two ......," said the deputy director of the gastrointestinal surgery department, "the most outrageous is the second time, the bill of lading is preparing for the operation, and the patient suddenly says that the pain is reduced." ”

"I also think about this, is it acute cholecystitis? Although cholecystitis is not severe on ultrasound, severe pain and acute abdomen can occur. Antibiotics should be given intravenously every time you are hospitalized, and it is normal for cholecystitis to be suppressed under the effect of antibiotics. ”

"I don't think it's that simple. In general, cholecystitis causes pain in the upper abdomen, and there are no signs of a plate-like abdomen except in the case of a perforated gallbladder and a full stomach with bile flow. ”

Many doctors have their own opinions, and there is no unified answer.

Lu Gang's hair drooped, he didn't care about it at all, looking at his brain running rapidly, wondering what was going on with the patient.

There was a knock on the door.

Ji Xiang immediately pushed open the door and crept in.

"I don't think I can do it." The surgeon said, "The patient had the pain relieved before the surgery the first two times, but if I couldn't see the problem after opening it this time, or I could only barely cut off the gallbladder after looking for a long time, and it still hurt after the operation, what should we do?" ”

"The acute abdomen is already obvious, and this is a typical exploratory sign of laparotomy!" The gastroenterologist insisted, "If you don't do this, what else can be done?" ”

The two sides insisted on their own words and quarreled.

The more he talked, the more intense it became, and there was even a precursor to slapping the table and scolding his mother.

"Be quiet!" Lu Gang raised his voice to suppress everyone's quarrel, "Can't you say good things?" What are you talking about? ”

Several doctors held back their words in disbelief.

(End of chapter)