Chapter 907 - 448: The Dangers of Anuria—Clinging to Pride Only Makes Things Worse

Chapter 907: Chapter 448: The Dangers of Anuria—Clinging to Pride Only Makes Things Worse

Since there were no obvious lesions found in the large intestine, Director He performed procaine block and applied hot compresses to the mesenteric root.

However, the extent of the small intestine lesion was very large, making the surgical plan difficult to formulate.

Is it impossible to remove all these sections of the small intestine?

Director He must have thought deeply before putting the intestines back into the abdominal cavity and instructing the subordinate doctors to suture the skin and close the abdominal cavity for the patient.

In other words, although the patient’s abdomen was cut open, there was no substantive surgery performed.

This approach is somewhat irresponsible.

Or rather, afraid of taking responsibility.

It’s really hard to evaluate.

In fact, similar situations to this patient’s often occur. Doctors open the cranial or abdominal cavity, only to find that they cannot handle it, or the surgical risk is too high, so they sew it back up.

First of all, whether it’s an abdominal or thoracic incision, as long as it’s cut open, the damage to the patient is very significant.

The purpose of opening the abdomen is to solve the disease.

Almost nothing truly effective was done for resolution, and then the abdominal cavity was closed; the patient and family must be feeling as desperate as wanting to die.

Already sick, the body is in a poor state.

Opening the abdomen without treating the disease, is this a joke?

The crux is that after the patient was sent back to the ward, in less than four hours, he expelled about three to four hundred milliliters of dark red liquid from the anus.

The patient’s blood pressure immediately dropped, consciousness became blurred, and he vomited a large amount of coffee-colored liquid.

Urine output was also significantly reduced.

This series of symptoms combined is a very bad sign.

Because the patient’s condition has reached this point, there’s a possibility of further deterioration, leading to death at any time.

Li Jingsheng finally understood why Director Bi chose to call him overnight, humbly seeking help.

He believes Director Bi must have detected the danger too.

"Have you checked the urine analysis?"

Li Jingsheng finished reviewing the patient’s basic situation and looked up at Director He.

The whole process of reviewing the data did not take long, only about three minutes.

He is very clear that He Qingzhi is likely extremely anxious now.

"Which urine analysis are you referring to? Admission or post-operative?"

"Definitely post-operative!"

Li Jingsheng could determine that Director He was already in panic, losing his composure.

Otherwise, he wouldn’t have asked such a senseless question.

"Here it is!"

He Qingzhi directed Li Jingsheng to check on the computer.

To print the patient’s examination report, one usually needs to print from the self-service machine in the outpatient clinic, which requires entering the patient’s card number or scanning an ID card, which is relatively bothersome.

The family’s mood must be particularly bad right now, it’s best not to bother them.

Li Jingsheng scrolled through the examination report to check: Urea nitrogen 33.8 mmol/l, creatinine 249 umol/l/, blood potassium 3 mmol/l, sodium 144 mmol/l, chlorine 96 mmol/l.

Looking at these results, Li Jingsheng’s first thought was acute kidney failure.

"This seems like kidney failure! Is there any medication administered?"

It is generally treated with diuretics.

"Yes, I immediately administered a large dose of furosemide and other medications, trying to help the patient resume urination."

He Qingzhi, at least being a chief physician of ample skill.

Could he possibly not know basic resuscitation procedures?

"How is the effect? Is the urination normal now?"

"Alas, it would be great if it were normal. There’s still no effect after the medication, even resulting in anuria."

He Qingzhi shook his head and sighed.

He picked up a thermos cup, opened the lid, and gulped down two large mouthfuls of tea.

It was hard to say if he was trying to calm his anxious mind with tea or instinctively wanting to drink more water to urinate.

But no matter how much water he drank, it’s only his own urination.

The patient still couldn’t urinate.

"How long has the patient been in anuria?"

"Almost exceeding eleven hours now."

"Then his condition is very dangerous. Why not consider a second laparotomy to perform the surgery? There’s a clear bowel obstruction and multiple segments of small intestine obstruction, the extent is large.

Not dealing with it, the lack of urine isn’t surprising."

Li Jingsheng asked genuinely, not just idle talk.

With the attitude to solve the problem.

"I did think about resecting the intestine. But with such a large extent of small intestine lesion, which segment do you remove? All of them?"

He Xianzhi countered.

"At least try to get the patient’s intestines unblocked; then the patient can be saved. Absolutely not all segments need to be removed. Unless absolutely necessary, it cannot be done."

The human intestine is long, with the small intestine being relatively narrow.

But in nutrient absorption, the small intestine plays an absolutely crucial role.

Resecting a small section of the small intestine might not significantly affect the patient’s postoperative life.

But removing a large part of the small intestine, or even the entire section, is simply a joke.

The patient’s future nutrient absorption would be essentially ruined.

Even if the surgery were completed, how would the patient survive afterward?

Living on a constant drip of nutritional injections to sustain life?

He Qingzhi dared not perform random resection, which both shows irresponsibility and responsibility.

This is not contradictory.

He was deemed irresponsible for putting the bowels back without performing substantial treatment.

If it’s difficult to handle during the surgery or you’re uncertain about the surgical plan, you can call for a consultation!

