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

Chapter 293 Do a Tricky Surgery!

"So we must be rigorous in the future, and this kind of problem can't happen again!"

The doctor doing the examination nodded repeatedly.

The others also listened to Lin Yi's words and nodded in a daze.

Then, they reacted immediately.

its not right!
They weren't the ones doing the pregnancy test, so why should they listen to this kid's teachings? !

"The cause of the bleeding has been found, so what should we do next?"

asked a doctor.

It's not that they don't know how to do it.

For ordinary patients, they just make a list.

But the problem is, this is a psychopath with schizophrenia.

Lin Yi thought for a moment.

"Tell everyone first that they have cancer. Although uterine choriocarcinoma is a malignant tumor, it is fortunate that it is in the early stage. She is given 5-fluorouracil combined with chemotherapy."

The reason why I want to tell all the personalities is because I am afraid that during the treatment, a certain personality will suddenly appear and want to escape from the hospital, thus delaying the treatment.

After listening, everyone nodded unanimously.

As for how to treat schizophrenia, leave it to the psychiatrist.

After making arrangements, Lin Yi went straight back to the consulting room.

He took a sip of water and finally let out a sigh of relief!

I didn't expect it to end up like this...

………………

"Xiaolin, I have a patient here. Come and help me if you have time. The patient has severe toxemia and jaundice."

Two days later, Director Liu from the Department of Gastroenterology came over and said.

Afterwards, Director Liu briefly talked about the patient's condition.

Lin Yi suddenly became interested, anyway, nothing happened these few days.

"What does the CT scan of the patient look like?" Lin Yi asked.

"A plain CT scan of the abdomen showed gas in the patient's biliary tract and an abscess in the liver with an area of ​​3CMx4.2CM."

Liver abscess?jaundice?
Any one of them is a tricky operation, two at a time, it will be fatal!

"The results of MRCP showed that between the proximal end of the duodenum and the common bile duct, the outline of the intrahepatic and extrahepatic bile ducts was unclear, and the initial diagnosis was a filling defect," Director Liu said.

Lin Yi hurriedly quickened his pace, followed him to the Department of Gastroenterology, and asked, "Have you had a consultation?"

After all, the patient's condition is so serious that a consultation is needed to determine the direction of surgery.

"I asked the general surgery department for consultation, but the general surgery department said that the operation is not sure enough, the patient's condition is not good, and the preoperative diagnosis is not accurate enough, so I dare not operate rashly." Director Liu said.

Lin Yi's heart sank after hearing this. Sometimes it's not that doctors don't want to save people, but they don't want to take responsibility. After all, if the pre-operative diagnosis is inaccurate, and the laparotomy is rash, the possibility of operation failure is very high.

"Does the patient have any past medical history?"

"Yes, more than ten years ago, I had a cholecystectomy."

Only cholecystectomy?Lin Yi was a little puzzled, but he had to know that the sequelae of cholecystectomy did not include jaundice and liver abscess.

"Take me to the ward to have a look." Lin Yi also didn't believe in the diagnosis of gastroenterology.

"Okay." Director Liu led Lin Yi to the ward.

At the request of Director Liu, the junior doctors of the Department of Gastroenterology stood near the ward with their medical record folders in their hands.

"Study hard and watch well." Director Liu scolded with a straight face.

The junior doctors all bowed their heads, most of them were regular trainees and interns. After Director Liu knew that Lin Yi was coming, he asked them all to come and study if they were free, saying that it was a once-in-a-lifetime opportunity.

Walking into the ward, Lin Yi saw the patient.

According to Lin Yi's analysis, the patient suffered from blind end syndrome, also known as blind fossa syndrome, which is an extremely rare complication after surgical common bile duct or duodenal lateral resection and anastomosis.

The high probability of complications is due to a series of symptoms caused by the accumulation of food residues and stones at the biliary-enteric anastomosis.

The patient's skin was too yellow, just like the bronze man in Shaolin Temple, covered with gold powder.

Lin Yi touched the patient's skin, it was very hot!
The patient's body temperature is at least 38 degrees, which belongs to high fever. It should be the high fever caused by the decline of the body's immunity caused by abdominal infection.

Lin Yi conducted another physical examination and found that in the upper right abdomen of the patient, near the duodenum, the patient had obvious tenderness, accompanied by rebound tenderness and muscle tension, and had obvious gastrointestinal symptoms.

"Director Liu, is there a B-ultrasound?" Lin Yi turned his head and asked.

Because the patient's medical history has not undergone relevant operations, there is no corresponding triggering factor, so Lin Yi still wants to do other examinations cautiously, to see and judge what is the trigger, and find the trigger point. Surgery.

