Chapter 325: What empties the liver?
To be honest, Wu Xiaofu had seen a lot of liver abscesses, but this was the first of its kind.
Compared with the CT findings, the patient’s symptoms are somewhat insignificant.
They were not just liver abscesses. Wu Xiaofu also saw many tumor-like structures on the walls of the liver abscesses, and the walls were very thick.
In this case, if treatment is not taken as soon as possible, Master Wang's life and health may be threatened at any time.
Wu Xiaofu immediately asked Peng Xia to make an order, admit him to the hospital, and complete relevant examinations first.
Wu Xiaofu returned to the department after finishing the outpatient clinic at around eight o'clock in the evening, and found that the ward was still very lively, with nurses, patients, and patients' family members coming and going, making it extremely busy.
Whether it is the nurse, the patient or the patient's family, they all know Wu Xiaofu. After seeing Wu Xiaofu, they all hurriedly said hello.
Lu Xiaoyue was not off work at this time, and was busy with the nurse in the department.
“Boss.”
Wu Xiaofu nodded, "Sister Xiaoyue, how are you? There are a lot of patients today. Have they settled down?" Knowing that Wu Xiaofu would not hold back and let go of the patients, there were thirty-two patients, plus five patients transferred from other departments, and thirty-seven of the fifty beds in the department were taken in an instant. open.
More than half of the ward was occupied by patients, and various examinations, medication, and admission work were piled up. Lu Xiaoyue divided the nurses into two groups, and they both worked for a whole day before settling down all the patients.
Hearing Wu Xiaofu’s question, Lu Xiaoyue nodded quickly.
“Everything is settled, boss, don’t worry.”
Wu Xiaofu naturally knew the intensity of today's work. Seeing that Lu Xiaoyue could handle all the patients very well, this also showed that his belief in Lu Xiaoyue was worthwhile.
"I bought some midnight snacks and drinks for everyone. They will be there in a moment. I left your mobile phone number and I will be here in a while. You can send someone to pick it up."
So busy In the afternoon, I'm afraid these nurses haven't had dinner yet. As the boss, it's appropriate to show some expression.
When the nurses heard Wu Xiaofu's words, they all smiled.
In fact, these nurses are also very satisfied with just a late-night snack. In fact, the resentment they accumulated because of a day's work can be turned into nothing, and their grief and anger are turned into appetite.
"Thank you, boss."
......
In the medical office, Feng Lingling and Yuna have not left. Feng Lingling is on duty today, but there are too many patients. Yuna is a good sister. , so he took the initiative to stay and help. After Peng Xia came back, he also hurriedly helped.
There are also Deng Yimin and Lu Xu. They are training doctors, so now they can only be junior doctors to Feng Lingling and Yuna, and they can be regarded as working.
Thirty-two patients, that is thirty-two admission medical records, thirty-two physical examinations, doctor's orders, treatment plans, etc., etc., these are not time-saving and labor-saving. work.
Even with so many doctors, not everything has been settled at this time.
"How is it? It's not a big problem, right?"
In fact, Wu Xiaofu knew all about the seriously ill patients. After coming back, Wu Xiaofu meowed a few times in the ward, but nothing happened. , it should be just some routine problems, that is, patients are piled together and there is a lot of work, but for Feng Lingling and the others, it should not be a big problem.
"They are almost the same. Thirty-two patients, sixteen of us each. Only some supplementary medical records are left and everything is done."
Wu Xiaofu nodded.
"Give Peng Xia ten patients, and there will be just a few in each group in the future. Let's work hard these two days, and the new doctor will be in place soon."
"Okay, boss."
"I ordered something. Peng Xia will bring it over in a moment. Let's have some together."
"Thank you, boss."
Not only the nurses did not have dinner, but Feng Lingling and the others also, after Shi was already hungry, so Wu Xiaofu's words were simply life-saving words. Of course, it was basically impossible to lose weight.
"How many results have come out of Master Wang's examination?"
Wu Xiaofu told Feng Lingling that Master Wang's examinations and tests are all emergency tests. Now some simple tests should be done. Some of the emergency department tests I checked it back then, but it hasn't come out yet, and it should be almost there now.
"Boss, take a look, the situation is not optimistic."
Feng Lingling's face also became serious. In fact, there is no need to look too much. The patient's blood routine, biochemistry, and erythrocyte sedimentation rate And so on, all came out at this time, and a closer look can tell how bad the patient's condition is.
The white blood cells are ten times higher, the lymphocyte percentage is over ninety, and eosinophils, monocytes, etc. are basically all high.
