Chapter 670: Abdominal Pain Triggered by Malignant Hypertension

"Lu Zhuren, we do not recommend surgery," the consultation Experts from the Hepatobiliary Surgery Department and the Gastrointestinal Surgery department said in unison.

The two of them exchanged a glance, then looked at Lu Gang simultaneously.

Their opinion was very clear; the Surgery Department felt this was a hot potato, so none of them wanted to be the one to carry it.

Similar examples have appeared in Clinical practice, though they are not very frequent.

An Acute abdomen—if you open it up and find there is nothing wrong inside, whoever performed the Laparotomy will be embarrassed.

What if you can't find the problem? Should you just close it up?

If the Patient is still in pain after coming down, how can you explain it clearly to the Family Member?

Therefore, when encountering this kind of situation, one can only organize an intraoperative consultation.

Facing a Patient with an opened abdomen, the Doctors in the operating room are at their wits' end. It's not as if you can really do what they say in jokes and install a zipper on the Patient's belly, pulling it open whenever you want to take a look.

But if you don't open it to take a look, the existing various examinations do not support an Internal Medicine disease.

The root of the disagreement lies right here.

Lu Gang furrowed his brows, and he sighed, "I will call Bai Chuzhang and ask for the leadership's opinion."

The meaning here was already very clear: if they were to go on the table and take a look, the Medical Affairs Department would have to be the one to take the blame, so that the Clinical Surgeons could rest easy.

"Lu Zhuren, esteemed teachers, I don't know if everyone has noticed a detail about the Patient," Ji Xiang suddenly broke the awkward silence.

"What detail?" Lu Gang had already taken out his phone, preparing to call Bai Chuzhang. He asked while looking for Bai Chuzhang's number.

Although Ji Xiang had started rambling, he did not stop Lu Gang's actions.

"During the previous two hospitalizations, the Patient recovered on his own. One time, he almost went in for surgery, but before the operation, the Patient refused the surgery because the abdominal pain had eased, and later he was discharged automatically after a full recovery."

"I know, we just said that," Lu Gang started pressing buttons on his phone, dialing Bai Chuzhang's number.

"Every time he was hospitalized, the Patient's blood pressure was very high, and they were all treated with antihypertensive drugs via a micro-pump. The Patient has a 2-year history of hypertension, and in those 2 years, he has not taken oral antihypertensive drugs; the only blood pressure-lowering measure has been the medication pumped in during his hospitalizations."

Lu Gang pressed the last button, his finger hovering in mid-air.

"Hypertension has nothing to do with abdominal pain. If it were an Abdominal Aortic Dissection, the grass on the Patient's grave would probably be quite tall by now," the Digestive Medicine Department Doctor said.

"I think it is related. The time for the antihypertensive drug infusion this time is about right, and I just asked—the Patient reports that the abdominal pain has eased slightly."

"Could it be that the pain has just numbed him?" the Digestive Medicine Department Doctor said.

He looked down on Ji Xiang.

Lu Zhuren had clearly already prepared to consult Bai Chuzhang from the Medical Affairs Department, which proved that Lu Zhuren was leaning toward Surgical Operation and Laparotomy.

For Ji Xiang to suddenly jump out and interfere, leaving the thorny Patient for himself—if this isn't looking for trouble, what is?

He looked at Ji Xiang with cold eyes; no matter what Ji Xiang said, he considered it wrong.

Although his tone was unfriendly, Ji Xiang did not mind, instead smiling slightly, "According to the drug dosage, the blood pressure should drop to around 150 in another half hour, and the pain should ease by then."

"Xiao Ji, don't talk nonsense," Lu Gang said in a low voice, "An Acute abdomen caused by blood pressure—does your diagnosis have any logic to it?"

"Lu Zhuren, it does," Ji Xiang also lowered his voice, as if whispering with Lu Gang.

It was just that the office was quite quiet, and what they were saying could still be heard if one listened carefully.

