Chapter 918 - 459: The Grim Reaper Descends, Mesenteric Artery Embolism

Chapter 918: Chapter 459: The Grim Reaper Descends, Mesenteric Artery Embolism

Some classic cases of aortic dissection may exhibit a bizarre phenomenon of higher blood pressure on the right side and lower on the left.

"His blood pressure is relatively high, with a systolic pressure of 149 mmHg and diastolic pressure of 102 mmHg. According to the family and himself, due to the high stress from studies in high school and his preference for strong-flavored foods, his blood pressure has always been high."

Nurse Sister Juan described the patient’s situation while standing nearby.

Having hypertension and a fondness for strong-flavored foods can easily exacerbate the symptoms of high blood pressure.

Preferring diets heavy in salt, oil, and sugar is greatly harmful to the body.

Occasionally indulging in such meals might not cause significant problems.

But consuming them daily could easily undermine one’s health.

The young patient had long-term hypertension, which over time could likely result in atherosclerosis.

Both hypertension and atherosclerosis are critical causes of aortic dissection.

Li Jingsheng had good reason to suspect that the patient’s condition might be due to an aortic dissection.

"Have you done an ECG on him?"

"We have. An ECG was taken upon arrival at the ER, allowing a preliminary exclusion of aortic dissection."

Xiao Linlin handed the patient’s ECG over to Li Jingsheng for review.

Upon receiving it, Li Jingsheng examined it closely.

"The ECG indicates the presence of atrial fibrillation, and suggests some level of heart failure!"

This is a very concerning sign.

Simple abdominal pain usually doesn’t cause atrial fibrillation or heart failure.

The most common cause of abdominal pain is gastrointestinal issues, such as enteritis or irritation from consuming raw, cold, or excessively spicy foods. This can lead to stomach pain.

However, Li Jingsheng had never heard of enteritis causing heart failure and atrial fibrillation.

Perhaps he was just ignorant.

So what exactly is this patient’s illness?

He tried using a stethoscope to check the patient’s bowel sounds.

Normal.

The abdomen is soft, tenderness is not pronounced, and bowel sounds are normal, allowing for exclusion of various lower gastrointestinal diseases.

At that moment, the patient vomited again due to severe pain.

"Ugh..."

This time, the patient vomited dark red blood.

Instantly, everyone’s nerves tightened.

If this were just an ordinary gastrointestinal disease, it wouldn’t result in vomiting blood.

Moreover, the blood vomited was dark red, indicating that bleeding had been occurring for some time.

Fresh blood, when it first appears, is bright red.

Li Jingsheng realized the patient’s condition was critical and urgent, necessitating rapid identification of the true cause.

The second hospital insists on monopolizing the entire southern city area despite its mediocre capabilities.

This leads to the transport of patients with high diagnostic difficulty, which the hospital struggles to handle effectively.

This certainly isn’t favorable for the patients.

Patients who might have survived with proper rescue ultimately couldn’t be saved and died.

Who’s responsible for this?

The hospital typically wouldn’t bear responsibility. According to medical protocol, as long as the hospital fulfills its duty to provide emergency care, it generally isn’t liable.

"Have you performed an ultrasound on him?"

Li Jingsheng asked.

"An abdominal ultrasound has been done."

Among routine examinations, ultrasound and X-ray are perhaps the most frequently used diagnostic methods.

Some hospitals now pursue higher efficiency.

When an ultrasound reveals problems, further CT scans or even MRI might be necessary.

Hospitals encourage experienced doctors to engage in thorough communication with patients and, upon receiving consent, directly employ CT or other non-routine tests.

This approach is especially beneficial for acute illnesses.

It significantly shortens the patient’s waiting time for examinations.

It allows rapid identification of the cause, enabling timely and accurate treatment.

This greatly enhances the rescue success rates for patients with acute conditions.

Li Jingsheng reviewed other test materials from the patient.

There are many conditions that could cause severe abdominal pain, including appendicitis, gallstones, kidney stones, and other diseases consistent with this patient’s symptoms.

Appendicitis was preliminarily excluded, and both gallstones and kidney stones could be mostly ruled out.

Abdominal aortic dissection was similarly excluded.

"Have you tested cardiac enzymes on him?"

Given the presence of atrial fibrillation and heart failure, Li Jingsheng deemed heart cardiovascular issues likely.

Aortic dissection was excluded, but what about acute myocardial infarction?

Based on the ECG findings, myocardial infarction seemed unlikely.

Where did the blood in the patient’s vomit come from?

It’s basically unlikely that the blood came from the stomach.

There’s little chance of bleeding from the lungs, bronchi, or trachea, as bleeding from these areas generally results in frothy blood.

He believed the blood most likely originated from the digestive tract.

Therefore, it could only be traced further down from the stomach.

The duodenum, jejunum, and ileum are all possibilities, with the blood being dark red, and initial vomiting not containing blood.

Based on Li Jingsheng’s diagnostic experience, he could basically ascertain that the bleeding site was likely the small intestine.

Most likely at the ileal segment of the small intestine.

Is it seepage or intestinal bleeding?

These questions required him to clarify them one by one.

"Cardiac enzymes have already been tested, showing abnormal elevation."

Xiao Linlin replied.

During their consultation, the patient’s condition rapidly deteriorated, his complexion became more pallid, and symptoms like cyanosis of the lips appeared.

