526 Lecture to the director of the Burn Department

Su Yang and Huajun soon arrived at the office.

"Xiao Li, take the patient's information!" Hua Jun shouted at one of his resident doctors, who hurriedly ran out to get the information.

"Boss Su, sit down!" Hua Jun pointed to the chair next to his desk. Su Yang was not polite and sat down.

"Boss Su, you seem to have a lot of research on superior mesenteric artery syndrome, right?" Hua Jun asked straight to the point and straightforwardly.

"There is no question of research, I have some understanding." Su Yang said.

"Tell me!" Hua Jun looked humbly asking for advice.

Well?

Su Yang was stunned.

He didn't understand whether Huajun really wanted to know or just said it casually.

Seeing him hesitating, Hua Jun said, "I still know this disease. Although it is not common in our burn department, I think it is better to understand it. It is also a difficult and complicated disease in our burn department, right? I have seen it once when I was with my master, but I have never seen it later. My intuition tells me that you should know a lot about this disease, so I want to ask you to tell me, so that I can save me from going to the digestive department or asking for your help every time in the future."

Seeing that he was very sincere and didn't look like he was joking, Su Yang thought about his character and felt that he could still give him all his gifts, so he nodded and started talking.

"The incidence rate of superior mesenteric artery syndrome is 0.13‰~0.3‰, and the clinical manifestations are not specific. It is often misdiagnosed as chronic gastritis, peptic ulcers, functional indigestion, gastric sagging, intestinal spasm and neuronal vomiting. The misdiagnosis rate is 57.1%~67.3%. The probability of occurrence in the burn department is not very high, but you will definitely encounter it. In recent years, with the significant improvement of imaging examination methods, the incidence of smas has also shown an upward trend and has begun to receive attention."

Hua Jun's eyes lit up when he heard this.

"Boss Su is indeed awesome. Even the misdiagnosis rate and incidence rate can be understood so clearly. Those who don't know think he is the director of the major department of the gastroenterology department!"

He became more and more impressed by Su Yang.

He looked at Su Yang without blinking, looking eager to know.

Su Yang was soon infected by him and began to talk endlessly: "The occurrence of smas is closely related to the anatomic relationship between the abdominal aorta, sma and the duodenum. Under normal anatomical relationship, sma originates from the anterior wall of aa at about the height of the first lumbar vertebra, descends from the back of the splenic vein and the pancreas head, crosses the front of the pancreas hook process, and enters the mesenteric root between the lower duodenum of the lower edge of the pancreas. When standing or lying, it walks downward to the right in the small mesenteric, forming an acute angle with aa, and crosses the horizontal part of the duodenum before entering the small mesenteric, and reaches the right end of the right iliac fossa and anastomosis with the ileum branch of the ileum artery..."

He said as he picked up a pen and a piece of paper to write and draw.

After hearing this, Hua Jun suddenly realized the many doubts and confusions in his heart.

continue.

He looked at Su Yang with a longing look.

"For middle-aged and thin young people with weak body types, if the clinical manifestations are intermittent, repeated attacks of upper abdominal pain, stubborn vomiting, large amount of vomiting, vomiting is mainly gastric content, bile but no fecal odor, and the symptoms worsen or relieve with changes in position, the possibility of smas should be considered and further examination should be conducted.

At present, color Doppler ultrasound, selective SMA angiography, magnetic resonance angiogenesis, and multi-row helical CT angiography have all become effective auxiliary examinations for diagnosing SMAs.”

Just as he was talking about this, the inhabitant sent by Hua Jun came back, and he knocked on the door: "Boss, you have brought the information!"

"Give it to me!" Hua Jun stood up quickly, reached out his hand, and then said to the resident doctor: "Pour Boss Su's glass of water."

Su Yang took the information from Huajun, took out the film from it and inserted it on the film reader.

"Boss Hua, look!" He pointed to the location of the patient's abdominal aorta and superior mesenteric artery on the film.

"The rogue sign is a typical manifestation of the decrease in the angle between the abdominal aorta and the superior mesenteric artery. Here, the angle should generally be 40-60 degrees. However, the angle shown here is about 18 degrees, so it compresses the second and third sections of the duodenum."

Hua Jun nodded after hearing this.

"If you are doing an X-ray of the standing abdomen, you should see the double fluid surface signs unique to duodenal obstruction. Because there are often a large amount of fasting fluid retention in the ampulla of the stomach and duodenum, you can see that there is a liquid plane in the stomach and ampulla of the duodenum in the standing abdomen."

After talking about the 64-bit ct film on the abdomen, Su Yang talked about x-ray examination again.

"Apart from these two tests, are there any other diagnostic methods?" Hua Jun digested it for a while, then raised his head and asked.

"If you are doing a gastrointestinal barium meal symptomography, you can see the knife sign. At the junction of the horizontal section of the duodenum and the ascending section, you can see smooth and neat longitudinal pressure marks (knife sign or pen sign) or fall in a waterfall-like manner. The barium cannot pass through the blocked duodenum horizontal section, the barium head is flush, and the duodenum descending and ascending sections expand (normal descending section, the width of the horizontal section is 2 to 4 cm); the barium is prolonged in the local retention time and cannot be emptied after 2 to 4 hours. Most patients can pass through the obstructive part smoothly when the knee chest or prone position. In addition to the knife sign, the pendulum sign can also be seen..."

Su Yang talked one by one, and explained all the diagnostic techniques and experiences he knew about this disease. If you want to gain respect from others, you have to show your true talents and knowledge. At this moment, these things are Su Yang's true talents and knowledge. Hua Jun nodded frequently after hearing this.

"Boss Su, how is the most appropriate treatment?" Hua Jun asked again.

"Conservative treatment is generally available. For example, our patients can be treated with fasting, gastrointestinal decompression, anal tube exhaust, etc. When gastrointestinal decompression, the gastric tube can be properly fixed and kept unobstructed. Avoid pressure, twisting, folding, and squeezing the tube wall regularly to maintain effective drainage. Observe and record the color, nature and amount of drainage fluid in each shift, and record the inlet and exit in detail for 24 hours. After fasting and gastrointestinal decompression treatment for 1 week, the patient's abdominal distension is slightly relieved... After the symptoms are relieved, the patient can be given a nutritional support method that combines enteral nutrition with parenteral nutrition. The amount required for nutritional support is 83.6-104.5j/kg per day during the acute stress period of severe patients. After the stress and metabolic state is stable, it is performed at 125.4-146.3j/kg per day."

"Of course, in addition to conservative treatment, surgical treatment can also be used. The main procedures now include duodenal jejunal anastomosis, Que's ligament release, Bi-style gastrojejunal anastomosis, duodenal anastomosis, etc...."

"Overall, it is better to treat this disease based on the principle of early detection and early treatment. Our patient has just developed this symptom, so it should be relatively simple to treat it conservatively, but if it is allowed to develop, the consequences will be difficult to predict."
Chapter completed!