In other words, the patient's infection indicators indicate that the patient may have a mixed infection.
Bacteria, viruses, etc. are possible.
Of course, there is another possibility, that is, none of these are, these are just secondary data increases brought by the pathogen. If that is the case, it can only be said that the situation is more complicated.
The patient's liver function has soared to 200, which means that the patient's liver function has been seriously damaged. It is possible that even if the disease is controlled, the liver function may not be restored.
The electrocardiogram came out and I saw that the heart rhythm was also affected.
If it's a transient change, that's okay, but if it's a damaging change, it's even more troublesome.
Wu Xiaofu frowned as he watched the tests and examinations, then led them to the ward. At this time, Master Wang was lying on the bed, looking uncomfortable. However, Master Wang did it I was used to hard work and had a high tolerance. Even if it was painful, I didn't make a fuss in the ward or anything, I just endured it silently.
After seeing Wu Xiaofu, he also struggled to get up and say hello to Wu Xiaofu. Wu Xiaofu stopped him and said, "I want to do a puncture and drainage on you."
Yes, Wu Xiaofu decided Under the guidance of ultrasound, Master Wang performed puncture and drainage of the pus ball. What is the condition of the abscess? It is actually difficult to see clearly with CT and MR alone. To truly understand the condition, we still need to rely on pathology.
Now that he has arrived at the hospital, Wu Xiaofu does not want Master Wang's condition to drag on any longer. Many changes may occur overnight, so it is better to determine the condition as soon as possible and treat it as soon as possible, so that Wu Xiaofu can rest assured.
Master Wang trusted Wu Xiaofu very much and expressed his full cooperation. Even if it was an invasive examination, he would do it as long as Wu Xiaofu felt it was necessary. In the operating room.
A large amount of gray-white pus flowed out, and the puncture and drainage was completed smoothly. Wu Xiaofu did not drag it. The department was equipped with a set of machines for pathological examination, which was specially requested by Wu Xiaofu. Although pathological examination is difficult, for Wu Xiaofu and others, it is actually quite easy to master as long as you are willing.
Even if you are not that proficient, you can still see the basics of simple situations.
Wu Xiaofu began to explore the pus directly under the microscope, but strangely, no bacteria, fungi, tuberculosis, or malignant tumors were found after the examination.
So what is the cause?
Wu Xiaofu also shook his head. In fact, there are only so many possible causes of pus balls. Since it is not bacteria, fungi, viruses, etc., then the only answer left is the answer Wu Xiaofu least wants to get.
"Think carefully about what you have eaten recently, mainly things you would not normally eat."
Hearing this, Master Wang also pondered for a while. After a minute, it seemed that Thinking of something, he hurriedly said that Master Wang once made pickled fish in his hometown. At that time, in order to make the taste more tender, the fish fillets were simply soaked in hot water and eaten.
Sashimi!
The condition became clear at once, the cause was known, the examination provided supporting evidence, and the results also gave corresponding hints, so it was estimated that they were almost inseparable.
"Master Wang, I'm afraid the entire left half of your liver will have to be removed."
Master Wang came here on his own, so Wu Xiaofu couldn't even notify his family about this. He could only discuss it with himself. After hearing Wu Xiaofu's words, Master Wang's face was full of pain.
He had to have an operation, and he still had to cut out half of the liver. How could Master Wang, a man who had never even done it in a hospital before, accept such a major operation?
“Is there no other way?”
"Master Wang, sashimi is not suitable for direct consumption, especially some raw fish with poor water quality, which contain a large number of parasites. Now your liver has been eroded by these parasites, along with bacteria and fungi. Or it may be a different viral infection.
The damage caused by parasites is almost impossible to heal on its own, and there are not many ways to deal with it, especially if the parasites have been in your body for too long, pus balls will form. It's very big, and your condition progresses quickly. Conservative treatment may not only not be able to completely eliminate the parasites in your body, but will force those parasites to move to other parts of the body, aggravating the condition.
I think then. If another operation is needed, I'm afraid it won't be as simple as cutting out half of the liver.
In fact, the current situation is pretty good. After cutting out half of the liver and completely cutting off the source of the disease, plus medical treatment, it should be done soon. It can be cured, and the source of the disease is in the liver. After cutting half of the liver, you can recover after a period of time.”
In fact, you can treat it conservatively first, but as a doctor, you will always be there. When making a treatment plan, you can know which plan has the best and most direct effect. The possibility that conservative treatment can cure the patient is very slim, but it is more likely to aggravate the condition. It is really unnecessary to try, so Wu Xiaofu Patients are directly advised to undergo surgery.
