Chapter 351： Postoperative mental illness?

Decompensated liver cirrhosis, portal hypertension, hypoproteinemia, ion disorder, ascites, pleural effusion...

A series of diagnoses is dazzling.

It seems that it is a patient with hepatitis B progressing to cirrhosis, splenomegaly, portal hypertension, and then leading to refractory ascites.

The diagnosis and progress of the previous period are similar.

Decompensation of cirrhosis has two life-threatening conditions - hematemesis and ascites.

Once the ascites reaches a stubborn period, ordinary diuretic and other means are not easy to use. Low protein causes exudation of body fluids, causing ascites while causing the protein to continue to increase.

The common way to treat hypoproteinemia clinically is intravenous infusion of human serum albumin.

However, in the face of stubborn ascites, human albumin is useless regardless of the point of entry, and soon it will become ascites.

This complication is not the same as hematemesis. Although it seems that the stubborn ascites is not as urgent as hematemesis, the hematemesis caused by portal hypertension can also be operated on.

Stubborn ascites can only wait until the TIPS operation. Nowadays, because of the extremely high difficulty of TIPS surgery, the hospitals are only limited to large-scale top three hospitals in provincial capital cities.

Got this disease, if there is no TIPS surgery, it is equivalent to Ling Chi.

The patient is extremely painful, and life is in a slow torment, going to the end.

Zheng Ren simply checked the body and asked about the patient's condition and laboratory return.

The resident doctors who were next to the director of Xia answered the questions one by one and were well trained. The diagnosis of the Department of Gastroenterology is similar to the diagnosis of the system panel, and there is not much difference.

The patient does not have an absolute preoperative contraindication and can be treated surgically.

Zheng Rendao: "Director Xia, the patient is doing a nuclear magnetic resonance of the liver today, adding the dispersion. My bill of lading is preparing for surgery tomorrow."

"Nuclear magnetic dispersion?" Director Xia stunned.

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

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

Mainly used in the treatment of neurology.

The sensitivity to diagnosis of acute cerebral infarction is 94%, specificity is 100%, and can reliably identify arachnoid cysts and epidermoid cysts, subdural empyema and effusion, abscess and tumor necrosis.

Do TIPS surgery, Zheng Ren want nuclear magnetic dispersion to do?

Director Xia has heard that the experts of the Imperial Capital and the Devil use the nuclear magnetic dispersion of the liver to see the tumor. But this is not a tumor, it is a stubborn ascites in the late stage of cirrhosis.

Xiao Zheng, this is...

Director Xia Shen.

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

If you talk from the beginning, I am afraid that it will not be enough for a few days.

There are other things, Zheng Ren is also lazy trouble.

After explaining this, Zheng Ren and Xia gave a speech and went to the ICU.

Changing clothes and entering the ICU ward, Zheng Ren felt the suppressed atmosphere in the entire ICU.

The head of the medical office is also sitting here, frowning.

Su Yun sat on the bedside of Yang Lili, and the black hair floated in front of her forehead, looking down at the test sheet in her hand.

"What's wrong?" Zheng Ren came to Su Yun and whispered.

"Boss, the situation is a bit wrong." Su Yundao, "This morning, the sedative was stopped and the patient developed mental symptoms."

Mental symptoms?

Zheng Ren also stunned.

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

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

"What is the mental symptoms of Yang Lili?" Zheng Ren frowned and asked.

"Fear, very serious fear." Su Yundao, "Like seeing the ghost, the incitement is very powerful, the tied hands are almost unable to tie. The heart rate is soaring, after stopping the tranquilizer, the heart rate is 95 times / The score rose directly to 156 times/min."

"Weird." Zheng Ren recalled Su Yun's test results, the overall look is not bad, but the blood sugar is slightly higher, there are urine sugar, ketone body, considering the body's transient stress response to severe trauma.

And hell!

This is not a good explanation.

Was it because of the terrible shock that day, leaving a shadow in her heart?

There is such a possibility, but the psychological treatment, the country is considered a new discipline, Zheng Ren does not know who is professional.

And most importantly, Yang Lili's current situation, the psychiatrist has no way to do psychological counseling.

After a few days of delay, the trachea will be cut. When complications such as intrapulmonary infection occur,

Zheng Ren is also very helpless.

It's no wonder that the atmosphere in the ICU is so depressing, and the patients who look good in the tests have had strange complications.

In particular, this patient is the focus of the city, and it is said that the patient's condition is reported directly to the Director of the Health Bureau and the deputy mayor in charge of culture, education and health every day.

What do you say today's report? Do you want to say that the patient calms down and sees the ghost?

Zheng Ren brows tightly and locks up the diagnosis given in the system panel.

After re-applying the tranquilizer, Yang Lili’s heart rate is still very fast.

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

Pulmonary embolism? Caused by respiratory distress, chest pain, causing heart rate to speed up?

Zheng Ren picked up the stethoscope and listened to Yang Lili's breathing sounds on both sides. Not a pulmonary embolism...

No need to do CTA examination of pulmonary vessels, Zheng Ren can be sure.

The physical examination and the system diagnosis are combined into one, which is basically qualitative.

Is it a cardiac insufficiency caused by a large amount of fluid replacement after surgery? Zheng Ren pondered and asked: "How much is the amount of access?"

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

“The amount of postoperative injection was much higher than that of the postoperative; on the first postoperative day, the gap was reduced. Yesterday, the amount of access was basically the same.”

The amount of postoperative is due to the massive bleeding of Yang Lili.

It took only 2 days to recover. It can be said that the results of the joint efforts of Su Yun and ICU medical staff, coupled with Yang Lili young, good physical fitness.

Moreover, Yang Lili has no history of cardiovascular disease and no similar family history. She does not consider the performance of cardiac insufficiency for the time being.

This is also ruled out... then what?

Finally, only diabetic ketoacidosis can be considered.

Because Yang Lili has urinary ketone positive, elevated blood sugar and acidosis, but oxybutyric acid is normal, ICU doctors temporarily give patients low doses of insulin treatment.

Ketoacidosis is not a problem.

It’s not really a mental illness... Zheng Ren is a headache.

A careful look at the diagnosis in the system panel, Zheng Ren suddenly shines!

Is this this?