Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Chapter 132 Stable patient emergencies! (Please subscribe!)
"He suddenly said that his stomach hurts and he was still shivering. We took his temperature and it was 40°C!"

The nurse quickly told Lin Yi about the situation.

"what?!"

Several people in Lin Yi's office exclaimed in unison.

"Is this the patient with acute pancreatitis having an accident?"

"It shouldn't be, isn't it cured and all right?"

"Yeah, he was still chatting and laughing lively 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?"

Seeing this sudden situation, the water friends in the live broadcast room couldn't help posting barrage discussions.

"How could there be such a high body temperature? His pancreas is obviously fine. How could this be? It shouldn't be!"

Lin Yi frowned and asked back,
"Could it be that pancreatitis suddenly got worse?"

Wu Jiang on the side also frowned and said:

"In this case, did he have complications, such as fluid accumulation around the pancreas, pancreatic pseudocyst, accumulation of necrosis, encapsulated necrosis, etc.?"

Lin Yi shook his head and said:
"It's really hard to say, let's go, you follow 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've come, he...he doesn't know what's wrong, he's feeling uncomfortable!"

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

"Don't worry, I'll take a look."

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

"Does it hurt here?"

"It doesn't hurt, the top hurts."

"What about here?"

"It hurts, it hurts!"

After Lin Yi finished reading it, he couldn't help but said in doubt:

"It's strange, he now has obvious tenderness in the upper right abdomen, which is different from when he was admitted to the hospital."

"When he was admitted to the hospital, he had obvious tenderness in the whole abdomen, but now the focus is on the upper right abdomen, and the situation is different."

"There is obvious tenderness in the upper right quadrant. This should be a problem with the liver and gallbladder, such as acute cholecystitis, acute hepatitis, liver abscess, etc. However, the previous CT scans have not found any problems with the liver and gallbladder!"

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

After finishing speaking, Lin Yi immediately said to Wu Jiang:

"Hurry up and give him a reexamination to see if the blood amylase level has increased."

"it is good!"

Wu Jiang agreed and started to act.

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

"Doctor, wasn't everything fine in the morning? Why is something wrong now! Such a high fever!"

The woman is a little emotional now!

Because she just saw hope in the morning, and her husband was about to be discharged from the hospital, and now it was undoubtedly pulling her into the bottom of the valley, how could she accept it in her heart!
Lin Yi can also understand her current mood very well.

So he said to her:

"Ma'am, don't worry, aren't we checking the reason?"

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

"Oh, what's going on!"

The woman clasped her head in her hands and shouted.

After a while, Wu Jiang rushed back to the ward with the report.

"Brother Yi, the test results are out!"

"How? Say it quickly!"

Lin Yi said to him immediately.

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

Wu Jiang said directly.

"Sure enough, this is a new problem..."

After Lin Yi finished listening, he said in his mouth.

“但是白细胞计数却比以往任何一次都要高，竟然达到28x10E9/L（正常值3-9）！这一定还是有感染，我已经安排抽了血送去培养了。”

Immediately afterwards, Lin Yi continued.

"Ah."

Lin Yi nodded slightly, thought about it and said,

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

The patient's wife couldn't help feeling anxious, looked at Lin Yi and said:

"Doctor, why do you want to do CT again? Since my husband was admitted to the hospital, he has done CT three times! It's not an option to always do this!"

"This CT does not radiate a lot to the body! Is there no other diagnostic method? CT must be done?!"

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

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

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

"Judging from his current situation, there is a high probability that it is a liver and gallbladder problem, and the most likely one is infection and inflammation of the liver and gallbladder."

"Although I'm sure, what if it's not? So I need to do CT to get accurate results."

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

So he nodded and said:

"Okay then, doctor, just listen to you."

So Lin Yi didn't waste any more time, and said directly to Wu Jiang:

"Take the patient for abdominal CT!"

"it is good!"

…………

Soon, the results of the CT report came out.

"Brother Yi, look!"

Wu Jiang handed the CT film to Lin Yi.

After Lin Yi saw it, he couldn't help being stunned!
From the above, it can be seen that the patient's gallbladder was significantly enlarged and thickened, but there was no sign of stones in the gallbladder, and there was no obvious problem with the pancreas!
"what's going on?"

Lin Yi couldn't help frowning and said something, then thought in his mind,
"Gallbladder enlargement and gallbladder wall thickening are obviously manifestations of acute cholecystitis, but the patient does not have gallbladder stones...More than 90% of acute cholecystitis is caused by stones!"

Wu Jiang also analyzed from 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 the CT scans performed these few times did not show that the patient has gallbladder stones!"

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

"Because the inflammation is usually caused by a stone irritating the gallbladder wall or by a stone blocking the opening of the gallbladder and causing an increase in pressure."

After a moment of silence, Lin Yi suddenly said:
"However, without gallstones, cholecystitis does not necessarily occur."

"There is a kind of acute cholecystitis called acalculous acute cholecystitis. That is to say, there is no gallbladder stone, which can also cause cholecystitis, but this is rare, and less than 5% of cholecystitis will be like this."

"But... okay, why did the patient develop acalculous acute cholecystitis?"

After Lin Yi finished speaking, he couldn't help shaking his head in doubt.

Wu Jiang also fell silent.

After a while, Lin Yi suddenly said:

"I have some ideas."

"what reason?"

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

"His acute cholecystitis is most likely caused by giving him fasting water before."

