Chapter 358: 351 Postoperative Psychiatric Disorder?

351 Postoperative Psychiatric Disorder?

Decompensated cirrhosis, portal hypertension, hypoproteinemia, electrolyte imbalance, ascites, pleural effusion……

A string of diagnoses leaves one dazzled.

It looks like another case of hepatitis B progressing to cirrhosis, splenomegaly, portal hypertension, and then leading to refractory ascites in the patient.

The early diagnosis and disease progression are roughly the same.

The decompensated stage of cirrhosis has two life‑threatening conditions—hematemesis and ascites.

Once ascites becomes refractory, ordinary diuretics etc. are ineffective. Ascites leads to hypoproteinemia, which in turn causes fluid extravasation, worsening ascites while protein continues to drop.

This is a vicious cycle.

Clinically, the usual treatment for ascites and hypoproteinemia is diuretics plus intravenous infusion of human serum albumin.

But in the face of refractory ascites, no amount of infused human serum albumin helps; it quickly seeps out into the ascites.

This complication differs from hematemesis; although refractory ascites seems less urgent than hematemesis, the hematemesis caused by portal hypertension can still be treated surgically.

Refractory ascites, before the advent of TIPS Surgery, could only wait for death. Now TIPS Surgery, due to its extreme difficulty, is offered only in large tertiary hospitals at the provincial capital level and above.

Having this disease, without TIPS Surgery, is tantamount to death by a thousand cuts.

The patient suffers greatly, life slowly dragging toward its end.

Zheng Ren performed a brief physical exam and inquired about the patient's relevant condition and lab results.

The Inpatient Doctor beside Director Xia answered point by point, well‑trained. The diagnosis of Xiao Hua Nei Ke and that of the System Panel are similar, with little discrepancy.

The patient has no absolute contraindications and can undergo Shou Bing treatment.

Zheng Ren said: "Director Xia, the patient will have a liver Nuclear Magnetic Resonance with diffusion weighting today. I'll put up the list, preparing for Shou Bing tomorrow."

"Nuclear Magnetic Resonance diffusion weighting?" Director Xia stared for a moment.

Nuclear Magnetic Resonance diffusion weighting, full name magnetic resonance diffusion‑weighted imaging.

Unlike conventional Nuclear Magnetic Resonance imaging (MRI), the basis of Nuclear Magnetic Resonance diffusion weighting is water molecule motion, which can provide clinical information based on brain physiological status.

It is mainly used in neurology treatment.

Its sensitivity for diagnosing acute cerebral infarction is 94%, specificity 100%, and it can reliably differentiate arachnoid cyst from epidermoid cyst, subdural empyema from effusion, abscess from tumor necrosis.

For TIPS Surgery, what does Zheng Ren need the Nuclear Magnetic Resonance diffusion weighting for?

Director Xia had heard that experts in Di Du and Modu use liver Nuclear Magnetic Resonance diffusion weighting to look at tumors. But this is not a tumor; it is refractory ascites in end‑stage cirrhosis.

Xiao Zheng…

Director Xia pondered.

Zheng Renye didn't explain much more to Director Xia. This is a diagnostic and localization method for TIPS Surgery, honed in the System Operating Room, used to determine the position of the portal vein and hepatic vein to increase puncture success rate.

If we were to start from the beginning, a few days might not be enough.

Besides, Zheng Renye couldn't be bothered with the hassle.

After finishing this side, Zheng Ren and Director Xia said goodbye and went to the ICU.

Changing clothes, entering the ICU ward, Zheng Ren felt the oppressive atmosphere throughout the ICU.

The Director of Medical Affairs was also stationed here, brow furrowed with worry.

Su Yun sat at Yang Lili's bedside, her black hair fluttering above her forehead, head lowered as she looked at the lab sheet in her hand.

"What's wrong?" Zheng Ren approached Su Yun's side and asked softly.

"Boss, the situation is not right." Su Yun said, "This morning, after stopping the sedative, the patient showed Fear."

Fear?

Zheng Renye was also taken aback.

The System Panel's diagnosis had no Fear.

"The routine blood count is roughly normal, intra‑operative disinfection was good, no clear infection. Biochemical glucose 15.49 mmol/L, sodium 134 mmol/L, potassium 4.15 mmol/L; blood gas analysis: pH 7.46, pO2 61 mmHg, HCO3− 38 mmol/L, base excess 3 mmol/L; urine ketones +++." Su Yun, without even looking at the sheet she held, casually read out the results of this morning's emergency panel.

"What is Yang Lili's Fear?" Zheng Ren frowned and asked.

"Fear, severe Fear." Su Yun said, "It's as if she saw a ghost—she is extremely agitated, the restraints almost couldn't hold her. Her heart rate surged, rising from 95 beats/min to 156 beats/min after the sedative was stopped."

"Strange." Zheng Ren recalled Su Yun's test results; overall it's not bad, just slightly high blood sugar, with urine glucose and ketones, considered a transient stress response to severe trauma.

And seeing ghosts…

This is really hard to explain.

Could it be because she suffered a severe fright that day, leaving a shadow in her heart?

That is possible, but psychological treatment is still an emerging Discipline nationwide, and Zheng Renye doesn't know who is professional.

Moreover, the most important thing is that Yang Lili's current condition cannot be addressed by a psychologist's counseling.

If delayed a few days, a tracheotomy will be performed. Once pulmonary infection and other complications arise…

Zheng Renye felt helpless as well.

No wonder the ICU atmosphere is so oppressive; a patient whose tests look fine develops a bizarre complication.

Especially, this patient is a key focus of the city; it is said that daily reports must be made directly to the Director of the Health Bureau and the Vice Mayor in charge of culture, education, and health.

What should today's report say? Are we supposed to say that after stopping the sedative, the patient saw a ghost?

Zheng Ren furrowed his brows, pondering the various diagnoses given by the System Panel.

After reapplying the sedative, Yang Lili's heart rate remained rapid.

Post‑Shou Bing infection? The patient only has low fever, considered postoperative absorption heat. CRP also shows no obvious abnormality, so severe infection is unlikely.

Pulmonary embolism? Causing respiratory distress, chest pain, leading to rapid heart rate?

Zheng Ren picked up the stethoscope, listened to Yang Lili's bilateral breath sounds. Not a pulmonary embolism…

No need for a CTA of the pulmonary vessels; Zheng Ren can confirm it.

Physical examination combined with Xitong Diagnosis basically allows a definitive classification.

Could it be heart Function failure due to massive fluid infusion after surgery? Zheng Ren pondered, asking: "How much is the input and output?"

Su Yun shook his head; it was obvious he had also considered this.

"Postoperative input far exceeds output; on the first postoperative day, the difference showed Reduction. Yesterday, input and output were basically equal."

The high postoperative input is due to Yang Lili's massive bleeding.

It recovered in just two days, which can be said to be the result of joint efforts by Su Yun and the ICU medical staff, plus Yang Lili being young and in good physical condition.

Moreover, Yang Lili has no history of cardiovascular disease, nor any similar family history; for now we do not consider the manifestations of heart Function failure.

This also ruled it out…… So what then?

Finally, we could only consider diabetic ketoacidosis.

Because Yang Lili had urinary ketones positive, elevated blood glucose, and acidosis, but normal hydroxybutyrate, the ICU orders temporarily gave the patient low-dose insulin therapy.

Ketoacidosis, also not.

It couldn't really be a mental illness…… Zheng Ren was quite troubled.

Looking carefully at each diagnosis in the System Panel, Zheng Ren's eyes suddenly lit up!

Could it be this?