Chapter 1609: 1557 What the Hell Is an Aortic Adventitial Ulcer?

Doctor, is my lover's condition serious or not? In the emergency resuscitation room, a middle-aged woman followed the internal medicine doctor out.

Zheng Ren was dazed, hearing someone speak nearby.

"Serious!" The internal medicine doctor said firmly: "GI bleeding, there's a faucet gushing blood inside—do you think it's serious?"

The emergency internal medicine doctor said, looked up and saw Zheng Ren, greeting: "Chief Zheng, is the director's condition okay?"

"It's fine." Zheng Ren smiled. "What patient?"

Nausea, vomiting, low blood pressure—considering upper GI bleed, preparing to admit.

This situation is fairly common; TIPS surgery targets portal hypertension patients, and gastric mucosal or intestinal mucosal ulcers with rupture bleeding are another kind.

If it weren't for portal hypertension with gastric varices from cirrhosis causing hematemesis, bleeding arteries usually aren't large; admit for GI decompression, IV hemostatics, or if worse, oral Zhengbing Ice Salt Water, and after 2-3 days it's about the same.

"What's the blood pressure?" Zheng Ren asked casually.

"75/50 mmHg." The emergency internal medicine doctor took the patient's family to fill out the admission form, leaving Zheng Ren a data point.

Fortunately, although it's shock-level blood pressure, it's not especially low.

Zheng Ren peered in; on the emergency resuscitation room bed lay a middle-aged man, pallid, the ECG monitor showing values…

How could the oxygen saturation be so low? The ECG waveform also had some issues.

Zheng Ren felt something was off, stepped inside and took a glance.

The system panel glared red, frightening—diagnosis seemed to be dripping blood: massive pericardial effusion, aortic adventitial ulcer.

Uh…… what disease is this?

Zheng Ren knew the emergency internal medicine doctor's diagnosis was wrong. As for why they made this mistake, he hadn't thought about it yet.

He immediately opened a drawer on the operating table, which held a mercury sphygmomanometer and a stethoscope.

He picked up the stethoscope, and Zheng Ren began auscultating the patient.

Bilateral lungs had abundant wet rales; heart sounds were low, dull, distant—definitely the sounds of pericardial tamponade.

Because the patient was male, Zheng Ren didn't check for the "disguise" patient he'd encountered before.

Pericardial tamponade also comes in acute and chronic types; if traumatic, the heart has a large hole, blood can't escape, pools in the pericardial cavity—this is acute pericardial tamponade.

If cardiac or renal failure occur, they can cause fluid circulation obstruction, leading to chronic pericardial tamponade.

Pericardial effusion, even pericardial tamponade, is understandable. But an aortic adventitial ulcer—what the hell kind of diagnosis is this? Where does it come from?

Aortic ulcers can occur; this refers to atherosclerotic plaque rupture in the aortic intima forming an ulcer, which penetrates the internal elastic layer.

However, Big Pig Trotter gave an aortic adventitial ulcer.

Is there inflammation? Or something else?

While thinking, the emergency internal medicine doctor finished the admission order for the gastroenterology ward, came out, and called to accompany the patient for admission.

She saw Zheng Ren examining the patient by the bed and asked: "Chief Zheng, what's wrong?"

"Don't rush admission; order a chest CT." Zheng Ren said: "What's the medical history?"

The emergency internal medicine doctor paused, quite certain it was an upper GI bleed—why wouldn't Chief Zheng admit him and instead order a chest CT?

"Male patient, 42. Came to our hospital three hours ago due to recurrent nausea, vomiting accompanied by dyspnea." Although doubtful, the emergency internal medicine doctor habitually reported the history.

The superior physician's authority is no joke; we've long grown accustomed to it.

"The patient suddenly developed dyspnea three hours ago, mild chest tightness, accompanied by nausea and vomiting multiple times, each time a small amount of gastric contents and a small amount of coffee-colored material, no abdominal pain, unrelated to eating or posture. There was fecal incontinence, stool yellow and loose."

"Nausea and vomiting? Coffee-colored?" Zheng Ren asked.

"Yeah, occult blood positive, considering it's due to upper GI bleed. Since there's no hematemesis, the bleeding probably isn't severe." The emergency internal medicine doctor said.

Zheng Ren fell into thought.

Things are very off.

Based on the history, the emergency internal medicine doctor's diagnosis is correct.

Nausea, vomiting, the vomitus sent for testing shows occult blood positive, leading to the inference of upper GI bleed. All this is logical, no problem.

But why would there be dyspnea?

Seeing Zheng Ren staring blankly at the patient, the emergency internal medicine doctor whispered: "Chief Zheng, hurry and send him to gastroenterology; if the bleeding won't stop, we might need major resuscitation."

In the emergency department, once a diagnosis is made, you send the patient wherever indicated.

All resuscitation happens in the emergency department; this side is also overwhelmed.

Outside, piles of a dozen or several dozen emergency patients; encountering someone with a bad temper and urgent condition, it's literally just opening your mouth to curse.

Even getting beaten is not uncommon.

Even while taking slaps and performing resuscitation, it's not unheard of.

Zheng Ren shook his head and said: "Go order a chest CT; I'll take the patient for the exam."

The emergency internal medicine doctor didn't know why Zheng Ren insisted, nor did she hesitate; the superior physician had spoken, she'd also given her opinion, he didn't listen, so just follow the superior's orders first.

If the sky falls, the superior physician will hold it up—what's there to fear?

"What patient, Boss?" Su Yun finished with the female student and returned to Zheng Ren's side.

"Very strange, listen." Zheng Ren handed the stethoscope to Su Yun.

"Huh? Strange?"

"According to the history, the patient is diagnosed with upper GI bleed, no doubt. But auscultation of both lungs and pericardium shows problems; I plan to first take the patient for a CT."

Su Yun, half-believing, took the stethoscope and began auscultating.

Less than a minute later, he lifted his head with a grave expression, saying: "There's a problem; hurry to get checked."

After speaking, Su Yun asked again: "Diagnosed with upper GI bleed?"

"Nausea, vomiting, the vomitus occult blood test positive."

"Chief Zheng, the CT order is ready; you take him?" the emergency internal medicine doctor asked.

"Mm."

The patient's family were a bit dazed; just now they were told to send the patient to Xiao Hua Nei Ke for hospitalization, and the doctor had described the condition as very serious, saying a slight delay could be fatal. Why do we need to do another test now?

"Doctor, what's going on?" the patient's family asked anxiously.

"Have you had any recent external injuries?" Zheng Renye didn't explain, while he and the attendant hurriedly lifted the patient onto the gurney, he asked.

"Recently? No." The patient's family said: "Just a few years ago I had an injury, a clavicle fracture, and had surgery. Recently there's nothing much; everything's been quite normal."

Zheng Ren glanced and saw an old surgical scar in the patient's left sternal area; it had been from a long time ago.

Strange, there's no external injury, where did this external aortic ulcer come from?

According to Big Pig Trotter's diagnosis, Zheng Ren began to ponder.

But no matter how he thought about it, it was a dead end, with no idea at all.

Zheng Ren and Su Yun pushed the gurney, jogging all the way, and with the attendant they sent the patient to CT Shi.

Only after the patient got onto the examination table and the CT scan began did he let out a sigh of relief.