"I asked the B-ultrasound doctor to come over to do the bedside B-ultrasound." Director Liu asked a junior doctor beside him to go to the B-ultrasound room.

After more than ten minutes, the doctor in the B-ultrasound room pushed the emergency B-ultrasound car to the ward, and began to prepare for the patient's B-ultrasound examination. When the B-ultrasound doctor applied the gel on the patient's abdomen, Lin Yi suddenly frowned .

"Let me see the patient first." Lin Yi said.

The B-ultrasound doctor paused. The B-ultrasound doctor knew Lin Yi. After all, apart from the ICU, Lin Yi's emergency department needed the most bedside B-ultrasound.

"Doctor Lin also knows about B-ultrasound?" The B-ultrasound doctor half-jokingly asked.

"I understand a little bit, but I don't understand much." Lin Yi took the B-ultrasound probe, stroked the patient's stomach a few times, determined the position, and looked at the B-ultrasound image.

The B-ultrasound doctor also hugged his shoulders and watched Lin Yi operate without opening his mouth. In fact, Lin Yi's behavior was contemptuous of the B-ultrasound doctor, and the B-ultrasound doctor did not turn his face on the spot.

Looking at the B-ultrasound, Lin Yi found that the distal end of the patient's bile duct was indeed blocked. Lin Yi changed the side view again, and compared it with the front view, it was confirmed that the blockage was not a stone, but rotten and fermented food residue.

The blockage point was also consistent with a postoperative complication of the choledochoduodenectomy and anastomosis, ruling out several other related procedures.

The most important point is that the patient's bile duct dilation is obvious, which is also the reason for the patient's obstructive jaundice. Air accumulation can be seen in the biliary tract, and cystic parcels can be seen in the liver. The preliminary judgment is liver abscess. The patient's current situation can only be treated with emergency surgery.

Lin Yi put the B-ultrasound probe back on the B-ultrasound car, and asked the B-ultrasound doctor to wipe off the gel on the patient.

"Cow."

The ultrasound doctor sighed.

"Director Liu, let's explain to the patient's family and see if they agree to the operation. If they agree, let's do the operation now." Lin Yi said.

Director Liu nodded, his expression became serious.

Lin Yi walked out of the Department of Gastroenterology, thinking about which method is better for this operation. Currently, there are two options, one is laparoscopic surgery and the other is laparotomy.

If laparoscopic surgery is performed, the patient's trauma will be small, but Lin Yi cannot solve the problem of complications. It is very likely that Lin Yi will perform laparoscopic surgery on the patient's front foot, and the patient will be discharged from the hospital on the back foot.

When the complications occur, it will be a bad thing for the hospital and the family members of the patients.

If the laparotomy is performed, I am afraid that the family members of the patient will not agree. If the laparotomy is performed, Lin Yi must solve the patient's complications along the way, and the incision will be very large. The knife might die on the operating table. This kind of contradiction often appears in the preoperative explanation.

This is what Lin Yi struggled with. After thinking about it, Lin Yi still read the pre-operative explanation to his family members. If the family members disagreed with the operation, everything was for nothing.

Lin Yi returned to the office and stayed for a while, then received a call from Director Liu, saying that the patient's family members agreed to the operation, and Director Liu was arranging for the patient to be transferred to the emergency department to prepare for the operation. Director Liu was making preoperative preparations. Easy to explain before surgery.

Before the surgery, Lin Yi was going to do it himself.

The family members of the patient came to Lin Yi's office soon under the leadership of Director Liu. They were a middle-aged man and a middle-aged woman.

Lin Yi first asked about the patient's previous situation, but the patient's family members spoke vaguely. After all, they did not know some professional knowledge. They could only describe some general symptoms, and Lin Yi judged by the symptoms.

After understanding, Lin Yi also roughly understood the situation. It wasn't that the family members concealed the medical history, but that the family members might be too young when the patient underwent the operation, so they didn't even know if they had undergone similar operations.

After learning about the situation, Lin Yi began to explain the situation before the operation, explaining the patient's current situation to the family members of the patient. The patient must undergo surgery, and if he does not undergo surgery, he will definitely die, and there is a 20% chance that he will not be able to get off the operating table.

After Lin Yi finished speaking, the face of the patient's family members was a little ugly, maybe they didn't expect the situation to be so serious.

"Doctor, is my father's illness so serious?" The middle-aged man asked urgently.

"Well, if you agree to the operation, just sign here." Lin Yi pushed the signature sheet in front of the two patients' family members.

The family members of the patients were obviously caught in a tangle. If you don’t have the operation, you will die, and if you have the operation, you may die. This makes it difficult for the family members to choose.

