The Love Story of the Doctor
Doctor Marof
" Dok, from the results that I just checked, the patient was exposed to Emboli of the macenteric artery, "Abigail told Reyhan.
Abigail went to see Reyhan in her room.
" Tell me about Abi's Masenterika atrial Embolism."
" The upper mesenteric artery supplies the entire small intestine, the large intestine is blind, ascending and partially transverse.
The source of upper brachial artery embolization is different. At 90-95% - these are thrombi in the left atrium, as well as thrombi in the mitral valve or aorta affected by prosthetic or pathological, migratory particles of atheromatous plaque.
The main clinical signs of upper mesenteric artery embolism:
* Sudden acute pain in the navel or upper right quadrant of the abdomen;
* Cold sweat;
*Vomiting;
* Diarrhea (not intentional, sometimes within hours);
* Intestinal bleeding (out of the anus blood or mucus stained with blood) - is a sign of an intestinal mucosal infarction; appears after a few hours;
* Bloating, slight pain in the abdominal wall during palpation;
* The appearance of symptoms of irritation of the peritoneum with the development of pathological processes (pronounced abdominal wall tension), which indicates necrosis of all layers of the intestinal wall and the development of peritonitis; during this period, the intestinal sound is lost;
* Vascular sound in the epigastrium;
* Blood pressure drop, tachycardia;
* Increased body temperature;
Pronounced leukocytosis;
" Increased pneumatization of intestinal loops on survey radiography of the abdominal cavity;
" Laboratory tests show leukocytosis, usually more than 20x10 9/l, with metabolic acidosis necrosis - of the intestine.
With radiographic examination of abdominal cavity organs, it is sometimes possible to detect air-filled intestinal loops with thinning walls, which allows suspect ischemia. However, according to most researchers, radiographic surveys of the abdominal cavity have no diagnostic significance. To confirm mesenteric ischemia in patients with suspected ischemia it is recommended to perform percutaneous hip retrograde arteriography. This study is considered the first stage of diagnosis. This can be done harmlessly in patients in such cases when there are no signs of peritonitis, the hemodynamic parameters are stable, normal kidney function is maintained, etc, and the patient does not have an allergy to contrast substances containing iodine, doc."
" There are also opponents of angiography. Their objections are as follows. First, in their opinion, people over the age of 45 may have visceral artery blockage that has varying degrees of severity, which does not cause any noticeable disturbance. Therefore, angiographic signs of mesenteric blockage, found in patients, will not help to know when this occlusion occurred and whether this is the cause of this symptomatology. Second, the absence of hagiographic data on blood vessel blockage for surgeons is not of decisive diagnostic significance and, if symptoms are present, peritonitis cannot and should not prevent it from laparotomy" Abigail said.
" As for most experienced surgeons, according to A.Marston (1989), they agree that angiography findings are far from always specific and, when in doubt, safer to operate patients. Nonetheless, they prefer to have angiographic data, starting surgery for suspected superior mesenteric artery occlusion.
Treatment of upper brachial artery embolism is surgery. Emergency surgery is performed - embobectomy and resection of necrotic intestinal sites. Prompt diagnosis and timely treatment contribute to better outcomes, but overall, the high incidence of mortality continues. Repeated embolization was observed in 10-15% of cases, " Abi said.
" Right Abi, refer to doctor Marof gastroenterologist ya Bi ".
" Well doc, I also had a consul yesterday about checking paaien to doctor Marof doc."
" Yes Bi, he's the master."
" You're getting rooted, you're learning a lot in the ER, so you're ready, preparing and thinking about your specialist later."
" Well doc, I'm sorry" Abigail said.
" Abi, our guest at the VVIP, Reyhan Smith, he just wants to, you handle, please pay attention to Bi, because his shares in this hospital are the biggest."
" Good doc, " said Abi nodding.
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