I can see the status bar

Chapter 287 Diagnosis
Zhan Hao lay on the bed, his face turned yellow.

After Sun Li'en sent the doctor back from the Second Hospital, he and Zhan Jun pushed the bed into the emergency room, and deliberately placed him near the gate to facilitate the imaging examination later.

"Have you brought all the previous cases and inspection reports?" Although the emergency department of the fourth hospital and the second hospital had some unpleasant stories, the two sides still recognized each other's inspection results and reports.Although the prescription network in the province allows Sun Lien to see what medicines the Second Hospital has used for Zhan Hao, the detailed imaging results and some specific treatment details still need to be obtained by asking the patient's family members.

"According to what you said, I brought them all." Zhan Jun took out a thick book of stapled materials from his bag and handed them over, "Xiao Sun, please check everything first, if there is anything that is not detailed enough , I will go to the Second Hospital again."

Sun Lien nodded, and after receiving the materials, he instructed, "I'm going to invite someone to come for a consultation now, and you go and go through the registration procedures for him." Zhan Jun nodded and walked to the registration window in the rescue hall, while Sun Lien Turn around and enter the small meeting room.

In the conference room, Xu Yourong, Yuan Ping'an, Pascal, Zhou Ce and Liu Pingchuan were all sitting in their seats. Seeing Sun Li'en walk in, they temporarily stopped chatting.

"Excuse me, everyone." Sun Li'en smiled at them embarrassedly, then put the data in his hand on the digital projector, and the camera enlarged the data to 150 inches and projected it on the wall of the conference room. "This is the patient we need to deal with today."

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Zhan Hao, male, 39 years old.Nine days ago, he was sent to the Emergency Department of the Second Central Hospital due to severe abdominal pain.After admission, the liver function showed that the alanine aminotransferase (ALT) level was 1970 U/L, which was much higher than the reference value of 0~40 U/L.After B-ultrasound examination, after excluding the acute temporary blockage caused by choledocholithiasis, the emergency department of the Second Central Hospital determined that Zhan Hao's severe abdominal pain was caused by acute liver injury.However, the cause of acute liver injury is still unclear.Rapid tests and immunological tests ruled out the possibility of viral hepatitis.And Zhan Hao himself firmly denied any experience of taking drugs before the onset of the disease.

The emergency doctor at the Second Central Hospital palpated Zhan Hao's abdomen, and there was no rebound pain or tenderness, but Zhan Hao's pain was very severe, with profuse sweating, snot and saliva, his body curled into a forced position, and his expression was extremely painful. ——but apart from a racing heart and rising blood pressure, his body temperature and even his breathing rate were within normal limits.

After the B-ultrasound examination confirmed that it was not perforation of the digestive organs, in order to further diagnose and treat, the emergency department of the Second Central Hospital gave Zhan Hao three doses of pethidine in an attempt to relieve the pain.But the analgesic effect is very limited, which leads to the second diagnostic point of view in the emergency department of the Second Central Hospital-drug addiction attack?
Fortunately, a quick urine test proved Zhan Hao's innocence.All his tests came back negative.This means that he has not been exposed to these drugs for at least two months.A follow-up hair test also confirmed that he had not taken drugs in the past year.This diagnosis does not hold.

Two hours after admission, the emergency doctor at the Second Central Hospital added a diagnostic opinion—intestinal obstruction.The analgesic effect of pethidine is poor, the pain is severe and tends to be paroxysmal, and Zhan Hao did vomit after admission, and the vomiting did not relieve the symptoms of abdominal pain. The doctors at the Second Central Hospital suspected strangulated intestinal obstruction. It is very well-founded.

Although no obvious obstructive area was found on the plain abdominal film, this may still be due to the early onset of obstruction and the inconspicuous imaging features.In order to confirm this diagnosis, the doctors of the Second Central Hospital gave Zhan Hao an injection of atropine.While observing the effect of atropine, in order to prevent the rapid progression of intestinal obstruction, fluid replacement, blood transfusion and antibiotic treatment were given at the same time.In this way, in case atropine is not effective in relieving smooth muscle spasm, it is safer to perform emergency laparotomy directly.