Li Jingsheng isn’t very familiar with the situation in the General Surgery department.

Based on his survival experience at the First Hospital, the larger the department, the more competitive it is.

It’s not office politics per se, but rather a mutual competition.

Because the number of slots for department trainings, director, vice director, and outstanding individual awards is limited.

If you want to achieve something, or even compete for the coveted slots, you have to defeat a lot of competitors.

Once this competition begins, unity practically disappears.

When He Xianzhi encountered a problem after opening the abdomen, he should have invited other chief physicians to consult and discuss together. But getting people to agree is often unlikely.

A simple "I’m really busy right now" can easily dismiss the request.

Li Jingsheng could imagine this happening.

"What’s the patient’s current body temperature? No high fever?"

"Here, this is the latest physical examination data for the patient."

Director He Qingzhi handed a handwritten paper to Li Jingsheng for review.

Temperature is 37.2 degrees, indicating a low fever.

Heart rate is 104 beats per minute, respiration is 24 breaths per minute. Blood pressure is crucial, with a systolic pressure of 151 and diastolic pressure of 79.

Wasn’t the blood pressure supposed to be low?

It seems it has risen now.

Judging by the patient’s blood pressure, there shouldn’t be any immediate risk of death.

"Is his blood pressure so high because there’s complete cessation of urination?"

Li Jingsheng considered a possibility.

"Yes."

He Qingzhi wasn’t too confident and sounded a bit unsure when answering.

Li Jingsheng carefully recalled the scene he saw in the ward earlier, the patient looked pained.

"Is the patient’s consciousness clear now?"

"Consciousness is fine, he answers questions normally."

Generally, as long as spatial orientation is normal, consciousness can be considered clear.

Li Jingsheng began to think about the patient’s current condition.

Acute renal failure is the first consideration, followed by the possibility of intestinal necrosis after mesenteric vascular obstruction surgery.

The temperature in the abdominal cavity is actually quite high.

In cases of low fever, the time for intestinal necrosis tends to be shorter.

It’s been over ten hours since the surgery, and the likelihood of necrosis has greatly increased.

Additonally, one must consider the possibility of toxic hepatitis in the patient.

The patient has no urination, which leads to a large amount of toxins in the intestines being absorbed into the bloodstream, exacerbating acute renal failure.

"Dr. Li, do you have any diagnostic suggestions?"

He Qingzhi was a bit anxious, even subtly stamping his feet.

His proactive inquiry showed a lack of composure.

But he was indeed very worried.

"I have three preliminary diagnostic views: acute renal failure, intestinal necrosis, toxic hepatitis. As for suggestions, we should definitely find a way to confirm if intestinal necrosis is really present.

In terms of rescue, we should remove the severely diseased, even necrotic, intestinal segments of the patient.

This seems necessary."

Li Jingsheng provided a suggestion, but he noticed Director He was clearly reluctant to proceed.

He had to propose an alternative plan.

"We could also consider trying intestinal decompression drainage surgery."

"This is acceptable. Doing intestinal decompression drainage requires another laparotomy, which makes me worry about frequent disturbances causing the patient and the family to curse."

He Qingzhi said this with a slight blush on his face.

As an experienced chief physician, he didn’t want to lose composure and get cursed by patients and families.

He instinctively wanted to avoid such situations.

"We’ve reached this point where being cursed by the family, if it resolves the issue, seems worth it to me. If we wait until the patient dies, and the family files for a medical accident appraisal, then takes it to court and the authorities, whether your career can be maintained will be uncertain."

Li Jingsheng explained the stakes involved.

He wondered what Director He was thinking, as this wasn’t the time for vanity.

If there’s an error or something is not done right, you must stand firm and face the consequences.

The more you fear being cursed and hesitate, the bigger the problems will ultimately be.

"Alright, I’ll arrange it immediately! Even though our conversation was brief, it’s clear you’re a capable young physician. Director Bi invited you to assist me; would you stay to help with the consultation and surgery?"

He Qingzhi looked at Li Jingsheng with some restraint, like a child.

Seeking his opinion.

"Don’t worry, since I’m here, even if I need to sleep at the hospital tonight, I’ll help you resolve this. The patient’s situation is extremely dangerous, and I suggest if conditions permit, it’s best to immediately perform a second abdominal surgery. Before that, a well-planned surgical plan could be made. However, I think waiting until after the abdomen is opened to examine the patient’s abdominal state before setting the main surgical plan will be more accurate."

Li Jingsheng suggested they immediately perform an abdominal surgery on the patient.

Being called back for a second operation is a bit embarrassing.

No doctor desires it, but if it’s necessary, it must be done.

"Thank you, Dr. Li! I can assure you one thing; even if an accident happens to the patient, all responsibility won’t fall on you as the assisting physician. I will take it upon myself, without implicating you."

He Qingzhi felt quite moved after hearing this.

He also gave Li Jingsheng assurance.

"Please hurry with the arrangements! I’ll review the patient’s documents and organize things."

"Okay! You can pour water yourself, and if you’re hungry, there’s food here."

He Qingzhi took out some meat floss cakes and placed them on the table before leaving in a hurry.