Chapter 174 Mechanical Intestinal Obstruction (two in one chapter)
What's the girl's disease?
The old magician and the girl lying on the bed looked at Elder Wood with expectant eyes. On the other hand, the female knight Salina stood aside with her sword pressed, a pair of emerald green eyes flashed slightly, looking at Elder Wood,
Looking at Grete again, in the end, it still fell more on Grete.
Grete glanced at her, and Selina nodded slightly at him, with a smile in her eyes. Then, she pointed at the girl on the bed and made a mouth shape silently. Her beautiful eyes were filled with tears, obviously asking: What is the disease?
do you know?
This... Gretel looked at Elder Wood, and moved his right foot inconspicuously towards the female knight. Before his left foot could catch up, the elder had already turned around and looked at Gretel with a smile:
"Little Gretel, what do you think?"
"I..." Grete opened his mouth to say the answer. When the words came to his mouth, he paused:
"I have some guesses, but whether they are correct or not, I have to check to be sure."
"Then check it out." Elder Wood smiled and raised his hand. Gretel immediately jumped up:
"Wait a minute, I'll get pen and paper!"
inquiry!
Check up!
Write a medical record!
He held a thick notebook and sat down in front of the girl. When he opened it, he saw that the front was densely packed and he had memorized half of the notebook. He flipped to the latest page, looked at the girl on the bed, and gave a smile:
"Girl, may I ask your last name?"
"Maineland." The girl lowered her face and tightened the blanket, her ears red. Gretel coughed, buried his head in writing, and continued to ask:
"age?"
"17 years old."
"What's wrong with you?"
"My belly... my belly is getting bigger..."
"How long?"
"..."
"How long has it been since your belly started getting bigger?"
"Three, three or four months..."
"Is it this big in the first place?"
"of course not!"
"Does your stomach hurt?"
"A bit..."
"Does it hurt all the time or does it come from time to time?"
"In a moment..."
"Is it bloated?"
"Yes, a little..."
"Do you feel like vomiting? How is your bowel movement? Do you have it every day? How much? Do you fart?"
"You... you! Why do you ask questions about everything!"
The girl's ears were red, she turned her head inward and ignored him. Gretel raised his head helplessly, spread his hand to Elder Wood, and continued to write furiously:
"03.12
Iris Mainland, female, 17 years old.
The abdomen becomes distended and progressively worsens over 3 to 4 months, reaching the size of the sixth month of pregnancy.
Paroxysmal abdominal pain, abdominal distension, and occasional vomiting."
Uh... I can't write any more. He took out another piece of paper, wrote down a lot of questions, looked around, and waved to the female knight. Selina took the paper from his hand, swept it up,
I was stunned on the spot:
"You have to ask all these questions?"
"You have to ask."
"Do you really have to ask?" The female knight clicked on the paper with her slender fingers, "What have you eaten? What medicine have you taken in the past few months? Have you been here..." Her cheeks turned red, "You have to ask?
"
"I must ask!" Gretel put down her pen, clasped her hands together, and bowed to her:
"Sister, please help me! It's not convenient for me to ask these questions. You are a girl and she is willing to talk to you...Really, the more accurate and detailed the answers, the more accurate I can judge the condition..."
"...Okay." Selina took away the paper, smiled half-heartedly, and pointed outside the curtain. Grete quickly picked up the stool and rolled it up, consciously avoiding the curtain, and waving to call out the two elders.
. He sat down against the curtain with his notebook in his arms, pricked up his ears, listened to the conversation between the two girls, and tried to record:
"Loss of appetite, weight loss, constipation, and a small amount of flatulence. I underwent magical treatment five days ago, but there was no improvement - what kind of damn medical record is this? People will laugh to death if I wear it back!"
Complaints are complaints, but records still need to be recorded. Thank God, this is considered an outpatient clinic - Grete took it upon himself to classify the patients as outpatients - there is no need to write medical records in the inpatient format. Otherwise, just two or three pieces of paper would be enough to record the admission.
Not enough to write about.
Behind the admission record, there are also disease course records, consent forms, various record documents and report sheets, each of which can be found in a thick stack. Added together, it must be as thick as the notebook in his hand...
After whispering in the curtain for a while, the female knight opened the curtain and came out. Her cheeks were slightly red, and she threw the paper into his hand. Gretel hurriedly scanned it and saw that it was almost the same as what he had dictated, and only added a few sentences.
Then he closed the book and walked up to the old magician:
"I've asked all the questions I need to ask about the young lady's condition. Next, I need to do some tests on her - may I touch her body?"
