Early the next morning, Yang Ping went to the ICU for ward rounds again.
Nie Shun'e's vital signs were very stable, and her blood pressure was slightly higher than last night. In the absence of blood transfusion, her hemoglobin increased slightly, indicating that there was no obvious blood oozing in her body.
Various biochemical indicators are also good. The blood sugar is a little lower than last night's results, but still much higher, indicating that the remaining pancreas has not completed compensation so quickly.
The transaminase has dropped slightly, the bilirubin has dropped significantly, and other indicators have not changed much.
ICU doctors have installed an insulin pump on Nie Shun'e to temporarily use insulin to lower blood sugar.
The function of the pancreas is still there, but compensation takes a certain amount of time, so the use of the insulin pump needs to be slowly reduced, otherwise it will inhibit the remaining pancreatic function and eventually destroy the secretory function of the remaining pancreatic cells.
In fact, what Yang Ping is most worried about is not the quality of his surgery. This is definitely no problem and is within his control.
What he is most worried about is that the remaining liver and pancreas have insufficient compensatory capacity to bear the physiological needs of the human body, because no one can make an accurate estimate of this, and to a certain extent, it is uncontrollable.
Judging from the changes in blood test indicators, the problem is not big, but the operation involves ex vivo tumor resection of eight organs and autologous transplantation of five organs. The operation is too large and is a blow to the human body, so it is better to stay in the ICU longer.
A few days is better.
The surgery itself is a blow to the human body. The bigger the surgery, the greater the blow to the human body.
For example, in trauma surgery, there is the concept of a second blow. Trauma is the first blow, and surgery is the second blow to the human body. Therefore, for severe multiple trauma, in order to reduce the destructiveness of the second blow, trauma surgery has proposed the following points:
The concept of step therapy.
Yang Ping's patients are very welcome whether they are in general ICU, trauma ICU or cardiovascular ICU, because not only can they learn something, but they are also good thesis materials.
If a doctor wants to be promoted to a professional title, a paper is a must. Many doctors worry about the paper, which has given rise to the "paper industry" and a larger "professional title industry". Many people rely on this to make a fortune.
The name of the Institute of Surgery is not for nothing. It studies surgical theories, surgical methods and new instruments all the time, and introduces new ones. This creates the best conditions for writing papers. In fact, at the Institute of Surgery, papers are just a by-product.
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Because Song Zimo and Xu Zhiliang followed Yang Ping, they were the second authors of several of the 13 CNS articles. They also wrote many papers in top journals, so they can be promoted to professional titles soon. The application for associate professor has been passed, and they are waiting for the certificates to be received.
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It is not a big problem for Zhang Lin and Xiaowu to be promoted to attending physicians. After all, they follow the team and have so many scientific research resources. They are on a first-come, first-served basis. A few important papers are enough for promotion, not to mention the informative monograph "Surgical Retractor Science".
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If you are not a genius who walks sideways, most people cannot get around professional titles. They must follow the crowd, otherwise they will suffer losses. Therefore, for things that cannot be changed, it is best to adapt, and you can only adapt.
Dr. Jin from the Department of Orthopedics is a maverick. He is honest about everything. He is not flexible when publishing papers. It took him a long time to write a paper. Now he has finally put the paper together. However, during the deputy senior review, he lacked the minimum knowledge of relevant experts.
respect, so in the end he is still the attending physician.
"Professor Yang, can we write a paper on this patient?" said Dr. Meng from the ICU.
In fact, there is no overlap between ICU papers and surgical papers. ICU mainly discusses the postoperative care of cases, while surgery focuses on treatment and surgery, so there will be no overlap with each other.
"It's okay, you can write whatever you want."
Dr. Meng was very happy to get Yang Ping's permission. This was a rare material.
After watching Nie Shun'e, Yang Ping left the ICU and communicated with her husband a few words about her condition in the family waiting room at the door. Hearing that his wife's condition was stable, her husband felt very relieved.
When Cao Cao was told, Cao Cao arrived. On the way back from the ICU, Yang Ping met Dr. Jin. Dr. Jin pulled Yang Ping to chat for a while.
"Professor Yang, do you still need someone over there?"
Dr. Jin asked directly. He felt that he was too old, already in his early forties, so he never mentioned this matter to Yang Ping.
Dr. Jin was actually very good both in terms of character and skills, but he was too honest, too honest to adapt to society, and so honest that his life circle was limited to hospitals.
Most of his classmates are deputy chief physicians, some are already chief physicians, and many have become department directors. He is also an attending physician. In terms of quality, he is better than most chief physicians.
For a small foreign body removal operation, he can study all the X-rays, CT and MRI of the foreign body in Sanbo Hospital, then establish a geometric model, and use the geometric model combined with the images to locate the foreign body.
Yang Ping actually admires this type of people very much. Since Dr. Jin is willing to come, Yang Ping is also willing to accept it. The Institute of Surgery is currently short of manpower, but Yang Ping has always adhered to the principle of preferring shortage to overfill and has always been cautious in recruiting people.
The current business of the Institute of Surgery is quite complex, and I don’t know whether Dr. Jin likes it or whether he can adapt to it.