Hypertension and abdominal pain—is there a connection between them?

If Ji Xiang were just an ordinary Standardized Training Doctor, he would likely have been kicked to the Department of Science and Education by his department, and they wouldn't even issue his Standardized Residency Training certificate.

"What logic! You're joking," Lu Gang was somewhat displeased, but he did not directly mock him like he did when talking to other Doctors.

"Hyperactivity of the sympathetic nervous system and increased release of vasoconstrictive substances, such as renin and angiotensin II, cause blood pressure to rise sharply, leading to spasms of small blood vessels throughout the body, reduced circulating blood volume, and reflex activation of vasoconstrictive substances, which leads to further vascular constriction and the production of inflammatory factors."

"At the same time, the elevated blood pressure leads to damage to the vascular endothelium. Through the combined effects mentioned above, tissue exudation increases significantly, resulting in ascites and perirenal effusion. With effective control of blood pressure, the multi-serosal cavity effusion disappears, the abdominal signs vanish, and diagnostic treatment rules out surgical diseases of the abdominal organs."

"Anyway, if we perform a Surgical Operation, the blood pressure is too high to administer Anesthesia. The Anesthesiology Department will also have to wait for the blood pressure to drop a bit before doing anything, so let's just wait."

Ji Xiang said this very easily and naturally.

The door was pushed open at some point; Lin Jiuze walked in and stood in the corner, staring blankly at Ji Xiang.

What Ji Xiang said was reasonable, but Lin Jiuze had been working in Clinical practice for about ten years and had never encountered a single similar case.

This logic looked clear, but in reality, it only existed in theory.

One couldn't say it was unreasonable, only that it was too idealistic.

However, Ji Xiang's last sentence was correct—the Patient's blood pressure was too high, and the Anesthesiology Department would have to wait until the blood pressure was controlled before going on stage.

Suddenly!

A thought popped into Lin Jiuze's mind—the Patient had backed out at the last minute during his second hospitalization, even when he was ready to go to the operating room for surgery, and the pain had suddenly eased.

Could it be that at that time, the Patient's blood pressure had dropped, and his stomach stopped hurting?

Although Ji Xiang's judgment was groundless and seemed "untenable," when connected to the Patient's actual situation, it had a feeling of fitting together perfectly.

"Hmm? Wait and see?" Lu Gang asked.

"I estimate that the acute renal failure is also related to the hypertension, but fortunately, the Patient did not develop complications like Aortic Dissection due to Malignant Hypertension," Ji Xiang smiled, "Let's wait and see. The Anesthesiology Department hasn't arrived yet, and even if they did, they wouldn't take the Patient."

That was correct.

Under Ji Xiang's "mediation," the Internal Medicine and Surgery departments reached a basic consensus—lower the blood pressure first.

Regardless of whether surgery is performed or not, lowering the blood pressure is a must.

Lin Jiuze was full of confusion and bewilderment; he silently watched Ji Xiang, repeatedly savoring what Ji Xiang had said in his heart.

These words... they sounded like a joke, like mediation, yet they didn't sound like treating an illness at all.

But Lin Jiuze had a feeling that perhaps after the Patient's blood pressure dropped, his stomach really would stop hurting.

Time flew by.

Forty minutes later, everyone went to the ward together.

The Patient's blood pressure was 155/80 mmHg, and the Board-like Abdomen already showed signs of easing; it no longer felt hard like a wooden board when touched.

Moreover, the Patient reported that his symptoms had eased, and just like his last hospitalization, he expressed clear dissatisfaction with the surgery.

From the Patient's perspective, if taking some medicine could solve the problem, why undergo surgery and be cut open?

Seeing the Patient's condition and performing a careful physical examination, after ordering every test that could be done bedside, Lu Gang smoothed back the lock of hair that had fallen down.

"No surgery needed, let's head back to the office."

(End of this chapter)