Auto chess in the operating room

Chapter 145 Cholecystitis Complicated with Myocardial Infarction

On the screen, Lin Dong saw that Tang Lou had already begun to dissect the gallbladder triangle, and separated the cystic duct and cystic artery very skillfully.

After sorting out the cystic duct, common hepatic duct, and cystic artery, Tang Lou directly chose to clamp the cystic artery.

"Preparation for electrocoagulation"

Tang Lou gave the order very calmly, and Ye Kai naturally followed it immediately.

Tang Lou clipped directly at a distance of 0.5 cm from the common bile duct, which was very precise.

"Scissors Ready"

Between movements, there was basically no chance to breathe. Ye Kai cooperated wholeheartedly. Even after doing so many cholecystectomies with Lin Dong, he was still a little Alexander.

The rhythm of Tang Lou is really too fast.

Soon Tang Lou cut off the cystic duct with scissors.

The next step is naturally a very critical step: stripping the gallbladder.

Since the previous steps of Tang Lou were done very cleanly and the separation was very clear, the anatomical layers were very clear.

Ye Kai watched Tang Lou quickly peeling off the gall bladder from the neck, and was very shocked. It was obvious that Tang Lou controlled the force very well. At a glance, the layers between the gallbladder and the gallbladder bed were very clear, so he was naturally very easy to peel off.

"Electrocoagulation hook preparation"

Tang Lou issued another order.

Ye Kai quickly handed over the equipment, and soon Tang Lou completed the hemostasis.

After that, the puncture device under the xiphoid process was routinely pulled out, and the size of the lower stone was evaluated. Tang Lou directly chose to use blunt expansion with fingers.

On the side, Lin Dong didn't expect Tang Lou to be so decisive, to use his fingers to expand bluntly, which required very high control of strength.

After the expansion is completed, the resected gallbladder is naturally taken out from the incision under the xiphoid process.

Looking at the stone on the screen, with Lin Dong's experience, he could tell at a glance that such a large stone cannot be removed by pulling it out.

Sure enough, Tang Lou tried it, but couldn't take it out.

Just as Lin Dong was about to remind him, Tang Lou was already sucking the bile from his gallbladder.

"Pliers, specimen bag"

Ye Kai didn't quite understand Tang Lou's intentions, but he still obediently handed over the pliers and specimen bag.

On the screen, Tang Lou put the excised gallbladder into the specimen bag. After further sucking up the bile, he crushed the stone with pliers. After the treatment was completed, he easily took the gallbladder out of the incision.

"What a quick reaction."

Lin Dong whispered secretly. Generally, novices here are very easy to panic. Sucking out bile and crushing stones seem to be very simple operations, but they are very unconventional. Only those who have encountered them before can handle them so calmly.

"Explore the abdominal cavity again for bleeding and exudate."

After Tang Lou finished his work, he gave Tian Linsheng instructions again.

Tian Linsheng immediately followed Tang Lou's request and checked it carefully again to confirm that it was correct.

Lin Dong nodded slightly. Tang Lou's control over the entire operation was still very rigorous and thorough. After the gallbladder was taken out, many novices simply checked that there was no bleeding, checked the instruments, and then directly chose to suture.

At this point in the surgery, it was naturally coming to an end.

Tang Lou personally performed the final suture on the patient.

Lin Dong and Ye Kai were a little surprised when they saw Tang Lou's textbook-level stitching, and then they were a little admirable.

This hand suturing was obviously practiced under the operating table countless times.

[Ding, the chief surgeon performed the first cholecystectomy, completed, 2 gold coins will be rewarded, and the card library will be refreshed]

【Cholecystectomy (one star, 2), cholecystectomy (one star, 2), choledochojejunostomy (one star, 2), cholecystostomy (one star, 2), cholecystostomy (one star) star, 2)]

Tang Lou directly clicked on two cholecystectomies (one star, 2).

[Cholecystectomy (one star, 2), cholecystectomy (one star, 2), cholecystectomy (one star, 2) autosynthetic cholecystectomy (two stars, 6)]

After finishing the suture, Tang Lou walked out of the operating room, leaving Tian Linsheng and Ye Kai to deal with the aftermath, and Lin Dong also left the operating room together.

Tang Lou changed his clothes and was about to go to the general surgery office. When he passed the general surgery clinic, he saw a female patient, leaning on the corridor, facing the trash can, retching, wanting to vomit but unable to vomit, The whole person clutched his abdomen, accompanied by panting.