The middle-aged man negotiated with the middle-aged woman for a long time, and even had a quarrel between the two. In the end, the middle-aged man silently signed and agreed to the operation, while Lin Yi and Song Borui went to the operating room to change their clothes.

operating room.

"Doctor Lin, how do you anesthetize?" the anesthetist asked.

Lin Yi had already exited the training room at this time, glanced at the patient, and said, "General anesthesia."

The anesthesiologist nodded and began to administer general anesthesia to inject the patient, while Wang Qiaoya prepared the instruments that might be used in the blind-end syndrome surgery.

Lin Yi and Song Borui carried the patient onto the operating table together, and the anesthetist began to administer the anesthesia.

After the anesthesia was completed and the sterile drapes were laid, Lin Yi came to the stage to look at the patient, holding a scalpel in his hand, while Wang Qiaoya stood aside, holding the iodophor gauze in the hemostatic forceps, ready to hand it to Lin Yi at any time.

Lin Yi still chose the oblique incision under the right costal margin, and opened an incision about 15 cm, because the patient had undergone laparotomy before and had a surgical incision on his body. Lin Yi had to bypass this scar tissue when making the incision, otherwise the scar tissue would appear Cross-infection is the fun.

When the opening is cut open, it looks weird, and the whole is crooked.

Lin Yi opened the abdominal cavity, and the patient had the first operation, so some of the patient's organ structure was changed. In addition, this time, the immune system of the human body was weakened, the patient was stimulated by inflammation, and the tissues inside the abdominal cavity appeared to be of different sizes. edema and adhesions.

Seeing the structure inside, Song Borui, who was on the sidelines, showed a shocked expression.

"Brother Yi, the adhesions in the abdominal cavity are too serious. The tissue structure can't be seen at all. Is this operation still possible?" Song Borui saw such complicated abdominal adhesions for the first time.

"It's okay, just help me with the surgery." Lin Yi is still confident about doing the surgery well.

Lin Yi did not respond to the changes in the abdominal cavity. He had already seen it in the training room. Lin Yi reached out to take the blunt scissors in Wang Qiaoya's hand, and Lin Yi began to use the blunt heads of the blunt scissors to separate the hyperplastic connective tissue, strip and cut it off. Move faster.

Song Borui was shocked by the sidelines. He also studied clinical surgery. The tissue in the abdominal cavity was so sticky. How could Lin Yi tell where the abnormally proliferated blood vessels were?
This kind of judgment is not found in the textbooks. Otherwise, why do so many doctors choose to close the abdomen after opening the abdomen and give up the operation directly.

Song Borui couldn't understand Lin Yi's operation, but he adored Lin Yi in his heart, and found that he still had a long way to go, at least he had to see Lin Yi's footsteps on the road of medicine.

The forest is easy to separate, clamp, and ligate a slightly thick blood vessel with a 4# thread.

Lin Yi felt that this operation was very meaningful, so he started the live broadcast.

At this time, the live broadcast room also exploded.

"I'll go, Brother Yi is too naive, isn't this a X-ray? Can you identify the abnormal blood vessels?"

"You don't understand this. In our general surgery department, there is another technique called pulsating pulse, which is to feel the pulsation of blood vessels keenly through fingers. It is similar to everything in Chinese medicine. It was developed by a big guy. , it’s just that it takes a lot of practice to learn this technique, anyway, no one in our hospital knows it, I just heard from my instructor.”

"It's amazing. I've heard of this technique. It's no problem to walk sideways in the general surgery department."

Someone explained it, and the doctors in the live broadcast room were all very surprised. This is a technique some of them have never heard of, and it is indeed true after careful consideration. Isn't this the same as touching the pulse in ancient times!

Lin Yi continued to operate, and the layers of tissue were disassembled by Lin Yi, and the seemingly complicated anatomical structure instantly became clear.

Although Song Borui didn't know how Lin Yi found the blood vessel, according to Lin Yi's movements, Song Borui could accurately pull the hook to the position Lin Yi wanted, helping Lin Yi expose his vision in advance.

Lin Yi was very satisfied with Song Borui, and performing the surgery was also a test of a doctor's basic skills.

When the surgeon is performing the operation, Kazuki is also thinking about how to do the operation, so that he can learn experience.

After peeling off the last layer of connective tissue, a rotten smell came out, Wang Qiaoya subconsciously took two steps back, even Song Borui frowned.

"Suction device." Lin Yi stretched out his hand, and Wang Qiaoya patted the suction device into Lin Yi's hand. Just as Lin Yi was about to insert the suction device, he found thick green juice appearing in the blind socket.

(End of this chapter)