The patient’s consciousness also seemed to be gradually becoming unclear.

Everything indicated the patient was swiftly approaching death.

"Director Xiao, I suspect there might be some bleeding or hemorrhage within his intestines. Should we immediately perform a CT or ultrasound to check the blood flow?"

Li Jingsheng still preferred ultrasound.

It’s cost-effective, and ultrasound is especially effective in examining blood flow.

"Dr. Li also thinks his vomiting blood is coming from the intestines?"

"Yes, that’s my suspicion. And it’s likely the small intestine; I’m personally inclined to think the ileum is problematic."

Li Jingsheng didn’t hold back in this situation and directly stated his diagnosis.

"Then let’s do a CT scan for him!"

Xiao Linlin worried about the patient’s death, decided not to do ultrasound but instead opted for a CT scan.

In terms of accuracy, CT has more advantages.

"Dr. Li, you can sit in my office for now; the patient’s results should be ready soon."

Many examinations can’t actually be done at night.

Because the doctors are off duty.

Although the Second Hospital hasn’t been rated as a Class A hospital, it still qualifies as a large-scale tertiary hospital. The emergency facilities, while not top-notch, are at least standard.

At night, there are doctors on duty in the CT room.

After all, no one can guarantee what kind of patients will come into emergency. Sometimes, a CT scan can even save a life.

Many emergency patients can’t wait until the next day.

Soon, the CT scan results for this young patient came back.

There was a sudden disappearance of the intestinal artery lumen.

Intestinal wall edema and thickening, intestinal dilation.

Reduced enhancement of the intestinal wall.

Generally, the cause of reduced enhancement of the intestinal wall is largely due to ischemia of this affected area.

Coupled with the sudden disappearance of the artery lumen earlier.

Li Jingsheng almost immediately realized there might be a problem with this patient’s intestinal artery.

"Director Xiao, is this the superior mesenteric artery?"

"Yes!"

"It’s very possible that this patient’s mesenteric artery is blocked. Only when the superior mesenteric artery is blocked will such a series of symptoms occur. Thus, the patient’s vomiting of dark reddish blood can be explained."

Li Jingsheng believed Xiao Linlin also had reached this diagnosis.

"So have you considered what might be the cause of this arterial blockage?"

As expected, Xiao Linlin had the same diagnosis as Li Jingsheng.

In the office, besides Li Jingsheng and Xiao Linlin, there were three other gastroenterology doctors.

They basically had no chance to speak.

But just by listening on the sidelines, they could learn a lot.

They could see how top gastroenterology doctors like Director Xiao and Li Jingsheng diagnose diseases.

And they could learn their diagnostic thought processes for this disease.

It’s like solving a complex problem—thought process is very important.

Different thought processes yield different solutions.

"Considering the patient’s tendency for spicy foods and the presence of heart failure and atrial fibrillation on the ECG, I tend to believe it’s a thrombus dislodgment, blocking the superior mesenteric artery."

Li Jingsheng’s diagnosis was mesenteric artery embolism.

The best way to confirm this illness is through an arterial angiogram.

Currently, arterial angiography is recognized as the gold standard for diagnosing this condition.

"What’s your diagnosis opinion?"

Xiao Linlin looked at the doctors under her.

She now has a strong desire to excel, wanting to make the gastroenterology department bigger and stronger, markedly increasing the training efforts for the doctors under her.

Previously, she seldom managed her subordinates.

"I support the diagnosis conclusion of Director Xiao and Dr. Li regarding the blockage of the superior mesenteric artery. As for whether it’s an arterial embolism, arterial angiography is needed to confirm."

"The cause of this patient’s condition was quite complex at the start of the diagnosis. But after checking the CT, I think the cause is very clear: it’s undoubtedly mesenteric artery embolism. Although arterial angiography hasn’t been done for confirmation, it can be determined this is the disease.

Due to the extremely high mortality rate of this illness, which is very dangerous, we must immediately administer thrombolytic therapy."

Xiao Linlin, with her intrinsic capabilities, after a few years of honing in the position of department director, handles such acute severe cases quite decisively.

Thrombolytic therapy is not considered difficult.

Thrombosis can simply be treated by continuous arterial catheter injection of alkaline and urokinase drugs.

While this treatment can’t be guaranteed effective, it’s at least symptomatic.

Thrombolysis is just the first step, as considerable time has already elapsed from the onset of the disease to diagnosing the result.

It’s estimated that the necrotic area of the intestine shouldn’t be small.

Contacting General Surgery to perform abdominal surgery and remove the necrotic bowel is definitely necessary, and possibly even arterial bypass surgery.

Once Li Jingsheng saw the pathogenic cause identified, he naturally didn’t involve himself in the subsequent treatment.

By now, it was already late.

He took a taxi home.

Returning to the clinic, there were still a bunch of things to handle. Indeed, the more money you make, the busier you are.

He really wished he could have a clone.

Tomorrow morning, the treatment result for that mesenteric artery embolism patient should come out. This disease has an extremely high mortality rate, reaching over 80% if not diagnosed promptly.

If the thrombolytic effect is quite good, attention then must be given to how much of the intestine is necrotic.

Some patients, after being rescued, may survive.

However, if more than 70% of their small intestine is removed, they might rely on intravenous nutrition for the rest of their lives. It has to be said, this is truly an insidious and deadly disease.