"It must be like this?" Elder Wood rushed to ask. Grete nodded helplessly:
"It has to be like this. I have to verify something - not by looking with eyes, hearing by ears, or detecting by magic or magic, but by touching and pressing with hands."
Treating female patients is like this...palpation and other normal methods in medical diagnosis and treatment, and you must first seek the consent of the parents and the patient. Grete sighed secretly, if he could, he didn't want to cause such trouble - but
The patient is right in front of him, and it is impossible for him to give up diagnosis and treatment.
"Can you cure it?" Master Tolga pondered for a moment and did not answer. Instead, he asked Elder Wood. The elder lowered his head and thought for a moment:
"I'm not very sure. I treated someone whose belly was smaller than hers before. I thought it was fine, but suddenly she died of abdominal pain for some reason. Besides," he glanced sideways at Gretel:
"This child's treatment ideas and methods are different from my magic. Frankly speaking, I am also looking forward to his method."
Master Tolga looked at the still hanging curtain, and then at Elder Wood, lowering his head and thinking. Elder Wood avoided his gaze and muttered in a low voice as if talking to himself:
"It's not like I haven't touched you just now..."
"That's it!" The old magician immediately made up his mind. He opened the curtain, pushed Gretel in, and personally brought him to his daughter:
"Iris, don't be afraid. Let the priest look at it again! Just touch it and press it a few times with your hands. It doesn't matter. It doesn't hurt!"
"I..." The girl's snow-white cheeks were already flushed, and even the roots of her ears were red. She lowered her head and clutched the blanket tightly. It wasn't until her father pushed her two or three times that she said, "
"Hmm" said.
Gretel: "..."
This won't work! Even if you are shy, you can't help but let me see you!
"Miss, please raise your head a little and let me see your face... Well, I'll just look at your eyes..." No, your face is so red that you can't tell whether it's yellow or not! Thank God,
Not even the whites of my eyes are red...
Grete tried hard to recall the skin he had seen before, and wrote: "Skin and sclera are not yellowish." Very good, liver lesions have been roughly ruled out, and the treatment pressure has been reduced by more than half. Next, start palpation!
He waved to the female knight to come out, lowered his voice and whispered:
"Would you like to accompany her to the toilet first?"
Then he dragged the female knight in to accompany him, testified, and explained to the girl in a soft voice what he was going to do next. Then he rubbed his hands together and lifted the blanket——
Physical examination, begin!
Grete tried hard to control his expression, making his look serious, yet gentle and friendly. He lifted the blanket on the girl's abdomen, first observed carefully, measured her abdominal circumference, and then——
"Miss, sit up and let me take a look. Slowly, just sit upright. Okay - lie down."
"Why do you make her sit and lie down?"
Elder Wood asked questions from behind. Gretel simply handed him the pen and paper:
"Elder, please help me record it. Note: The entire abdomen is distended, the abdomen is spherical, and the shape does not change significantly when moving."
Elder Wood frowned and wrote slowly. In just one sentence, there were two words he was not very familiar with, and he had to think carefully about how to write them. Gretel's explanation had already caught up:
"When you sit up or lie down, there is no obvious change in the shape of the bulging belly, which means that the bulging thing is hard, not soft, especially not water - if it is water, it will flow to both sides when you lie down.
Come on, exhale, inhale, exhale again, inhale again - remember, the swelling does not move with breathing. This means it is not caused by organs or masses under the diaphragm."
Every time he asked the patient to make an action, he would explain the reason. Iris' face turned pale and red, then red and white again. The female knight pressed her friend's shoulder beside her and whispered:
"There are so many things to consider——"
"Isn't that what you have to think about?" Grete smiled faintly.
The enlarged belly - medically known as abdominal distension - is divided into total abdominal distension and partial abdominal distension. There are three reasons for total abdominal distension alone: abdominal fluid (ascites), abdominal gas, and huge masses. And ascites is a
There are already three major categories and fifteen sub-categories, with at least seventy or eighty causes.
Even if the cause of the disease is finally determined, a large number of auxiliary examinations must be relied upon. Before these examinations are prescribed, a doctor's physical examination must be conducted to guide the initial direction.
"There are no varicose veins in the abdominal wall, and there are no abnormalities in the abdominal skin." Great, the possibility of intestinal strangulation is a little smaller!
Possibility of surgery↓↓
"Have you finished checking?"
The old magician asked anxiously. Grete took a deep breath: "It's almost here. Elder, come and see, are there long strips of protrusions on her belly - around her navel? Bend down and look at it from the side.
You can see it very clearly. Okay, pat it gently..."
