togophonebook Chapter 285: Hyperglycemia
Chapter 285: Hyperglycemia
A woman in her 50s traveled with her husband.
They are all members of the system.
The woman's name is Cai Yulan, and the man's name is Fang Yongxin.
I accidentally stepped on the air in the hotel, slipped down the hotel stairs, grabbed the handrail of the stairs with both hands, and sat on the ground gently, suddenly feeling dizzy and weak in the lower limbs.
Her husband came over and saw her lying on the ground, so he quickly helped her up and asked, "Alan, what's wrong with you?"
Cai Yulan waved her hand and said, "It's nothing, it just slipped a bit, maybe it's a side issue, just take it easy."
Fang Yongxin said, "Then I'll get you some water to drink."
When the man went to pour water, the woman suddenly experienced severe pain in her lower abdomen, and she screamed in pain.
The man ran over quickly, and the woman's pain gradually increased.
Her husband was frightened, and she was sent to the emergency department of the affiliated hospital at around [-]:[-] noon. Because of the woman's husband's special status, she went directly to the dean Xiang Hongzhi, and the dean Xiang Hongzhi called the director of the emergency department, Lu Yonglong. , let him personally see.
I gave Cai Yulan an emergency examination and auxiliary examination, and found that the hemoglobin was 97 g/L, the urine sugar was 3+, the urine ketone body ± , and the venous blood sugar was 36 mmol/L.
Abdominal ultrasound and pelvic CT showed that there was an irregular mixed mass around the bladder on the right side of the pelvis, about 8×3.7 cm.Insulin is given intravenously.
Fang Yongxin asked respectfully: "Director, what's going on with my wife?"
Lu Yonglong, director of the emergency department, said: "The blood sugar is very high, and there is a mass around the bladder. It is recommended to be hospitalized for further examination. It is recommended to be hospitalized first, and consultation with doctors from other departments is required."
Both Cai Yulan and Fang Yongxin agreed to be hospitalized for observation.
Admission examination: a mass with a diameter of about 10 cm was palpable in the right lower abdomen, with obvious tenderness and no pulsating sensation; tenderness, rebound tenderness, and muscle tension were palpable in the lower abdomen.
Dr. Huang, who was in charge of her, considered it an acute bleeding disorder at that time.There are two reasons. On the one hand, symptoms include sudden hypovolemia such as dizziness and weakness, and sudden abdominal pain, abdominal distension and other irritating symptoms of intra-abdominal hemorrhage.
On the second aspect of signs: there is a rapid pulse, low blood pressure, and obvious signs of peritoneal irritation.
Since it was a bleeding disorder with lower abdominal pain, physical examination and imaging revealed a solid mass in the pelvis, which was likely to be a gynecological disease.
Dr. Huang invited Dr. Hong from the Department of Gynecology for consultation.
The gynecologist looked at the CT and said, "This is a bit complicated."
Doctor Huang asked, "How?"
The gynecologist said: "The bleeding caused by gynecological diseases may be: ectopic pregnancy, trophoblastic tumor, rupture of ectopic cyst. But this patient has been menopausal for many years, pregnancy-related diseases can be ruled out, and the possibility of endometrioma cyst is also possible." No. The patient had no obvious history of trauma, and the most likely cause was spontaneous rupture and bleeding of ovarian or fallopian tube tumors.
However, the patient had no obvious vaginal bleeding, and both ultrasound and CT showed that the uterus was normal in size.Ultrasound showed that the pelvic mass was relatively uniform in texture, the blood flow was not obvious, and there were no obvious tumor characteristics. CT also showed that the mass density was relatively uniform, which did not support evidence of malignancy.
Therefore, before the diagnosis of bleeding caused by gynecological diseases is considered, it is necessary to rule out bleeding caused by other systems and other causes. "
After hearing this, Dr. Huang frowned even tighter. It seemed that he had to invite other departments. He immediately asked relevant departments for consultation to identify surgical diseases.
Zhao Yonghui from the General Surgery Department also came, and asked with a smile, "Deputy Director Huang, why did you come here to see patients today? Don't you have many students?"
Doctor Huang said with a wry smile: "Hey, our director asked me to come here, and the director specially explained it."
"Oh, so that's the case, aren't they locals?" Zhao Yonghui asked secretly.
"No, they came from Jiangzhou City." Dr. Huang said.
"It's from the provincial capital." Zhao Yonghui said, after he finished speaking, he read the report carefully and said: ""
Surgical intra-abdominal hemorrhagic disease is generally seen in organ damage.Injuries to parenchymal organs include vascular injuries such as the abdominal aorta and inferior vena cava.Generally, these injuries are secondary to severe blunt or penetrating injuries, and pelvic vascular injuries are mostly secondary to penetrating injuries, pelvic or lower extremity fractures.
The patient falls to the ground slowly after only a slight activity, and there is no obvious fracture, which generally does not cause damage to the above-mentioned organs and tissues.Therefore, spontaneous bleeding should be highly suspicious. At present, this diagnosis can best explain the patient's symptoms and signs.
Spontaneous bleeding is most likely due to rupture of a malignant tumor. "
Dr. Huang nodded and said, "If you have a tumor, you can check it tomorrow."
Zhao Yonghui said: "Because it's in the pelvic cavity, you can ask Lao Wang from the Department of Urology to come and have a look. They are more professional. This patient and his family members seem to be not simple, so we should be more cautious."
"Hmm, that's what I thought too. I just talked to the Department of Urology on the phone."
"Then I'll leave first, and contact me at any time if there is any abnormal situation." Zhao Yonghui left after explaining.
The urologist consulted that: the pelvic mass and the current progressive bleeding should also be considered as the possibility of retroperitoneal disease.The kidneys, ureters, and bladder are retroperitoneal organs, and their damage or rupture can also lead to lower abdominal pain and pelvic mass.
However, the patient had no history of injury to the lower back and bladder area. The urine color was clear, the urine output was normal, and the urine routine did not suggest microscopic hematuria.Abdominal color Doppler ultrasound showed no abnormality of kidney and ureter.Urology-related diseases are not considered for the time being.
Hematology consultation believes that: the patient's current diagnosis of bleeding disorders is clear.However, the cause of bleeding should be further confirmed: trauma or tumor erosion of blood vessels leading to rupture and bleeding, and bleeding caused by vascular lesions secondary to chronic diseases such as diabetes.
The consultation opinion of the endocrinology department was that the blood sugar was too high, and emergency surgery was not suitable.
The current consensus is that blood sugar is controlled at 8 to 10, and the risk of perioperative cardiovascular and cerebrovascular accidents and hypoglycemia is small.The best way to control blood sugar in the perioperative period is to use intravenous insulin pumping, monitor it every 1-2 hours, and adjust the pumping speed in time.It is best to maintain a physiological energy requirement of 5 g/L during the operation, and insulin resistance should be given while energy is given.
Consultation in almost every department has a different direction, but all point out the possibility of tumor.
That night, although the patient’s condition was stable, he hadn’t been diagnosed yet. Dr. Guan Chuhuang was worried and kept observing until midnight. Finally, he decided to communicate with the patient and his family, saying: “The examination is not perfect, and the patient’s blood sugar is too high. , the diagnosis is not clear, and the vital signs are still stable, it is not appropriate to perform emergency surgery immediately, and closely observe the patient's condition."
The patient Cai Yulan and her husband Fang Yongxin saw Dr. Huang rushing in and out, and knew that he had tried his best, and that surgery was indeed not suitable for high blood sugar. They both knew this.