At the Department of Orthopedics, Director Han has recommended Wenzhong, who specializes in spinal surgery and has good conditions.
Dr. Jin specializes in trauma and orthopedics. The Institute of Surgery is actually not suitable for ordinary people because the business is complex and it is easy to distract people. However, for people with strong learning ability, it is not scattered, but a wide range of contacts, and all disciplines are integrated.
"We are short of manpower. I wonder if you can adapt to it?" Yang Ping was not secretive.
"There's nothing wrong with it. If you don't mind that I'm an old attending, let me go over there and help."
"no problem."
Dr. Jin no longer has any hope of promotion in his professional title. In fact, he also has connections. His mentors and classmates are his biggest connections. However, he has never gone to find them at all. He always disdains doing this, even if he just opens his mouth.
To put it bluntly, I'm sure this matter can be solved, but he just didn't open his mouth and just kept his head down and focused on clinical practice.
In fact, some colleagues introduced Dr. Jin to the boss of the agency company, but Dr. Jin was indifferent. He really didn't want to do this.
After chatting with Dr. Jin for a while, back to the department, Song Zimo and Xu Zhiliang had already gone for surgery.
The brothers in the department recently built a website for the Institute of Surgery. There is a forum on the website. The purpose of this forum is mainly to help patients with difficult cases seek medical treatment, and to radiate the strength of the Institute of Surgery to the world through the Internet.
The forum on the website has just been opened, and no one has commented on it.
Just after sitting for a while, director Fang, a strategic partner, called: "Professor Yang, I am consulting a patient with intestinal pseudo-obstruction in the Department of Gastroenterology, but the cause has not been found. Can you help me check."
Now Director Fang is very neurotic. Whenever there is something he can't understand, he thinks of the Institute of Surgery and Yang Ping. He is obsessed with getting rid of poverty and becoming well-off.
Yang Ping looked at the time. It would be okay to go to the operating room later. Song Zimo and Xu Zhiliang would call him even if they encountered difficulties. It was better to go and see what was going on. Lao Fang still had some sense.
He was the one who discovered Nie Shun'e. If he hadn't referred her, Nie Shun'e would still be seeking medical treatment everywhere.
Yang Ping came to the Internal Medicine Building from the Institute of Surgery. When he came out, he saw many signboards hanging at the gate. He wanted to laugh in his heart. So many signboards were really impressive, but the more he looked at them, the more he felt like laughing.
When we arrived at the Department of Gastroenterology, Director Fang had not yet left. He was chatting with Dr. Chen Feiyu from the Department of Gastroenterology in the office. When Director Fang saw Yang Ping, he immediately became energetic: "Professor Yang, come and take a look, this case is interesting."
The chair was ready, and Dr. Chen asked Yang Ping to sit down.
Dr. Chen and Yang Ping are familiar with each other. After Yang Ping diagnosed a patient with "auto-brewery syndrome" in the emergency department, he was given to Dr. Chen for treatment with an allogeneic fecal transplant. In order to thank Yang Ping for providing this rare case, Dr. Chen returned the favor.
Several quotas were allocated to the Institute of Surgery for donating feces. So far, graduate students have enjoyed this benefit and easily received a monthly subsidy of several thousand yuan.
Yang Ping sat down on the chair next to him. Dr. Chen introduced the condition and said: "Female, 25 years old, has had repeated abdominal distension and pain and diarrhea for 7 years, which has worsened for 3 months. Now she is at least three times a day, and sometimes seven or eight times a day. She has been in multiple hospitals.
The hospital diagnosed it as intestinal pseudo-obstruction. After each symptomatic treatment, the abdominal distension and abdominal pain were relieved a lot, but the diarrhea remained and had not improved at all. As time went by, the symptoms became more and more severe in the past three months, especially in the past few days.
I can't get out of bed at all. Let alone eating, my stomach is so distended and painful even after taking a sip of water. After I came in, I gave him an enema, and now he feels a little more relaxed. However, it happens again after eating. Currently, I can only rely on
Parenteral nutritional support.”
"Have you also had a colonoscopy?" Yang Ping asked.
Dr. Chen smiled and nodded: "I did colonoscopy six times and found no abnormalities. I also did colonoscopy in the outpatient department of our hospital and found nothing."
Yang Ping looked through the patient's cases and found that the 25-year-old girl was unmarried and had no special medical history. After the onset of symptoms, she ate less and less, especially in the past three months, because her nutrition could not keep up, so her weight dropped significantly.
I have lost more than 20 kilograms in a month, and my height of 1.65 meters is now only 60 kilograms. The diagnosis given by the previous hospitals was pseudo-intestinal obstruction.
Intestinal obstruction is actually the obstruction of the intestinal tract as a transportation channel. Medically speaking, it refers to the inability of intestinal contents to move and pass through the intestines due to various reasons. It is divided into mechanical, dynamic and blood circulation.
Mechanical intestinal obstruction means that there is physical narrowing or obstruction in the intestine. Dynamic intestinal obstruction means that there is no physical narrowing or obstruction in the intestinal tube, but the power of intestinal peristalsis is insufficient or missing, and food or food residues cannot pass smoothly in the intestine.