After gentle patting, the long bulges on the snow-white, high-bulging belly kept squirming, one after another. Some moved forward, some backward, in different directions. Iris moaned softly: "It hurts."
——”
"It's almost gone, just be patient." Gretel comforted softly. The old magician said in surprise behind him:
"What's this?!"
"This is the intestines - or in other words, this is what is blocking the lady's intestines and making her belly bloated so big."
Grete explained confidently. He looked back at Elder Wood and made gestures with his hands:
"Remember, you can see the multi-layered trapezoidal intestinal pattern and peristaltic waves - Elder, do you have a long empty tube here? I want to listen to the bowel sounds!" Damn it, I didn't bring a stethoscope...
"I'll have someone look for it." Elder Wood put down his paper and pen, stood up and was about to go out. Master Tolga grabbed him and said, "Why do you need so much trouble? I'll do it!"
He stretched out his hands and pulled the air. A straight round tube immediately appeared in the air, hollow, translucent, and as thick as a palm. Grete let out an "ah" sound:
Magic trick! This is using magic tricks to shape the void! How could he not think of it before! Yes, although he can't make a stethoscope, he can still make one with a round tube! Magic tricks are apprentice-level magic, and he can throw several in a day
Ten, the consumption is almost negligible!
He thanked him, took the stethoscope, and put it to his ear. He pressed one end against Iris's abdomen, his face immediately became serious, he breathed evenly, and listened attentively. He flexed the five fingers of his free left hand and counted one by one:
"Remember, abdominal pain is accompanied by high-pitched bowel sounds, which sound metallic..." Bowel sounds can reach more than 10 times per minute, and the sound is loud, "hyperactive bowel sounds."
At this point in the physical examination, the symptoms had been basically confirmed. Grete still did not dare to be careless. He pressed carefully from the liver and spleen downwards to make sure there were no other lesions before getting up and washing his hands. The old magician followed beside him anxiously.
Urgent inquiry:
"It's just that her intestines are blocked, right? Give her some laxatives to clear it up, right?"
"It's not that easy..."
Gretel glanced at him speechlessly. Mechanical intestinal obstruction was confirmed, but where was the obstruction? Is it complete or partial obstruction? Simple or strangulated? Is there volvulus? Intussusception? Intestinal perforation?
Besides, intestinal obstruction is not necessarily caused by constipation. It can be cured by taking some laxatives... What if it is a foreign body? Is it gallstones? Is it a tumor? Even taking laxatives is useless!
He stretched out his hand to Elder Wood: "Elder, please lend me your oak staff."
"Are you going to use [Detection Magic] again?" Elder Wood handed over the oak staff with a smile, moved behind Gretel, released the spell, and opened his meditation vision. Soon, he frowned and his eyes were blank:
"What are you looking at?"
The old magician frowned even more than the elder. Gretel shrugged: He must not be able to understand. He doesn’t understand the structure of the human body and has never studied medical imaging. He doesn’t know what to look at when the film is placed in front of him.
Not to mention laymen, even novice doctors need to study for a year or two and watch hundreds or thousands of films before they can understand it!
He turned over the page and sketched the pictures he saw in his meditation field of vision. First, he took a lying flat picture, then asked Iris to stand up, activated [Detection Magic] for the second time, and then drew an upright flat picture.
.Based on the skills accumulated through years of drawing and explaining to patients, body contours, bones, organs, intestines, etc., quickly appeared on the paper.
The advantage of magic is that what you see is what you get. A healer can handle everything from examination to treatment by himself, without asking the patient to queue up for X-rays. The disadvantage is that as soon as the magic ends, the pictures in the meditation field disappear immediately, except for drawing them on the spot.
I think there is no way to preserve the image——
Hey, if conditions permit in the future, we still have to get an X-ray machine!
After drawing two plain X-rays - let's call them X-rays - and then drawing B-ultrasound images. After all were completed, Grete spread the three pictures into one piece and explained to the patient and the patient's family:
"Look, this is a flat film in the supine position. You can see the intestines - is it thicker than the one next to it? This is where the intestines are blocked. Here, here, the places with different brightness are pneumatosis in the small intestine.
Look at the standing position again, one ring after another, arranged upward like a ladder, this is the liquid-gas plane..."
"There are some clustered images here. The clusters are very large, exceeding..." Gretel gestured with his hand: "10 centimeters in diameter. Combined with what the elder said before, I feel a lot of messy life breath, I feel...
…”
The two old men's eyes were full of mosquito-repellent coils. Elder Wood was still trying to identify, remember, and recite, but Master Tolga had already grabbed him with one hand and Grete with the other. Steam was steaming from his forehead, almost smoking: