bookpower Chapter 380
Chapter 380
ECG monitor, showing that everything is normal in the patient's physical condition.
Lin Feng frowned.
"Did you vomit this blood from your stomach or cough it up from your airways."
In order to confirm, Lin Feng asked the patient Zhang Chen more.
Zhang Chen: "It's nausea, vomiting out..."
Lin Feng: "That's vomiting blood..."
"Have you ever had stomach ulcers, duodenal ulcers, cirrhosis, hepatitis B, alcoholism?"
Lin Feng asked this because the vast majority of patients' hematemesis is related to gastric ulcers, gastric cancer or cirrhosis.
"No, neither." Zhang Chen shook his head and replied.
"Have you had bloating before?" Lin Feng asked.
"For a while, last month, about a week or so, I didn't eat much, but my stomach was a little bloated... Could it have something to do with me vomiting blood? "
Lin Feng nodded: "There is this possibility..."
Among them, cirrhosis of the liver will lead to stomach bloating, and cirrhosis will lead to hematemesis.
Principle: Because the blood of the esophageal fundic vein needs to pass through the liver to enter the heart, if the liver is cirrhosis, the blood vessels are narrow, the blood return is definitely not smooth, over time, the esophageal and gastric fundal veins will become varicose, and excessive varicose may rupture and bleed.
"I'll check your abdomen... Don't strain your belly..."
Lin Feng carefully checked,
Earlier, because the patient only said that he had low back pain, Lin Feng did not carefully examine his abdomen, which was a mistake by Lin Feng.
Lin Feng briefly checked Zhang Chen's abdomen:
Abdominal distension is not obvious (inference: no major bleeding)
The stethoscope found that bowel sounds were more active (inference: increased fluid, possibly due to gastrointestinal bleeding... ）
"Forget it, first transfuse blood, rehydrate fluids, use some hemostatic drugs to avoid the patient from vomiting blood again, and prevent shock..."
It is definitely not so fast to find the cause, then stop the bleeding first and fight shock, which must be done.
Lin Feng instructed the nurse to prepare some medicines,
The nurse quickly went to dispense medicines, infusions ...
On the side of the infusion,
Because patient Zhang Chen's ECG monitor has been very stable, Lin Feng made a decision:
He said to Zhang Chen:
"Now your condition is quite stable, so take the opportunity to do a CT of the abdomen first to see if there is cirrhosis, liver cancer or other conditions..."
Zhang Chen also became a frightened bird because of vomiting blood.
What Lin Feng arranged, he would not object.
"Okay, Dr. Lin, you have arranged!"
"Lin Feng explained, do you usually drink a lot?"
Drinking alcohol can lead to cirrhosis of the liver ...
Zhang Chen shook his head: "Drink some occasionally, not much." "
Lin Feng nodded: "I'll open the bill, and then the nurse will push you to do CT..."
"Yes..."
......
The nurse carefully pushed the patient Zhang Chen to do CT, because it was a queue cut, so the results were available on the spot, and then uploaded the electronic data to the hospital database.
Lin Feng here to call,
Reading CT.
Soon, Lin Feng breathed a sigh of relief.
No cirrhosis, no liver cancer...
But with a little ascites...
Lin Feng said to Zhang Chen: "Congratulations, it's not liver cancer... It's not cirrhosis either..."
Zhang Chen breathed a sigh of relief.
"It's okay, it's okay..."
If it is really liver cancer, he probably has the heart to die.
The girlfriend also breathed a sigh of relief at this time.
At this time, Lin Feng said:
"Since it is not cirrhosis of the liver, liver cancer, then it is necessary to see if it is a gastroduodenal disease, such as ulcers... This has to be done with a gastroscope to see clearly... Rest assured, you can be anesthetized, painless..."
"Okay, gastroscopy is gastroscope..."
Zhang Chen was extremely obedient...
After all, he had only vomited blood not long ago, and he still wanted to save his life.
At this time, Zhang Chen's girlfriend asked: "Doctor Lin, is there anything else that may vomit blood?" "
Lin Feng: "There are indeed other possibilities, such as esophageal problems: foreign body, esophageal cancer, but just now your boyfriend said that he didn't feel a strange feeling in his throat, so it should be a problem with the stomach or duodenum... Moreover, with a gastroscope, you can see the esophagus, stomach, duodenum all the way ..."
At this time, Lin Feng thought of the patient Zhang Chen's anemia.
"By the way, have you had any blood in your stool lately?" That is, black, red stool..."
"No..."
Lin Feng nodded.
There is no vomiting blood in the front and no blood in the stool, indicating that there is usually less bleeding, or the first bleeding.
......
The patient agrees to do a gastroscopy,
Then Lin Feng began to arrange the operating room.
That's right
It is arranged for the operating room, not sent to the gastroscopy room.
Because I am afraid of heavy bleeding in the middle, or encounter a bleeding port in the middle, it is just enough to perform gastroscopy to stop the bleeding.
Once a big problem occurs, it is good to rescue it in time, so you can't go to the gastroscopy room, you have to go to the operating room.
Admitted to the operating room,
Anaesthesia......
Start gastroscopy...
But
When Lin Feng operated the gastroscope to go down to the ground, he found the bleeding point.
Not stomach ulcer or duodenal ulcer,
On the contrary, the "esophageal varicose veins" are very strong, very obvious, and I also see bleeding!!
Lin Feng was stunned!
That's not right!
Doesn't the previous CT rule out cirrhosis?
How can there still be "esophageal varices"?
There is a problem!!
At this moment, the interns who came to watch, the frying pan.
"What's going on?"
"In general, no cirrhosis means no esophageal variceal bleeding."
"That's right, esophageal and gastric varices are all due to cirrhosis..."
"What the hell is going on?"
I wondered.
Then look at Lin Feng.
They were expecting Lin Feng to find out this answer!
Since the bleeding is done, do a microscopic hemostasis.
This is the foundation for Lin Feng.
Specific method: "banding hemostatic treatment", that is, using rubber bands to tie up the bleeding holes.
Tied,
Then the bleeding stopped.
Although the bleeding stopped, the cause of vomiting blood was found.
But
2 huge mysteries are still there.
Low back pain, dizziness, what is the cause?
Why is there no cirrhosis but esophageal varices?
Many interns are full of confusion and curiosity...
And Lin Feng already had an idea in his heart!
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ps: Three more are coming.
ps: The above two questions are caused by the same disease, and the answer will be revealed in tomorrow's chapter.