Chapter 1556 What the Hell Is Aortic Adventitial Ulcer?

"Doctor, is my wife seriously ill?" In the emergency room, a middle-aged woman followed the physician.

Zheng Ren was stunned when he heard someone speak.

"Heavy!" The internist said with certainty: "Digestive tract bleeding, there is a faucet inside that is spitting blood, do you think it is heavy?"

The emergency physician said, looked up to see Zheng Ren, and greeted, "Mr. Zheng, is the director okay?"

"It's okay." Zheng Ren smiled, "What patient?"

"Nausea, vomiting, and low blood pressure. It is considered to be upper gastrointestinal bleeding and is going to be admitted to the hospital."

This situation is relatively common. TIPS surgery targets patients with portal hypertension, as well as ulcers and ruptured bleeding in the gastric fundus and intestinal mucosa.

If it wasn't for portal hypertension with cirrhosis and hematemesis with gastric varicose veins, the bleeding arteries would not be very large. After admission, gastrointestinal decompression, intravenous hemostatic drugs, and then oral administration of Zhengshen iced saline or something. 2-3 days is almost the same.

"What's the blood pressure?" Zheng Ren asked casually.

"75/50mmhG." The emergency physician took the patient's family to open a hospitalization order and left Zheng Ren with a data.

Fortunately, although it is shock blood pressure, it is not particularly low.

Zheng Ren glanced at the probe, and there was a middle-aged man lying on the bed in the emergency room, his face was pale, and the value displayed by the ECG monitor...

Why is the oxygen saturation so low? There are also some problems with the waveform of the ECG oscilloscope.

Zheng Ren felt that something was wrong, so he walked in and took a look.

The system panel was scary red, and the diagnosis seemed to be bleeding - a large amount of pericardial effusion, and aortic adventitial ulcers.

Uh...what's this disease?

Zheng Ren knew that the doctor in the emergency department made a wrong diagnosis. As for why he made this mistake, he didn't think about it for the time being.

He immediately opened a drawer on the console, which contained the mercury sphygmomanometer and stethoscope.

Picking up the stethoscope, Zheng Ren began to auscultate the patient.

A lot of wet rales could be heard in both lungs, and the heart sound was low and distant, which was undoubtedly the heart sound of cardiac tamponade.

Because he was a man, Zheng Ren didn't go to check on the "Yi Rong" patient he met last time.

Cardiac tamponade is also divided into acute and chronic types. If it is traumatic, a large hole in the heart is broken, the blood cannot flow out, and it is piled up in the pericardial cavity, which belongs to acute cardiac tamponade.

If cardiac insufficiency and renal insufficiency may lead to fluid circulation disorders, chronic cardiac tamponade may occur.

It is understandable to have pericardial effusion and even cardiac tamponade. But aortic adventitial ulcer, what the hell is a diagnosis? how did it get here?

Ulcers can also develop in the aorta, a condition in which atherosclerotic plaques in the aortic intima rupture to form ulcers that penetrate the inner elastic lamina.

However, what the big pig's trotter gives is the aortic adventitial ulcer.

Have inflammation? or something else?

Just thinking about it, the emergency physician came out after writing the hospitalization order for hospitalization in the gastroenterology department, and greeted the patient to escort the patient to the hospital.

Seeing Zheng Ren doing a physical examination in front of the bed, she asked, "Mr. Zheng, what's wrong."

"Don't be in a hurry, get a lung CT." Zheng Ren said, "What's the medical history?"

The emergency physician was stunned for a moment. It was obvious that the upper gastrointestinal tract was bleeding. Why didn't Mr. Zheng allow him to be admitted to the hospital, and he still had to perform a lung CT examination?

"Male patient, 42 years old. He came to our hospital for 3 hours because of repeated nausea, vomiting and dyspnea." Although there were doubts, the emergency physician habitually reported the medical history.

The arrogance of the superior doctor is no joke, it has long been accustomed to it.

"The patient suddenly had difficulty breathing 3 hours ago, felt a little chest tightness, and was accompanied by nausea and vomiting for many times. Each time there was a small amount of stomach contents and a small amount of brown matter. There was no abdominal pain, and it was not related to the eating position. He had fecal incontinence, and the stool was yellow and watery. convenient."

"Nausea and vomiting? Brown?" Zheng Ren asked.

"Well, occult blood is positive, and it is considered to be caused by upper gastrointestinal bleeding. Because there is no hematemesis, the bleeding should not be serious." The emergency physician said.

Zheng Ren pondered.

Something is not right.

According to the inference of the medical history, the diagnosis of the emergency physician was correct.

Nausea, vomiting, vomited things were sent for inspection, and there was occult blood positive, inferring upper gastrointestinal bleeding. It's all logical without any issues.

But why is it difficult to breathe?

Seeing Zheng Ren staring at the patient in a daze, the emergency physician whispered, "Mr. Zheng, hurry up and send it to the gastroenterology department. If the bleeding can't be stopped, you will need a big rescue or something."

What about the emergency department, after a diagnosis is made, send it wherever it should be sent.

They are all in the emergency department for rescue, and this side is too busy.

There are dozens or dozens of emergency patients outside, and when they meet someone with a bad temper and a serious condition, they really open their mouths to curse.

Even being beaten is not uncommon.

When slapped in the face for rescue, it is not without.

Zheng Ren shook his head and said, "Go get a lung CT, and I'll take the patient for an examination."

The emergency physician didn't know why Zheng Ren insisted, and she didn't hesitate. The superior doctor said it, and he also raised his opinion. If he didn't listen, then follow the superior doctor's doctor's order first.

When the sky is falling, there are senior doctors supporting it, so what are you afraid of?

"What patient, boss." Su Yun finished dealing with the female student and returned to Zheng Ren.

"It's weird, just listen." Zheng Ren gave Su Yun the stethoscope.

"Huh? Strange?"

"According to the medical history, the patient was diagnosed with upper gastrointestinal bleeding. There is no doubt. However, there are problems with both lungs and pericardium on auscultation. I am going to take the patient for a CT scan first."

Su Yun took the stethoscope suspiciously and began to auscultate.

In less than a minute, he raised his head with a dignified expression and said, "If there is a problem, hurry up and check it out."

After speaking, Su Yun asked again, "Diagnosed upper gastrointestinal bleeding?"

"Nausea, vomiting, positive vomit occult blood test."

"Mr. Zheng, the CT order has been issued, will you take it with you?" asked the emergency physician.

"Um."

The patient's family was a little stunned. He just said that he was sent to the gastroenterology department for hospitalization. Why do you need to check again now?

"Doctor, what's going on?" the patient's family members asked anxiously.

"Have you been injured recently?" Zheng Ren didn't explain, and asked while carrying the patient on the flat car with the escort inspector.

"Recently? No." The patient's family said, "I suffered an injury just a few years ago, fractured my collarbone, and had an operation. Nothing has happened recently, it's all normal."

Zheng Ren glanced at it. The patient had an old surgical scar in the left sternum area, which was a long time ago.

Strange, without trauma, where did the aortic adventitial ulcer come from?

According to the diagnosis of the big pig's hoof, Zheng Ren began to ponder.

But no matter how you think about it, it's a dead end, with no ideas at all.

Zheng Ren and Su Yun pushed the flat cart and trot all the way, and accompanied the examiner to take the patient to the CT room.

It was not until the patient went to the hospital bed and started to do CT that he breathed a sigh of relief.