Decompensation period of cirrhosis, portal hypertension, hypoproteinemia, ion disorder, ascites, pleural effusion...

A series of diagnoses are dazzling.

It seems that another patient with hepatitis B progressing, which leads to cirrhosis, splenomegaly, portal hypertension, and then causes stubborn ascites.

The previous diagnosis and progress of the condition are almost the same.

There are two fatal diseases in the decompensation period of cirrhosis - hemorrhage and ascites.

Once ascites reach the stubborn stage, normal diuretics and other methods are not easy to use. Ascites lead to low protein, which in turn leads to body fluids leaking, causing more severe ascites, while the protein continues to decrease.

This is a dead cycle.

In clinical practice, the common way to treat ascites and hypoproteinemia is diuretic + intravenous infusion of human blood albumin.

However, in the face of stubborn ascites, no matter how much human albumin is clicked, it will soon turn into ascites and seep out.

This complication is different from vomiting of blood. Although it seems that stubborn ascites are not as urgent as vomiting of blood, vomiting of blood caused by portal hypertension can also undergo surgical procedures.

Stubborn ascites can only wait to die before TIPS surgery appears. Now, because TIPS surgery is extremely difficult, the hospitals carried out are limited to large tertiary hospitals at provincial capital cities and above.

If you have this disease, if you don’t have TIPS surgery, it will be equivalent to lingchi.

The patient is in extreme pain and his life is heading towards the end in a slow torture.

Zheng Ren had a brief physical examination and asked about the patient's relevant condition and the test results were reported.

The resident doctor next to Director Xia answered one by one, and was well-trained. The diagnosis of the gastroenterology department is similar to the diagnosis of the system panel, and there is no big difference.

Patients do not have absolute preoperative contraindications and can be treated surgically.

Zheng Ren said: "Director Xia, the patient has a liver MMA today, plus diffusion. My bill of lading is ready for surgery tomorrow."

"Nuclear magnetic dispersion?" Director Xia was stunned for a moment.

Nuclear magnetic diffusion, the full name is magnetic resonance diffusion weighted imaging.

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

Mainly used in neurological treatment.

The sensitivity to the diagnosis of acute cerebral infarction is 94%, and the specificity is 100%. At the same time, it can reliably distinguish arachnoid cysts from epidermoid cysts, subdural pus and effusion, abscesses and tumor necrosis.

What does Zheng Ren do to undergo TIPS surgery?

Director Xia has heard that experts from the imperial capital and the magic have used liver magnetic diffusion to view tumors. But this is not a tumor, it is a stubborn ascites in the late stage of cirrhosis.

Xiao Zheng is...

Director Xia pondered.

Zheng Ren did not explain anything to Director Xia. This is a diagnosis and positioning method before TIPS surgery that he has refined in the system operating room. It is used to judge the location of the portal vein and hepatic vein and improve the chance of successful puncture.

If I talk about it from the beginning, I'm afraid it won't take a few days.

There are other things, and Zheng Ren is too lazy to get into 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 depressing atmosphere in the entire ICU.

The Director of the Medical Department was also here to stay, frowning.

Su Yun sat beside Yang Lili's bed, with black hair floating on her forehead, and looked down at the test sheet in her hand.

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

"Boss, the situation is wrong." Su Yun said, "This morning, the sedative was stopped and the patient developed mental symptoms."

Mental symptoms?

Zheng Ren was also stunned for a moment.

There are no mental symptoms in the diagnosis on the system panel.

"The blood routine is roughly normal, and the intraoperative disinfection is done well, and there is no clear infection. Biochemical sugar is 15.49 mmol/L, sodium is 134 mmol/L, potassium is 4.15 mmol/L; blood gas analysis: pH 7.46, oxygen partial pressure 61 mmHg, bicarbonate is 38 mmol/L, alkali remaining 3 mmol/L; urine ketone body+++." Su Yun didn't look at the order in his hand, and casually told the results of the emergency check report this morning.

"What are Yang Lili's mental symptoms?" Zheng Ren frowned and asked.

"Fear, very serious fear." Su Yun said, "It's like seeing a ghost. He was very restless and almost couldn't tie his hand belt. His heart rate soared. After stopping the tranquilizer, his heart rate rose from 95 times per minute to 156 times per minute."

"Strange." Zheng Ren recalled the examination results that Su Yun said were pretty good overall, but his blood sugar was slightly high, with urine sugar and ketone bodies. Considering that it was a transient stress response caused by the body to severe trauma.

And hell...

This is hard to explain.

Is it because I was violently frightened that day that left a shadow in her heart?

There is such a possibility, but psychological treatment is considered an emerging discipline throughout the country, and Zheng Ren doesn’t know who majors.

And most importantly, psychologists cannot provide psychological counseling for Yang Lili’s current situation.

If you delay for a few days, you will have a tracheotomy. Once complications such as intrapulmonary infection occur...

Zheng Ren was also helpless.

No wonder the atmosphere in the ICU is so depressing, and the patient looks good in the laboratory test, and there are strange complications.

Especially this patient is the focus of the city. It is said that he has to report the patient's condition 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? Do you want to say that the patient will stop sedating and you will see a ghost?

Zheng Ren's brows were locked tightly, thinking about the various diagnosis given in the system panel.

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

Postoperative infection? The patient only has low fever, and the postoperative absorption of heat is considered. There is no obvious abnormality in CRP, so the possibility of severe infection is not high.

Pulmonary embolism? Respiratory distress, chest pain caused by increased heart rate?

Zheng Ren picked up the stethoscope and listened to Yang Lili’s breathing sound on both sides. It was not a pulmonary embolism...

Zheng Ren can confirm without having to do CTA examination of pulmonary blood vessels.

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

Could it be that the heart function was insufficiency caused by a large amount of fluid replenishment after the operation? Zheng Ren thought about it and asked: "How much does it cost to enter and exit?"

Su Yun shook his head, obviously he also considered this.

"The amount of intake after surgery is much higher than the amount of intake; the first day after surgery, the gap decreased. Yesterday, the amount of intake and out was basically the same."

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

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

Moreover, Yang Lili has no history of cardiovascular disease and no similar family history, so the manifestations of cardiac insufficiency are not considered for the time being.

This also excludes...and what?

In the end, we can only consider diabetic ketoacidosis.

Because Yang Lili is positive for urinary ketones, has elevated blood sugar and acidosis, but hydroxybutyric acid is normal, the ICU doctor's instructions temporarily gave the patient a low dose of insulin treatment.

Ketoacidosis, not either.

It's not really a mental illness... Zheng Ren has a headache.

After carefully looking at the diagnosis in the system panel, Zheng Ren's eyes suddenly lit up!
Chapter completed!