The road to the rise of great doctors

Chapter 92 If you want to grow up quickly, you have to study in general surgery (please collect and follow up)
Wang Shuo carefully read the B-ultrasound report, handed the report to Liu Dong, and then called the couple to an empty consultation room next to the consultation room 2, which is usually used for consultation.

He first asked about the child's age and symptoms, and basically made up his mind.

This is a 1-year-old boy. In the afternoon, for no reason, he cried violently for more than an hour. He cried intermittently. No matter how he was coaxed, it didn't work. He refused to eat. When I changed his diaper, I found that the diaper was stained. Some blood.This frightened his parents and they rushed to the hospital.

As for Wang Shuo and Liu Dong, when they heard that it had been about an hour since the onset of the disease, they temporarily let go of their concerns.

Wang Shuo asked them for their medical records and wrote down them while asking.

Seeing Dr. Wang Shuo writing, and then looking at the child who looked sluggish and sobbing, the child's mother couldn't help but feel angry, but she still had no impulse and forcefully suppressed the anger. She knew that at this time, Conflict with a doctor is particularly irrational behavior.Moreover, the light in her mind told her that the doctor was not at fault, she just felt sorry for the child.

Her voice was a little trembling, and she was trying to control it, and asked: "Doctor, what's going on? Can you give us a cure quickly, what can we do if the child cries so much?"

Wang Shuo didn't even raise his head as he wrote: "The child is relatively young and is not very expressive. But based on his symptoms and B-ultrasound results, the diagnosis of intussusception is basically certain."

Liu Dong put the ultrasound report on the table in front of the two family members of the child, glanced at Wang Shuo who was writing the medical records, and said, "Yes, intussusception. Dr. Wang is writing the medical records, let me tell you As soon as he finishes writing, you sign, and we can arrange the treatment. These are all essential processes, and they are quick and will not delay things."

"Because treatment also has certain risks, we must let you know the situation before treatment. This is your right to know given by the law. If you understand, there is no problem, and we will go for treatment as soon as possible."

Intussusception in children ranks first among infant acute abdomen diseases.It is second only to acute appendicitis among all pediatric surgical acute abdomens.

Usually, acute intussusception is common in infants under the age of 2, especially in infants of 4-10 months. As the age grows, the incidence rate gradually decreases, and it is extremely rare to have the onset after the age of 5.

This disease may occur throughout the year, but is more common in spring and summer (March to June).

This disease, as the name suggests, is when one section of intestine is inserted into the lumen of another section of intestine.This kind of intrusion must be based on intestinal spasm, resulting in the inability to withdraw naturally, and then the same hazard as intestinal obstruction will occur-ischemic necrosis.The degree of risk is directly related to the degree of intestinal obstruction after intubation and is also closely related to time.

This is why, after listening to it for about an hour, I felt relatively relieved.

Because the baby's stomach is soft, during the physical examination, you can feel an intra-abdominal mass on the baby's stomach, combined with abdominal pain and blood in the stool, the diagnosis is basically clear.If it feels suspicious, B-ultrasound can be used to assist in the diagnosis.

After Liu Dong explained the diagnosis and the possible harm if not treated, he continued to discuss the treatment plan with the parents of the child: "Intussusception can be reduced through air enema. This is the most commonly used treatment plan. But It is also possible that the intussusception does not recover after air enema. If it fails several times, surgery will be necessary."

He introduced the treatment plan, possible complications, prevention and treatment plans one by one.

After the introduction, Wang Shuo also wrote a medical record.It took about less than 5 minutes.After hearing this, the husband and wife said again and again: "Doctor, I will do as you said. If we can not operate, we will not operate. Such a small baby"

"Yes, most intussusceptions can be restored through air enema." Liu Dong comforted the two people and continued: "You guys came in time. Some of them were delayed, and the intestines were already lacking when they came here. There is blood and necrosis, and if the symptoms appear for more than 24 hours or 48 hours, imaging examinations will show complete intestinal obstruction. Or later, symptoms of abdominal distension and poisoning will begin to appear, in which case surgery is likely to be necessary. That’s it.”

They walked towards the imaging department. On the way, Wang Shuo repeated several times that "it may not be successful, but I will try my best." I don't know if the two parents of the child listened.

In the imaging department, this is a room for fluoroscopy at night, and it is also a special place for air enemas for intussusceptions.

Liu Dong was told to stay in the room with the patient, and Wang Shuo walked in with ease.

After a while, I saw him walking in with a disposable medium, a catheter, and an air enema treatment device.

With the cooperation of the parents, place the child on the examination table and adjust the position to facilitate viewing under fluoroscopy.Liu Dong then inserted the catheter into the child's anus and connected it to the air enema therapy device.The pressure of this device is set and does not need to be adjusted.

Under X-ray surveillance, Liu Dong injected air through the catheter, and then saw that as the air entered, the intestines gradually emerged from the anus, and slowly reached the position of intussusception.

You can see the intussusception gradually receding and then disappearing.

Liu Dong glanced at the imaging doctor and Wang Shuo, who made an "ok" gesture.Then turn off the instrument, wait for a while, pull out the catheter, and throw it into the medical trash can.

It can be seen that the child's spirit is still a little depressed, but he no longer cries and looks relatively quiet, which is a sign of recovery.

Wang Shuo came over and told the couple again to pay attention to their bowel movements within 6 hours.Intussusception may recur. There are predisposing factors that can easily cause intussusception. Treatment is to reduce intussusception. Although predisposing factors may not be successful every time, you still need to be alert to whether it will be induced again!

The couple agreed repeatedly, shouting: "Thank you doctor, thank you doctor."

After they left, on the way back to the ward, Wang Shuo turned to Liu Dong and said with emotion: "Oh, this family is lucky. The symptoms and ultrasound are relatively typical. We all know about this disease and we need to treat it immediately. It was solved so smoothly. I have heard before that some babies come to see a doctor because of abdominal pain, but no lumps can be felt during physical examination, and there is no blood in the stool, and it is not typical on ultrasound. I guess it may be due to partial intussusception. After catching the diagnosis of intestinal spasm, I prescribed medicine and took it home for treatment. As a result, when the symptoms became severe, I didn’t see him again. Instead, his intestines became necrotic.”

"Sometimes, if everything is fine when you go to the doctor, you have to come back for a follow-up check if the symptoms become severe in the future. This should be written down in the medical record and discussed carefully with the parents several times."

Listening to Wang Shuo's words, Liu Dong was still emotionally focused on the diagnosis and treatment just now. "Today is another fulfilling day!" he thought happily.

(End of this chapter)