The reason why the intestinal contents can pass smoothly through the intestines is because the force of intestinal peristalsis pushes them out from far to near, causing them to be squeezed out step by step.
Another type is vascular intestinal obstruction, which means there is a problem with the blood supply of the intestines, and the peristalsis is weakened or disappeared. Any organ needs blood supply, and ischemia will cause the organ to go on strike, just like a car that cannot run without gas.
Pseudo-intestinal obstruction, as the name suggests, is false intestinal obstruction. It is not the three conditions mentioned above. There is neither mechanical obstruction, nor motility disorder, nor blood supply disorder, but it shows symptoms of intestinal obstruction.
Symptoms but no related causes are a common characteristic of diseases named "pseudo" in medicine.
Blood routine, biochemistry, liver and kidney function, and various tumor markers were all checked. There was a water and electrolyte imbalance at the beginning of admission, such as hypokalemia, which has been corrected now. It should be caused by insufficient food intake, diarrhea, and intestinal pseudo-obstruction.
Low potassium itself can also cause weakening of muscle contraction force, which can cause intestinal paralysis, that is, insufficient intestinal peristalsis, leading to intestinal obstruction, which is dynamic intestinal obstruction.
There is a disease called periodic hypokalemic paralysis, which can also cause muscle weakness, but generally it is muscle weakness in the limbs, and the lower limbs are heavier than the upper limbs. The symptoms are relieved after potassium supplementation. This patient does not have muscle weakness in the limbs, and through potassium supplementation
, it has been normal for several days now, but the symptoms have not improved at all. Dr. Chen has ruled out this diagnosis.
Surgeons are weaker in diagnosis than internists, while internists are better at diagnosis.
Generally, this situation may also be caused by intestinal adhesions, but Dr. Chen is still at a loss. The patient has never had surgery before, and has not experienced diseases such as digestive system tuberculosis or peritonitis. The possibility of intestinal adhesions is extremely small.
This disease is indeed a bit strange. Intractable abdominal distension and pain, pseudo-intestinal obstruction, Yang Ping recalled these keywords in his mind.
"During the colonoscopy in our outpatient clinic, we took multiple pieces of intestinal mucosa for pathological examination, but no abnormalities were found. It's really strange."
Dr. Chen really couldn't think of any other disease that would be like this. Dr. Chen also considered some relatively rare diseases, but ruled them out one by one.
This chapter is not over yet, please click on the next page to continue reading! "We have even done related research on bacterial flora analysis. Our laboratory is doing research on intestinal flora, so we pay special attention to this area."
"Let's see the patient first."
Yang Ping didn't see any clues from the cases.
"What does the patient do?" Yang Ping asked one more question.
Dr. Chen said: "Live streaming brings goods."
This seems to be very popular now. Yang Ping heard that Qin Xiaowei, a free-standing rock climber, is also doing live broadcasts to sell products related to outdoor sports. It is very popular and makes a lot of money.
"What products do you sell?" Yang Ping asked more carefully.
"Slimming products!"
"Slimming products?"
"It probably has nothing to do with this. She said that she doesn't touch this product at all, let alone eat it, and she only got involved in the live broadcast of weight loss products in the past few months. This girl is very smart. She found that she is very thin, especially in the past few days.
She lost weight quickly in a month, so she wanted to take advantage of her special situation to sell weight loss products. It happened that a boss took a fancy to her and asked her to live stream the goods. She must be eloquent and approachable, and with her skinny image, her performance
Very good." Dr. Chen explained.
The doctor in charge of the bed next to her immediately added: "She said that after discovering her special situation, she regarded her thinness as an advantage because she looked good. While seeking medical treatment, she also found interviews with some weight loss product companies. Who knew she would be hired by a weight loss product company?
The boss took a fancy to her and directly trained her to be an anchor selling goods."
"We don't even need to do special effects, just use her as a model, and let everyone see what it means to be skinny in front of the camera."
"This is also an opportunity. Originally, the boss asked a few girls to demonstrate the process of losing weight, saying that they wanted to lose weight. In order to achieve the effect, the boss asked a fitness coach to train these girls and strictly limit their daily food intake, but the effect was still not good.
Seeing that the cowhide was about to burst, the boss became anxious and gave several girls laxatives. Perhaps the diarrhea was so severe that one girl actually became dehydrated and was sent to the hospital for emergency treatment. The boss lost a lot of money."
"The boss was so scared that he never dared to do this again, so he could only look for ready-made styles."
"When it was her, she didn't have to do anything. She actually lost 30 pounds in three months, which made her boss's products popular. But when the boss saw her suddenly losing weight so fast, he was afraid that something might happen, so he asked her to rest for a while.
Recuperate and recuperate.”
''Actually, she really can't bear it anymore and needs to see a doctor."
"No, even while she was in the hospital, the owner of a weight-loss product approached her for cooperation."
After the doctor in charge of the bed finished speaking, Dr. Chen led the way: "Let's go see the patient together."