After a struggle between heaven and man, the patient still nodded helplessly.
"Let's do it."
Wu Xiaofu explained the pros and cons. Master Wang's education level is not high, but he can still understand what he said. What's more, just because the bottom class is treated well It had been too long, so he was more sensitive to feelings. How could Master Wang not be able to feel whether Wu Xiaofu was sincerely good for him.
Wu Xiaofu was relieved when Master Wang agreed.
Sometimes, it is really helpless when encountering patients who cannot explain. In this world, of course, it is not ruled out that there are a few doctors who do not care about their patients, but most doctors do not care about their patients. All patients are well and we hope they can recover and be discharged.
Doctors are dedicated and patients cooperate. This is the best medical condition.
Master Wang has reached the fasting standard. Wu Xiaofu did not delay anything and went directly to work overtime for surgery. He just cut out a liver and it was done in half an hour. Today is Friday and there are a lot of surgeries in the operating room. The nurses and anesthetists on duty in the operating room have not yet got off work, so they took the opportunity to add another one. Otherwise, if there is an additional surgery tomorrow on the weekend, they will blame Wu Xiaofu again.
Peng Xia still followed. Now Peng Xia's main thing is to be a hard-working person who doesn't complain.
I spent a day in the clinic with Wu Xiaofu. After I came back, I had to fill in medical records and see patients. Now I am being dragged by Wu Xiaofu to operate. After the operation, I will probably have to work overtime for most of the night. Well, I am really a chosen worker. But Peng Xia is still very positive.
Wu Xiaofu originally wanted to bring others in first to let Peng Xia rest, but Peng Xia said that who else would do this surgery?
For a motivated young doctor, it is not scary to endure it for a long time, but it is scary not to be able to see his progress. Every moment he follows Wu Xiaofu, Peng Xia can feel his progress. This state makes him very fascinated and also I like it very much. No matter how tired I am, I feel relaxed just thinking about my progress.
Operating room.
Wu Xiaofu chose laparoscopic liver resection. During the operation, Wu Xiaofu was also very careful.
It was just a half-cut liver. Wu Xiaofu took the easy way to prevent the contents of the pus ball from flowing elsewhere. The operation was not complete. Wu Xiaofu only opened the half of the liver for inspection after cutting it off.
However, Wu Xiaofu was a little frightened by what happened after the liver was cut open.
It was previously thought that there were a large number of tumor-like structures on the wall of the abscess, but after opening it, it was discovered that these structures were actually granulomatous inflammatory masses, which were densely packed with bulb-shaped, thick-shelled Clonorchis sinensis eggs, and there were countless in the abscess. Unclear.
When these parasites were drained before, due to the parasite's habits, they were not drained out at all, and they all tried their best to drill back.
Now after opening the liver, we can see clearly what is inside.
In terms of biological type, Clonorchis sinensis is a kind of fluke in the genus Clonorchis of the family Opisthorchidae of the order Polygonidae.
Adult worms are also known as liver flukes.
Clonorchis sinensis adult worms can parasitize in the liver and bile ducts of humans and various animals, causing clonorchiasis. The main manifestation is liver damage. It can also cause hypersensitivity and inflammatory reactions in the bile duct intima and around the bile ducts.
Patients with chronic infection may develop fibrous connective tissue hyperplasia around the liver and bile ducts, atrophy of the liver parenchyma, and even cirrhosis.
In 2009, WHO clearly stated that Clonorchis sinensis can cause cholangiocarcinoma in humans.
Wu Xiaofu has done relatively more research on cholangiocarcinoma and knows more about Clonorchis sinensis, but it is precisely because he knows so much that he knows how terrible this parasite is. Fortunately, it is If it is discovered early, the operation must be performed early, otherwise, it may not be as simple as cutting out half of the liver.
Clonorchiasis is a food-borne infection. The key to prevention is to control the "mouth", especially changing the habit of eating raw fish and shrimp.
Kitchen knives and chopping boards for raw and cooked food should also be kept separate.
Not only for yourself, your family members, but also your pets, it is best not to feed cats and dogs with raw fish.
Because patients, infected persons, infected domestic animals and wild animals that can excrete Clonorchis sinensis eggs can serve as sources of infection, that is to say, if your pet is infected with Clonorchis sinensis, it is very likely that it will You may also become infected.
The operation took less than half an hour. When the patient woke up, Wu Xiaofu showed him his liver without saying anything. He immediately understood that the liver could not be cut and so on. It must be Cut it, cut it quickly, I’m scared to death.
(End of this chapter)