The road to the rise of great doctors

Chapter 94

"How many ways can you write the word fennel for fennel bean?" Kong Yiji waited for a long time and said sincerely, "Can't you just write it down? I'll leave it to you. Remember it!"

Ahem, skewered.
"Appendicitis, how many treatments are there?" Wang Shuo and Liu Dong sat in the doctor's office.

Liu Dong finished writing the medical record and prepared the required materials before the operation. When he handed it to Wang Shuo, Wang Shuo looked at him seriously.

After Liu Dong heard it, he was in a daze at the time, as if he suddenly heard the words of Kong Yiji in the textbook.

He rubbed his face to wake himself up, glanced at Wang Shuo, and then replied:
"There are two main ways to treat appendicitis, one is conservative treatment with drugs; the other is surgical treatment."

Appendicitis, as one of the most common acute abdomen, is closely related to the physiological structure of the appendix.

It is a long, thin tube of intestine closed at one end.

Because it is thin, it is easily blocked by fecal matter, foreign matter, parasites, lymphoid hyperplasia of the appendix itself, etc. in the intestine;
Because it is long, it is easy to twist or be compressed by surrounding tissues, causing obstruction;

Because it has a mouth at one end and an atresia at the other end, instead of having mouths at both ends like other intestinal tracts, once this intestinal tube with only one mouth is blocked, the mucus it secretes cannot flow out, which will cause an appendix. The intraluminal pressure increases, which in turn blocks the blood supply to the appendix wall, and the mucosal layer is easily destroyed.Then, bacteria in the appendix cavity, such as E. coli, take this opportunity to multiply and invade the mucosa inside, causing infection.

So, appendicitis is a condition of infection.

Early simple appendicitis can be treated with anti-infectious drugs, which is sometimes called conservative treatment with drugs.However, only some will get better.For most people, anti-infective treatment may not relieve the disease, or it may temporarily relieve the disease. Later, because the predisposing factors have not disappeared, the disease may recur again and again in the future.

After a certain attack, drug treatment may not improve the infection, and the infection becomes purulent. If it is more serious, perforation may occur, and the local intracavity infection becomes a regional infection, and septic shock may even occur.

During drug treatment, these discomforts may be suppressed, but they are not eliminated. In fact, the disease is developing quietly. If it cannot be suppressed, it will explode!
"Is there any other way?" Wang Shuo looked at Liu Dong with a smile.

Liu Dong thought for a while and remembered the article he had seen.

"Well, that's probably what I'm asking about," he thought to himself, and then said, "The Department of Gastroenterology also has a treatment method - enteroscopic retrograde appendicitis treatment."

"Hey, you've seen this before!" Wang Shuo looked at him in surprise.

"I saw it occasionally, just occasionally." Liu Dong smiled slightly and did not explain any more.

Just as the pathogenesis is based on the fact that inflammation of the appendix, a segment of the atretic intestine, is caused by obstruction, then if the obstruction is removed, wouldn't it be cured?
This is the principle of this treatment plan of colonoscopy.

No anesthesia is required, but of course you can also choose the "painless" method of using anesthesia.At the beginning, the steps are exactly the same as those for a colonoscopy.

The colonoscope enters through the anus, then along the rectum and colon to the ileocecal junction, the junction of the ileum and colon, to find the opening of the appendix.Then, under the guidance of the colonoscope, two to three hundred milliliters of warm water is injected into it, and the appendix cavity is repeatedly flushed and drained with this warm water to flush out all the blocked fecal stones, secreted mucus, etc., thus relieving the problem. Obstruction reduces the pressure in the appendiceal cavity from the source and prevents further development of deterioration.However, this one isn't perfect.

Wang Shuo seemed to want to hear more, so Liu Dong told everything he knew.After all, the preoperative examination and preparations have not been completed yet. For them, the waiting time is boring, so they might as well chat.

Liu Dong continued, "In the final analysis, it can be divided into two categories, appendix preservation or appendectomy."

"Let's talk about preserving the appendix first. Medication is easier to understand. Less serious cases can be improved with medication. It saves money and eliminates the need for surgery. Why not choose it? The reason for not choosing is in most cases because of anti-infective treatment. The probability of being effective is not high, and simple appendicitis is relatively rare!”

"I think there are several reasons why endoscopic appendicitis treatment has not been popularized. First, a knowledge point, the intestinal emptying time of normal adults is about 14-26 hours. Before colonoscopy for other diseases, it is generally necessary to The purpose of taking laxatives is to clear the stool in the intestines as much as possible, because there is a lot of stool in the intestinal cavity under normal circumstances. When doing a colonoscopy, it is difficult for the colonoscope to pass through these stool obstacles, and the field of view is poor."

"Second, patients with appendicitis basically come to the hospital with abdominal pain. Except for chronic appendicitis or appendicitis that has been controlled by anti-infective treatment, it is difficult to remove the feces from the body first and then do a colonoscopy!"

"Third, even if everything is well prepared and the patient's condition is suitable, this operation still has higher requirements for doctors than colonoscopy. The mirror must be controlled well and the appendix cavity must be flushed. Technically difficult!"

"Let's talk about appendectomy. The theoretical basis is that the value of the appendix is ​​not high and it is not an irreplaceable thing. Secondly, appendicectomy is an entry-level operation for general surgeons after surface tumors, and it is not difficult. Again, attacks In addition to accidental factors, most people with appendicitis should have susceptibility factors. However, conservative treatment or colonoscopy cannot solve the potential 'root cause' of appendicitis, and naturally there is a high possibility of recurrence in the future. And removal, Once and for all.”

"Okay, Brother Dong. I see, you have a unique skill - you have a good memory!" Wang Shuo smiled and joked.

Liu Dong smiled.

"It's okay. It's really not a special skill. I just flipped through a few pages of the book occasionally and happened to see it. Teacher Wang, don't 'praise me to death'."

When he said this, Wang Shuo rolled his eyes and said, "Just pretend."

Sometimes you can ignore the gap between people just because they are in front of you.

As a senior resident in general surgery, I still have a good perspective.

Whether it is operation or theoretical knowledge, Liu Dong is very strong to the naked eye.This shows that his foundation is very solid and that his learning ability is very strong.In this way, when you encounter a problem, you can solve it effortlessly and easily.

However, he seems to be walking around the hospital all day long, so he must be single.If not, wouldn't it be nice to go on a date after work?I didn’t see him talking on the phone, nor did I see a strange girl come to the ward to look for him.

Wang Shuo's inner "Ah Q" seems to be rising
But he was still kind and did not say these words directly. Instead, he looked at Liu Dong with a slightly pitiful look.

After the patient was ready and pushed to the operating room, the two of them prepared for the operation.A small incision was made on the right lower abdomen. Wang Shuo skillfully separated it layer by layer, and then went to look for the appendix.
ps: I was very busy yesterday and today, so I missed the word count and will make it up before the end of this weekend.

(End of this chapter)