"Director Lu, we do not recommend surgery." Consulting experts from the Department of Hepatobiliary Surgery and Gastrointestinal Surgery said in unison.

They looked at each other and then looked at Lu Gang at the same time.

The opinion is very clear. The Department of Surgery thinks this is a scapegoat, so they don’t want to take the blame.

Similar examples have appeared clinically, although they are not very frequent.

In acute abdomen, if you open the abdomen and see that there is nothing wrong with it, whoever has the abdomen opened will be embarrassed.

What should I do if I can’t find the problem? Should I close it?

If the patient still feels pain after being discharged, how should he explain it clearly to the patient’s family?

Therefore, in this case, we can only organize an on-stage consultation.

Doctors are helpless in the operating room when faced with patients whose stomachs are open. They can't really put a zipper on the patient's stomach as the joke says, and just pull it open when they want to see it.

But if you don’t take a look, the various existing examinations do not support internal medicine diseases.

The source of the disagreement lies here.

The patient's blood pressure was 155/80 mmHg, and his slab-shaped abdomen had shown signs of relief, and it no longer felt as hard as a wooden board.

The door was pushed open at some point, and Lin Jiuze walked in and stood in the corner, looking at Ji Xiang blankly.

He looked down upon Ji Xiang very much.

He looked at Ji Xiang coldly, no matter what Ji Xiang said, he thought it was wrong.

An idea came to Lin Jiuze's mind - the patient got cold feet after being hospitalized for the second time and was about to go to the operating room for surgery. The pain suddenly eased.

Could it be that the patient's blood pressure dropped and his stomach pain stopped?

"What's the logic? You're kidding." Lu Gang was a little unhappy, but he didn't mock directly like he did when talking to other doctors.

"Xiaoji, don't talk nonsense." Lu Gang lowered his voice and said, "Acute abdomen caused by blood pressure, do you think your diagnosis is logical?"

"High blood pressure has nothing to do with abdominal pain. If it was abdominal aortic dissection, the grass on the patient's grave would have been growing taller by now," said the gastroenterologist.

What Ji Xiang said was reasonable, but Lin Jiuze had never encountered a similar situation in about ten years of clinical work.

Forty minutes later, everyone came to the ward together.

"I guess acute renal failure is also related to hypertension, but fortunately the patient did not suffer from complications such as aortic dissection due to malignant hypertension." Ji Xiang smiled, "Wait a minute, the anesthesiology department hasn't arrived yet.

They won’t pick up patients when they arrive.”

This meaning is very clear. If you want to take a look on the stage, the medical office must take the blame, so that the clinical surgeons can rest assured.

Under Ji Xiang's "harmony", medical and surgical departments have reached the most basic consensus - lower blood pressure first.

Director Lu is obviously ready to ask Director Bai of the Medical Department for instructions, which proves that Director Lu prefers surgery and laparotomy.

"At the same time, elevated blood pressure leads to damage to the vascular endothelium. The combined effect of the above results in a significant increase in tissue exudation, resulting in peritoneal effusion and perirenal effusion. With the effective control of blood pressure, multiple serosal cavity effusions disappear and abdominal signs

disappeared, and diagnostic treatment ruled out surgical disease of the abdominal viscera.”

Lu Gang frowned and sighed, "I'll call Director Bai and ask for the leadership's opinion."

"Every time he was hospitalized, the patient's blood pressure was very high, and he was given antihypertensive drugs using a micropump. The patient had a history of hypertension for 2 years. During these 2 years, he did not take oral antihypertensive drugs. The only measure to reduce blood pressure was hospitalization.

The medicine was pumped in during the period.”

High blood pressure and abdominal pain, are there any connection between them?

Although his tone was unkind, Ji Xiang didn't care, but smiled slightly, "Based on the dosage of the medicine, the blood pressure will drop to around 150 in half an hour, and the pain should be relieved by then.

"

"The hypersympathetic nervous system and the increased release of vasoconstrictor active substances, such as renin, angiotensin II, etc., lead to a sharp rise in blood pressure, spasm of small blood vessels throughout the body, reduced circulating blood volume, and reflex activation of vasoconstrictor active substances, leading to further vasoconstriction

, the production of inflammatory factors.”

"Anyway, for surgical operations, if the blood pressure is too high, there is no way to anesthetize the patient. The anesthesiology department has to wait until the blood pressure drops a little before proceeding. Wait."

If Ji Xiang was just an ordinary doctor with regular training, he would probably have been kicked to the Science and Education Department by his department, and the regular training certificate would not have been issued.

"I know, I just said that." Lu Gang started pressing the buttons on his mobile phone to dial Director Bai's number.

Regardless of whether you have surgery or not, lowering your blood pressure is a must.

"Huh? Wait and see?" Lu Gang asked.

This... sounds like a joke, like making peace with someone, but it doesn't look like treating a disease at all.

Lin Jiuze's face was full of confusion. He looked at Ji Xiang silently and rehearsed what Ji Xiang said in his mind.

Lu Gang pressed the last button and his fingers stopped in mid-air.

"What details?" Lu Gang had already taken out his mobile phone and was about to call Director Bai. He asked while looking for Director Bai's phone number.

It's just that the office is quite quiet, and you can still hear what they are saying if you listen carefully.

suddenly!

I can’t say it’s unreasonable, I can only say it’s too idealistic.

This is right.

"Director Lu, yes." Ji Xiang also lowered his voice, as if whispering to Lu Gang.

"I think it's related. It's almost time to pump the antihypertensive drugs this time, and I just asked and the patient reported that the abdominal pain was slightly relieved."

Although Ji Xiang's judgment is unfounded and seems "untenable", it makes sense when contacted with the patient's actual situation.

Ji Xiang said very relaxedly and contentedly.

However, Ji Xiang's last sentence is right - the patient's blood pressure is too high, and the anesthesiology department must wait until the blood pressure is controlled before going on stage.

But Lin Jiuze had a feeling that maybe the patient's stomach pain would really stop after his blood pressure dropped.

Time flies.

"Maybe it's pain and numbness?" the gastroenterologist said.

"Director Lu, teachers, there is a detail about the patient that I wonder if you have noticed." Ji Xiang suddenly broke the awkward silence.

Although Ji Xiang started to talk nonchalantly, he did not stop Lu Gang's movements.

Ji Xiang suddenly jumped out of the way and left the difficult patient to himself. This was not looking for trouble or anything.

This logic seems clear, but in fact it only exists in theory.

"In the first two hospitalizations, the patient recovered on his own. Once he almost didn't need surgery. Before the operation, the patient refused surgery because the abdominal pain was relieved. Later, he was discharged automatically after a complete recovery."

Moreover, the patient reported that his symptoms were relieved. Just like the last time he was hospitalized, he expressed obvious dissatisfaction with the surgery.

From the patient's point of view, when the problem can be solved with some medicine, why require disembowelment surgery?

After seeing the patient's condition, conducting a careful physical examination, and calling for all the tests that could be done at the bedside, Lu Gang smoothed back the fallen strand of hair.

"No need for surgery, let's go back to the office."
Chapter completed!