Tang Lou directly used the diagnostic technique:

[Patient: Hu Jie, female, 34 years old

Symptoms: Abdominal pain for 4 days, aggravated with wheezing for 3 hours
Sudden abdominal pain with no obvious cause 4 days ago, accompanied by nausea, poor appetite, no diarrhea and fever, no pre-emphasis, 3 hours ago, abdominal pain aggravated with wheezing, sweating, no chest pain, syncope, etc.

Past: found numerous gallbladder stones more than 10 years, no cholecystitis occurred.Hyperlipidemia for 5 years, usually taking statin drugs.

The mind is clear, the heart and lung examination is unremarkable, Mo's sign is positive, and the lower extremities are not swollen.

Diagnosis: acute cholecystitis, acute myocardial infarction.

Special reminder: The patient suffered from myocardial infarction due to long-term cholecystitis inflammatory response, long-term hypotension, and hypoxia damage to the myocardium.It needs to be diagnosed and treated as soon as possible, otherwise it will cause shock. 】

Hu Jie retched for a while, and continued to walk into the consulting room.

Tang Lou thought for a while, acute cholecystitis can still be detected, acute myocardial infarction is easy to be ignored, so I still plan to go in and have a look.

It happened to be Ma En who diagnosed and treated the patient. When Ma En saw Tang Lou, he was a little surprised and said hello.

The patient also turned his head to look at Tang Lou, but because he was really uncomfortable, he was not in the mood to appreciate Tang Lou's appearance.

"Doctor, I'm dying of pain, please give me an infusion as soon as possible. Since cholecystitis has been diagnosed, it's time for surgery. I'm really sick to death."

Hu Jie held his stomach weakly.

Ma En nodded slightly: "Okay, you have had gallbladder stones for more than ten years. This time, you have developed acute cholecystitis, coupled with vomiting, resulting in a lack of water in your body. I will arrange fluid rehydration for you first, and then decompress the stomach. Anti-infection, acid suppression, of course, if you want to cure the disease, the best thing is to remove the gallbladder.”

The patient nodded: "Then trouble Dr. Ma."

Looking at Ma En's diagnosis, Tang Lou on the side really ignored the acute myocardial infarction, so he said to Ma En: "Doctor Ma, the patient's vomiting is so severe, and he has hyperlipidemia and wheezing, have you done it for him?" Electrocardiogram, cardiac enzymes, and echocardiography."

If in the past, Tang Lou raised his opinion on his diagnosis, Ma En would naturally ignore it, but after several impressive rare cases were diagnosed, Ma En immediately looked at the patient's case information again.

"That's not done. Do you suspect that the patient has other complications besides acute cholecystitis?"

"But the patient didn't have chest pain or fainting, just abdominal pain and nausea, and according to the patient's past medical history, gallbladder stones for more than 10 years, plus these abdominal films, it is basically determined to be acute cholecystitis."

According to conventional deduction, Ma En felt that Tang Lou was a little too cautious.

"The patient's long-term cholecystitis inflammation, long-term hypotension, and hypoxia may damage the myocardium. I suggest to do an echocardiogram and an electrocardiogram."

Tang Lou looked at Ma En with conviction in his tone.

Seeing Tang Lou's serious expression, Ma En thought for a while, then looked at the patient, and discussed: "What Dr. Tang said is also reasonable, I should go for a heart color Doppler ultrasound and an electrocardiogram. After that, I will arrange rehydration and so on. "

After all, it is only Tang Lou's guess now, and the addition of additional examinations still requires the patient's consent.

She was already going to go for treatment, but when she heard that a bunch of tests were going to be done, Hu Jie frowned.

She looked at Tang Lou unkindly, she was not convinced by such a young doctor.

"Doctor Ma, I'm so sick, you'd better let me go for rehydration treatment."

Hu Jie clutched her abdomen, a little impatient, and instinctively rejected the thought of going to the queue to do an electrocardiogram and a heart color Doppler ultrasound.

Hu Jie's husband was on the side, and he couldn't stand it any longer: "Doctor, is there any mistake? My wife has cholecystitis, so it can't be wrong. Hurry up and arrange treatment, check the electrocardiogram and heart color Doppler ultrasound, she just has abdominal pain, It's not a heartache."

"It's an electrocardiogram and a color Doppler ultrasound. Are you trying to cheat us of money? What does this little doctor know? We don't do these unnecessary tests."

The patient's husband yelled a few words, Hu Jie thought for a while, covered his abdomen, and became impatient: "That's right, I know my own illness. I just have abdominal pain. It's an old problem. Cholecystitis. Why do you check your heart? Inspections cost money, hundreds of dollars. If we don’t do it, we won’t do it.”

(End of this chapter)