world famous doctor

Chapter 73 Esophageal Foreign Bodies
In the corridor of the emergency department, which was originally extremely quiet, the sound of hurried footsteps suddenly appeared the next second.

Nurse Bai Ting knocked on the door of the doctor's lounge.

"Doctor Zhang? Doctor Zhang?"

Zhang Jian stepped forward and opened the door.

"what happened?"

"A patient came to the emergency room with symptoms of vomiting blood and abdominal pain."

Zhang Jian nodded, and walked quickly to the emergency room in a white coat.

Zhou Chen followed behind.

From afar, they saw the middle-aged male patient in the corridor.

When the middle-aged patient walked into the emergency room, he bowed his waist and held his abdomen, with a painful look on his face.

There was blood on the collar of his clothes.

Zhang Jian and the two walked into the emergency room.

The woman supporting the middle-aged patient looked anxious and asked in a slightly crying voice:

"Doctor, save him quickly, what's wrong?"

"Does it hurt here? ... What is the pain method? Is it continuous or intermittent?" Zhang Jian squatted next to the middle-aged patient and asked.

"Persistent pain in the back."

The middle-aged man replied with difficulty.

Turning around, Zhang Jian began to ask about his past medical history:

"Is there any history of peptic ulcer?"

The middle-aged patient's wife shook her head: "I never had abdominal pain before, but when I woke up this morning, he said that his upper abdomen was in severe pain like a knife, and he also had nausea and vomiting."

Dr. Zhang quickly examined the patient while asking questions;
BP108/69mmHg, P:88/min, mild anemia, clear mind, painful expression, rebound tenderness and muscle tension, no jaundice on the sclera, no liver palms and spider moles, normal heart and lungs, soft abdomen, right under the sword Mild tenderness, liver, spleen and ribs not palpable...

Dr. Zhang Jian quickly issued a series of examination orders:

Gastroscopy, X-ray barium meal fluoroscopy, abdominal B-ultrasound, abdominal CT, and selective arteriography clearly identified the cause.

Just now Zhou Chen used 1000 likes to examine the middle-aged patient using the famous doctor system.

The preliminary diagnosis given by the famous medical system is that upper gastrointestinal perforation accompanied by strip foreign bodies is considered.

Zhou Chen came to Zhang Jian's side in two steps, lowered his voice and leaned into his ear and said:

"Doctor Zhang, he has a perforation of the upper gastrointestinal tract accompanied by a foreign body..."

Zhang Jian looked back at him in disbelief.

Before doing any examination, Zhou Chen actually told himself the exact cause of the patient in such a firm tone?

For medical workers, this is a very imprecise and extremely irresponsible thing for patients.

After all, there are many causes of upper gastrointestinal bleeding.

Generally, there may be chronic gastritis, esophageal cancer, esophagitis, esophageal ulcer, esophageal hematoma, esophageal cardia mucosa tear syndrome, gastric lymphoma, hypertrophic gastritis, anastomotic ulcer, duodenitis, vascular malformation, liver cancer, biliary tract bleeding wait……

Zhang Jian didn't argue with Zhou Chen too much.

He printed out the checklist and handed it directly to the woman.

"Take the patient for an examination immediately."

Seeing that the middle-aged patient's vital signs were relatively stable, and there would not be any major problems for a while, Zhou Chen no longer entangled with Zhang Jian about the examination.

Not long after.

The woman helped the middle-aged man back to the emergency room.

She handed the checklist to Zhang Jian.

Zhang Jian looked down.

I couldn't help being a little surprised. Indeed, the inspection result was exactly the same as what Zhou Chen "expected" before.

The patient's X-ray image and gastroscopic observation suggested that there was a strip-shaped foreign body in the middle of the esophagus, accompanied by peristalsis.

Zhang Jian stared at the checklist for a long time without making a sound, but his complexion gradually became serious.

In the past, there were many children who swallowed foreign objects, such as buttons, tiny batteries, coins, etc., and went to the emergency department.

Generally speaking, it is normal for those foreign bodies to move with the body position.

But on the inspection report in front of him, it actually says "squirming" instead of "moving".

The word wriggling proves that it is a living thing, and a living thing at that.

Could it be that the doctor in the examination department made a mistake in the report?
Zhang Jian immediately called the examination room number to confirm.

The other party told him that it was indeed wriggling, a strip-shaped living thing.

And the other party also clearly described:
"The patient's upper gastrointestinal bleeding and perforation are most likely caused by this wriggling creature."

Zhang Jian walked out of the emergency room, turned his back on the patient and his family, and asked in a low voice:
"Did you see clearly, what is this wriggling creature?"

"Rough observation, 90% may be leeches!"

Leeches, commonly known as leeches.

After hearing the words, Zhang Jian was stunned.

He could imagine what it would be like for the doctor who just performed a gastroscopy on the patient to see the leech wriggling in the patient's esophagus.

How did the leech get into the human esophagus?
Could it be... that the water source is not clean leading to parasitism?

Or... patients eating leeches raw?
Zhang Jian lost all sleepiness for a moment.

He rubbed his eyes and sighed softly, probably already had a bottom line in his mind.

This patient, the next situation is estimated to be difficult to deal with.

Otherwise, it is better to notify the anesthesiology department, thoracic surgery department, gastroenterology department and other multidisciplinary consultations in advance.

Zhou Chen overheard the conversation between Zhang Jian and the examination room.

Zhou Chen came over and asked calmly:

"If it is a leech, it is unlikely that it will be excreted from the body by itself, and it is not allowed to do so. If the leech wriggles into other organs, it will cause more damage."

Zhang Jian disagreed with him.

He made his point.

"If this leech was able to enter the stomach from the esophagus, I believe that it is impossible for the leech to survive because of the strong acidic and corrosive stomach acid."

In fact, what Zhou Chen just meant was that he was worried that the leech would wriggle in the upper part of the patient's stomach and other parts of the esophagus, and it might break through the esophagus and enter the trachea.

Leech itself carries a lot of bacteria, and at the same time, it can absorb blood equivalent to 2-10 times its own body weight, and has strong bloodthirsty.

After some discussion between Zhou Chen and Zhang Jian, they determined several treatment plans.

Throat picking to induce vomiting.

Or intragastric perfusion with mannitol.

It can also be removed endoscopically.

Of course, it can also be removed through surgical thoracotomy and exploratory surgery.

However, thoracotomy would cause great trauma to the patient's body, which is not conducive to later recovery. It should not be used lightly unless it is a last resort.

After some weighing.

Zhou Chen suggested: "I think it's better to take it out with a gastroscope, and then give him some mucosal protective agent and oral antibiotics..."

Zhang Jian thought about it, and there may be some risks in taking objects through the endoscope, which may cause massive bleeding in the patient.

Zhang Jian did not arbitrarily give a treatment plan immediately.

He fully understood the patient's past disease history, medication history, and various examination results to conduct a preoperative assessment.

After pondering for a while, Zhang Jian nodded in agreement with Zhou Chen's suggestion.

"That's fine, let's take it out with an endoscope."

He then called the hospital's endoscopist and anesthesiologist to the emergency room.

After close communication, a reasonable and complete anesthesia plan and retrieval plan were finally formulated.

Immediately afterwards, two nurses pushed the middle-aged patient into the endoscopy center.

(End of this chapter)