Lin Yi said directly.

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

"Cause of fasting water? Didn't you make fasting water at that time? Didn't you say that eating would increase the burden on the pancreas!"

"Why is this happening to my husband now, and you said it was caused by fasting water?"

"What exactly is going on!"

Lin Yi explained to her:
"That's right, I said it. Acute pancreatitis does require water fasting. There is no doubt about it, but...everything has two sides."

"After the food enters the digestive tract, the gallbladder will start to contract and excrete bile to help digest food, but if there is no food and water entering, 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 breed bacterial infections."

"That's why this happened, and there's no way around it."

Wu Jiang nodded and agreed:

"Well, it makes sense, that should be the case."

Hearing this, the water friends in the live broadcast room couldn't help discussing:

"I understand! It means fasting water is necessary to treat pancreatitis, but fasting water will cause gallbladder disease!"

"Yes, this is simply a dilemma!"

"The so-called success is Xiao He's failure is also Xiao He!"

"There's really no way around it. If you didn't stop drinking water at that time, the patient's pancreas would have to fail. It's even more dangerous!"

"Yeah, this situation can't be blamed on fasting water."

"That must be banned!"

"What should I do in this situation now? Does anyone know?"

"It might be necessary to have gallbladder surgery!"

Afterwards, Lin Yi sighed and said:

"Actually... I would rather the patient really have gallstones, and his cholecystitis is caused by gallstones."

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

"If it doesn't work out, there will be a danger of gallbladder gangrene and perforation at any time. If it really gets to that point, it will be troublesome!"

After Lin Yi said this, the patient's wife became even more anxious!

It's hard to get out of the ICU. It can be said that he escaped from death. I haven't had time to be excited for a long time. I didn't expect that now I have stepped into the gate of hell again!

It can be said that the excitement in the morning is as great as the disappointment now!
Immediately afterwards, Wu Jiang asked Lin Yi:

"Then... Brother Yi, how do you think we should treat him now?"

Lin Yi thought for a while, and then said:

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

"And we can't delay, we must hurry up!"

"After all, the gallbladder is so big now, it means that the bile stasis in it is very serious. If the stasis is not relieved in time, the gallbladder will break down at any time."

"At that time, the bile will spill over the entire abdominal cavity, and sepsis will appear in minutes, and there will be no way to recover."

"So it is necessary to make a decision as soon as possible, whether to cut off the gallbladder directly, or to do minimally invasive surgery (percutaneous transhepatic gallbladder puncture)."

"Cutting off the gallbladder directly is equivalent to uprooting, which can solve this problem once and for all."

"It's just that...the patient doesn't have gallbladder stones after all. It would be a pity to just cut off the gallbladder like this."

"The action of percutaneous transhepatic gallbladder puncture is much smaller, but the effect may not be immediate, and the bile may be too viscous to be pumped out."

"Of course, if it can be pulled out and the gallbladder decompressed in time, then the surgery of removing the gallbladder is avoided, and the advantages are also very prominent."

After Lin Yi finished speaking, he looked at the patient's wife and asked her:
"Ma'am, did you understand what I just said, which treatment method do you prefer?"

The woman nodded and said:
"Well, I roughly understand what you mean."

"I think it's better to try the puncture you mentioned first, instead of removing the gallbladder."

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

So Lin Yi nodded and said:
"Okay, in this case, let's perform gallbladder puncture first!"

So he said to Wu Jiang:

"Prepare to perform percutaneous transhepatic gallbladder puncture and drainage on the patient!"

Immediately afterwards, he turned his head to the woman and said:

"However, I still want to tell you in advance that this puncture was performed under the positioning of B-ultrasound, and it is relatively safe in general."

"But after all, this is not done under the naked eye. A needle pierces through the skin, first passes through the liver, and then reaches the gallbladder. Along the way, blood vessels may be punctured and cause massive bleeding, so there are still certain risks. of."

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

"Oh, I see………"

After listening to Lin Yi's words, the woman's face turned pale.

She clenched her fists tightly with her hands, bit her lips lightly, and was constantly struggling in her heart.

After a while, she finally made up her mind, nodded vigorously and said to Lin Yi:
"Okay, doctor, I see, let's do it!"

"Okay, let's arrange it now!"

After speaking, Lin Yi immediately made arrangements.

The puncture was performed successfully with no accidents!
When the news came out, the patient's wife who was waiting for the result couldn't help but breathe a sigh of relief.

Outside the clinic, Lin Yi said to Wu Jiang:
"The bile was indeed very thick just now, and a lot of dark brown and dark green bile was drained out."

"We need to test part of it to see what bacteria are in it."

"There must be bacteria in it, otherwise it wouldn't cause such obvious high fever, chills and elevated infection indicators!"

"Well, I'm going now!"

Wu Jiang nodded after listening, and then acted immediately!
After a while, the results of the blood culture came out first!

There is E. coli in it!
After a while, Wu Jiang hurried over and said to Lin Yi:
"Brother Yi! The results of the bile test are also out!
"There's E. coli in it, too."

After Wu Jiang finished speaking, Lin Yi didn't show too much surprise, but nodded slightly and said:
"Now it seems that the evidence is conclusive! The patient had cholecystitis caused by bile stasis, and due to the high pressure in the gallbladder, some bacteria entered the blood circulation and caused sepsis, so the patient had symptoms of high fever and chills!"

(End of this chapter)