Subsequent observations proved that atropine did have a very good effect.The abdominal pain was quickly relieved, and Zhan Hao's vital signs also stabilized. After 24 hours of observation, Zhan Hao was transferred to the Department of Hepatobiliary Medicine for follow-up examination.His acute liver injury, which does not lead to acute liver injury, has not yet resolved.

On the second day of hospitalization, Zhan Hao developed new symptoms-decreased lower limb muscle strength and decreased vision in the right eye.These symptoms were quickly diagnosed as central demyelination, but the cause remained unknown.

On the fifth day after being hospitalized, Zhan Hao was able to stand up with support. Although the alanine aminotransferase decreased somewhat, it was still at the level of 435U/L.She can eat and defecate normally, and she has not experienced acute abdominal pain in the past five days.

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"Their treatment idea is a typical internal medicine plan. Try it and it seems that the situation has improved." After listening to the introduction, Liu Pingchuan spoke first, "As long as the patient's condition improves, it will be fine. Specifically, what disease does he have and why does he behave like this? This kind of symptom is not in their first consideration."

This kind of diagnostic guidance is actually not uncommon, and it can even be said to be the norm.Cases that cannot be fully diagnosed Doctors don't know how many cases they see each year.Many diseases behave quite similarly and respond better to the same treatment.Lucky patients may not know what disease they have until they are cured, and those unfortunate...may die without knowing why they died.

It must be emphasized that this has nothing to do with the level of doctors in the Second Central Hospital.In fact, even if it is as strong as Cooperative, there are still many patients with "unknown etiology" every year.The human body is a very complex system, and there are too many interfering factors that can affect this system.

"So, we need to find out what's wrong with him?" Xu Yourong didn't seem very interested in this case, she shook her head and said, "Nine days have passed since the onset of the disease, and the Second Central Hospital has given him two kinds of antibiotics , hormones, blood transfusions... If we are the police who intend to start from the crime scene, then his body is the first crime scene that has been cleaned several times. What can we find out?"

Not only did Xu Yourong lack interest in this case, Yuan Ping'an also didn't quite understand why Sun Lien admitted this patient. "Isn't he already improving? Now that he is admitted to the hospital, even if we can diagnose what disease he has, it won't be of any practical help to him, right?"

"The main reason why I took this patient was because the course of the disease was not right." Sun Lien thought for a while and decided to tell the truth to his team members. "His acute abdomen, we can confirm it as smooth muscle spasm through the time period when the treatment takes effect. But this cannot be linked to acute liver injury. And the subsequent demyelinating lesions cannot be linked to acute liver injury—— If the smooth muscle spasm is caused by central nervous demyelination, I can accept it. But in general, this patient's disease lacks a unified explanation."

"The explanation is not important. The important thing is whether the patient's condition is really under control." Liu Pingchuan frowned and concluded, "I am most worried about autoimmune diseases. If the hormones mask the symptoms, then there is a possibility that the disease will continue.”

"In short, I think we should follow our rhythm." Dr. Pascal said, he was not very interested in the theory that Zhan Hao might suffer from autoimmune system diseases, after all, the sequence of his onset did not conform to the common autoimmune system. The law of "prior to the kidney or nervous system".But he still agrees with Yanagihira's remaining points.Although the use of hormones in rheumatology and immunology is a very routine method, Dr. Pascal always feels that hormones are not the best method.While relieving symptoms, hormones can also cover up many problems that doctors really need to pay attention to.Many diseases do have this special "onset-remission-relapse" volatility.There are many reasons for this fluctuation, but these diseases have a common feature-the second attack will be very serious, and the prognosis is extremely poor.

"The imaging examination is already underway." Sun Lien took out his mobile phone and looked at WeChat, "A CT scan of the abdomen showed a diffuse decrease in the density of the liver, a small piece of low-density shadow appeared in the head of the pancreas, and the small intestine was dilated to varying degrees with fluid accumulation."

"This is a new development." There was a tense atmosphere in the conference room.A day before, Zhan Hao's CT examination results showed that everything was normal.

