Chapter 315: 309 Sewage Pool Syndrome and the Little Yellow Person (1/4)

"Come take a look at the patient after TIPS surgery." Zheng Ren smiled warmly, "Which room?"

Director Xia did not continue rounds, but personally brought Zheng Ren to the resuscitation room.

The patient could already sit up, although still looked somewhat wan, with an anemic face, but the blackish hue on the face had faded considerably. (Note 1)

"From last night until now, he has vomited blood three times, the amount not large, totaling about 150ml, likely due to retained old blood in the stomach." Director Xia described the patient's condition, "This morning's lab report shows hemoglobin has recovered to 79g, coagulation function slightly off, blood ammonia 63, physical exam shows no typical signs of hepatic encephalopathy."

Because two stents were placed, the pressure of the patient's gastric fundus varicose veins was alleviated, but not completely.

As long as bleeding decreases, that's enough; the rest can be stabilized with hemostatic drugs plus oral Zhengbing Ice Salt Water.

Zheng Ren was concerned about the hepatic encephalopathy situation.

After the patient's surgery, because part of the venous blood bypasses the liver and misses the hepatic metabolic process, hepatic encephalopathy is especially likely to occur.

This is also the main reason for leaving two stents to reduce the inner diameter of the outflow tract.

Once the patient adapts, the second stent can be removed, and the likelihood of future hematemesis will drop linearly.

Zheng Ren inquired about the patient's condition and had the patient do a few simple math problems, such as 74+7+7+7=? and similar.

If the patient shows mild hepatic encephalopathy symptoms, these problems are still quite difficult to solve.

However, for math problems, only one or two additions can be done.

If you add more, even ordinary doctors can't figure it out.

The patient's condition is still quite good; Zheng Ren plans to observe for another two days, and if the blood ammonia does not continue to rise, the second stent can be removed.

Leaving the ward, Zheng Ren could see Director Xia's face bearing a sincere smile.

After all, they are close classmates, the kind who can sign off on things; being able to survive and not leave major sequelae is undoubtedly a cause for joy.

After seeing the patient, Zheng Ren planned to stop by the ICU on the way to check on the female patient who jumped from a building. Adenomyosis of the uterus, this case still has a task, which Zheng Ren occasionally recalls.

He has no obsessive-compulsive disorder; he wants to enhance his skills, and performing a TIPS surgery is enough. The skill points gained from a high-level surgery are equivalent to completing 3-5 tasks.

Of course, the experience points given by tasks can be used for emergencies; this detail will not be considered.

Just as he was about to leave, Director Xia's expression sank slightly, as if she had made a crucial decision.

She then said, "Xiao Zheng, I have another patient here; could you take a quick look?"

"Oh? Is it still a patient who needs TIPS surgery?" Zheng Ren asked.

"No, it's a difficult miscellaneous disease; diagnosis and differential diagnosis are unclear, and the patient's condition is poor." Director Xia felt a bit embarrassed.

After all, as a longtime chief, admitting an unclear diagnosis requires great courage.

This is because Zheng Ren successively performed a floating gallbladder procedure and a TIPS surgery these two days, greatly helping Director Xia. If it were someone else, Director Xia would likely prefer to refer the patient elsewhere rather than seek help from an inpatient chief of another department.

"What's the situation?" Zheng Ren also found it a bit Strange and asked.

"62-year-old female patient. The main clinical presentation is severe sepsis accompanied by abdominal pain and jaundice." Director Xia, while bringing Zheng Ren to the patient's ward, said, "An abdominal plain CT shows the patient has a liver abscess and gas in the biliary ducts. The liver abscess measures about 5.2×4.2 cm."

Liver abscess, complicated by jaundice, this is a deadly disease.

Upon hearing this, Zheng Ren's steps quickened a bit.

"The MRCP (magnetic resonance cholangiopancreatography) results show communication between the bile duct and intestinal tract near the duodenum and the common bile duct, with low-signal filling defects of unclear outline in the intra- and extrahepatic bile ducts." Director Xia also quickened her pace and continued, "Please consult the General Surgery Department; General Surgery says the surgery is not very assured, given the patient's poor condition and the preoperative diagnosis being unclear. An exploratory laparotomy would have a high chance of failure."

"Past medical history?" Zheng Ren asked.

"It is said that twenty-four years ago, she underwent a Gallbladder Removal Surgery."

"Just a gallbladder removal surgery?" Zheng Ren had doubts. If it were a gallbladder removal surgery, it should have no direct relation to this disease.

Speaking, several people arrived at the ward.

The junior physicians of the Xiao Hua Nei Ke stood in two neat rows in the hallway, holding their medical record folders, properly behaved.

"Boss, look at that young doctor, how proper." Su Yun whispered beside Zheng Ren.

"If we do it this way, the first one required to stand straight would be you." Zheng Ren, anxious to see the patient, snapped back.

Su Yun thought about it and indeed that was the reasoning.

Several people entered the ward, and Zheng Ren directly looked at the system panel in the upper right of his field of view.

An unfamiliar diagnosis appeared before Zheng Ren's eyes—Sewage Pool Syndrome.

Sewage Pool Syndrome also becomes Blind End Syndrome, Blind Pouch Syndrome. It is an uncommon complication after a surgical side-to-side anastomosis of the common bile duct and duodenum.

It is likely due to food residue, stones, etc., accumulating in the blind pouch formed from the bilienteric anastomosis to the Vater's ampulla, thereby causing a series of clinical symptoms.

The patient's whole body was yellowish, looking like a little yellow person.

The overall condition was poor; Zheng Ren rubbed his hands to warm them up, so the temperature difference with the patient wouldn't be too large.

As soon as his fingers touched the patient's body, he felt a wave of heat.

The patient's temperature was at least around 39°C, likely due to severe infection.

In the right upper quadrant, near the duodenal segment, tenderness was obvious, accompanied by rebound pain and muscle tension. Percussion yielded a dull sound, with typical gastrointestinal symptoms.

"Director Xia, I need a bedside ultrasound." Zheng Ren frowned in thought.

Since the patient's self-reported history of gallbladder removal surgery and the triggering factor of a side-to-side anastomosis of the common bile duct and duodenum do not match, Zheng Ren still cautiously wanted to do other tests to clarify.

Although the system's Big Pig Trotter has always been stable and reliable, doctors... especially those at tertiary hospitals, emphasize evidence.

Otherwise, if the surgery went well, the patient's family might turn around and accuse you of fraudulent medical practice, leaving you with nothing to eat but having to walk away.

Such situations are common; Zheng Ren also feels helpless.

But helpless as it may be, surgery that needs to be done must be done, and saving lives through treatment must be pursued.

After ten-odd minutes, the doctor from the ultrasound room pushed the emergency ultrasound machine into the ward.

After pulling the curtains, plugging in the power, the ultrasound doctor had just applied coupling gel to the patient's abdomen when Zheng Ren suddenly asked, "May I take a look first?"

……

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Note 1: The faces of liver disease patients are mostly blackish. This is not a fortune-telling text, so I will explain it here.