My Medical Skills Give Me Experience Points-Chapter 1251 - 493: The Gap Between Director and Deputy Director’s Skills, Resolving with Angiographic Intervention (2)
Fortunately, the business of the Cardiothoracic Surgery department has been steadily increasing recently, and the rise in complex cases provides him with opportunities to earn significant Experience Points in pathological diagnoses.
Zhou Can suspects that the patient might have intestinal malignant histiocytosis, though he’s barely grasping at the edges of it.
He even considered performing a bone marrow examination on the patient.
If it’s intestinal typhoid fever, conducting a bone marrow culture might likely reveal it.
As for performing a blood culture test, since the disease has progressed beyond its fourth week and the peak period of bacteremia has passed, the results are likely to be negative.
"Right now, it’s just a preliminary suspicion of intestinal typhoid fever. Diseases like this, with obscure causes and prolonged progression, after ruling out malignant tumors, leave only a dozen or so rare, hard-to-treat conditions. Such as Crohn’s Disease, ulcerative colitis, etc. However, most of these diseases have a slow onset, often accompanied by intestinal obstruction and abdominal masses, which clearly don’t align with this patient."
"There are acute onset cases of ulcerative colitis where severe types may present with high fever and bloody stools. This aligns more with the patient’s condition. The patient was admitted today, and even if we want to perform an emergency colonoscopy, preparing the intestines takes time. Especially with the accumulated blood residues in the intestinal cavity, it seems quite severe and would significantly impact the examination results."
Director Shang was very cautious when diagnosing the cause.
From his various expressions, he has mostly diagnosed the patient as having intestinal typhoid fever, possibly combined with lower gastrointestinal bleeding.
This is not the first time Zhou Can has witnessed Director Level diagnostic thinking, which he greatly admires.
In the following two days, further corresponding examinations were performed on the patient.
Including aspirating and monitoring gastric fluid.
The patient’s temperature remained between 37.7°C and 38.9°C, and the fever didn’t subside.
The gastric fluid aspirated on the first day was pale yellow and rather turbid, with some old streaks of blood found in it.
On the second day, the gastric fluid became clearer.
At this stage, upper gastrointestinal hemorrhage can be mostly ruled out.
Yesterday, the patient’s stool was still black, indicating the presence of bleeding.
With no bleeding from the upper gastrointestinal tract, yet the patient continues to pass black stools, it’s almost certain that there is still significant bleeding from the lower gastrointestinal tract.
Following the passage of black stool, the patient excreted dark-red bloody stools twice this morning.
This coincides with Zhou Can’s initial digital examination of the patient.
Back then, he found dark-red blood stains on the gloves.
The patient’s blood bacterial culture was indeed negative.
Having passed the bacteremia peak, this is usually the result upon re-testing.
The patient’s routine bone marrow examination results also came back, showing no abnormal immature cells or histiocytes. This is just the routine bone marrow examination result; the specific diagnosis depends on the results of the bone marrow culture.
This morning, the patient’s blood pressure had dropped to 60/42 mmHg, the pulse became very weak, and the heart rate was about 120 beats per minute.
This is a very bad sign.
It suggests that bleeding hasn’t been controlled and is ongoing.
If a method to identify the bleeding source and stop it isn’t immediately found, this patient might not survive.
This morning happened to be the day Zhou Can was on duty in the emergency room, and since the patient went into shock again, the resuscitation room worried about the patient’s condition and had no choice but to call Zhou Can over.
After Zhou Can arrived at the resuscitation room, he immediately performed muscle vein catheterization on the patient and measured the central venous pressure, which was only 0.78 KPA.
Unexpectedly, the patient’s condition deteriorated so quickly.
In just two days, despite having transfused 1000 milliliters of blood and implemented various treatment measures, shock occurred again. Moreover, the blood pressure dropped to a very concerning level.
At this time, the bleeding source is unclear, and there are no effective means of stopping the bleeding, using hypotensive drugs would only accelerate the bleeding.
Zhou Can quickly instructed the nurses and doctors to expand the blood volume and transfuse blood to counteract shock, and after transfusing three bags, they finally managed to raise the blood pressure again.
"Dr. Zhou, the patient is definitely continuously bleeding, please think of a solution quickly! I believe relying on Internal Medicine treatment approaches for hemostasis is unlikely to be effective, surgical intervention might be necessary for hemostasis."
Dr. Ali looked weary over the past two days.
She has been worried sick over this patient.
Every doctor fears encountering difficult-to-treat patients. Especially such extremely tricky cases of gastrointestinal bleeding; she, with her ordinary level as an attending physician, really can’t handle it.
Seeing the patient go into shock again just now, she is fifty years old, yet she frets to the point of stamping her feet.
"Don’t worry, we’ve narrowed it down to lower gastrointestinal bleeding. The color of the patient’s bloody stools is dark red, indicating bleeding likely from the ileum or colon. However, the patient’s current physical condition doesn’t allow for colon barium imaging, nor can a colonoscopy be performed. Even peritoneal examination requires pinpointing the bleeding site beforehand to be accurate."
Zhou Can has relatively rich experience in handling such difficult patients.
"The examinations aren’t feasible, the bleeding site can’t be pinpointed but the bleeding continues; what on earth should we do?" Ali’s face was full of concern.
Ordinary doctors with limited skill level really can’t manage when faced with such patients.
"Performing abdominal angiography might be a good solution. Although radiological intervention is somewhat invasive, it is extremely effective for locating the bleeding in cases of obscure digestive tract hemorrhage. We should choose the lesser of two evils, and to save the patient’s life, taking some risks for an abdominal angiography is worthwhile, I believe. However, the timing for this procedure is crucial. It must be carried out while the patient is actively bleeding."