A shout suddenly sounded from the emergency room outside the door, "The blood oxygen saturation of the bed has dropped!" The bed was talking about Zhan Hao.

A group of doctors jumped up from their seats as if they had been kicked in the buttocks, and everyone rushed to the emergency room.

Zhan Hao started to suffer from abdominal pain again. The severe pain made his cheeks flushed and his breathing short of breath. He curled up on the hospital bed like a big shrimp. At first he still had some strength to scream, but after less than 30 seconds, he could only cry out from his throat. There was a "boo hoo" panting sound from inside to outside.The blood pressure rose rapidly to 135/90mmHg, and the heart rate began to increase to 93 beats/min, but the blood oxygen saturation dropped from 98% at admission to 95%.

"Give him oxygen, draw blood for a routine blood test, and do a five-item liver function!" In the chaos, Sun Li'en took a favorable position and came to the bedside, stretched out his hand and pulled the quilt off Zhan Hao's body, and pressed hard his belly.There was no tightness in the abdominal muscles, and Zhan Hao did not respond to significantly aggravated pain after pressing down.Looking at his face again, sweat gushes out like a spring, and snot and saliva are also mixed in it, which looks very scary. "Zhan Hao, Zhan Hao?! Can you hear me?" Sun Lien patted Zhan Hao's shoulder vigorously and asked as loudly as possible.

"Yes..." Zhan Hao took two quick breaths, tried his best to hold back a response, and then continued to scream. "Help!"

"Zhan Hao, male, 39 years old, demyelinating disease of the nerve center, rapid loss of vision in the right eye, acute liver injury, smooth muscle spasm, acute hemolysis, hemolytic anemia." The status bar has updated three statuses very face-saving, and in the " There are still two words in front of "hemolytic anemia", and the handwriting is slowly deepening, which looks like "moderate".

"One milligram of atropine, intramuscular injection!" Sun Lien made a decision.Atropine was determined to be effective for Zhan Hao in previous treatments, and the pain relief effect was more effective than opioid painkillers.First stop his acute abdominal symptoms, and then the doctors can find a way to help him - in the forced position, Zhan Hao can only contract his body with all his strength, bending into the shape of a shrimp.In this state, it is very difficult to draw blood and establish a new venous channel - the indwelling needle in his hand has been accidentally pulled out during the abdominal pain attack.

The onset of action of atropine is fast, and the peak blood concentration is reached 15 minutes after intramuscular injection.The severe spasms were gradually relieved under the action of atropine.Next, it was Sun Li'en and the others' turn to have a headache.

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"The effect of atropine is so effective, which means that the spasm should be from the gastrointestinal tract or bladder. He hasn't had a catheter inserted yet, so it's unlikely to be bladder spasm." After confirming that Zhan Hao's symptoms were relieved, Xu Yourong finally lowered his voice. voiced his opinion. "Second episode of intestinal obstruction within a short period of time?"

"Ten minutes before his onset, the CT scan only showed dilation of the small intestine and some effusion." Yuan Ping'an raised his eyebrows, "Intra-abdominal hernia?"

"If it's intestinal obstruction caused by internal abdominal hernia, it's... it's... Strangulating Intestinal Obstruction (strangulated intestinal obstruction)." Dr. Pascal couldn't remember what the Chinese term for this disease was for a long time.It can only be replaced in English, "But this condition is almost impossible to be relieved by drug treatment. If it is really Strangulating Intestinal Obstruction (strangulated intestinal obstruction), how did he carry it without surgery after the last attack? came here?"

"The T1/2 metabolic rate of atropine is four hours." Yuan Ping'an suddenly thought of something, "When the Second Hospital gave him treatment, he was completely relieved after only one injection of atropine, right?"

Sun Li'en didn't quite understand what Yuan Ping'an wanted to say, but his memory was correct, "Atropine was indeed only used once."

"In other words, this kind of convulsion will not last for too long, or in other words, a certain treatment method used by the Second Hospital during those four hours successfully resolved the convulsion." Yuan Pingan expressed his guess , "He has received blood transfusions, I suspect he may have severe anemia!"

(End of this chapter)