Section 204

Chapter 156 Can pancreatitis also cause pneumonia? Zhang Yi is really strong

"How can this pancreatitis lung CT scan be like this?"

Qian Zhenggang stared at the film for a long time and said.

At this moment, the gray-black film was stuck in front of the slide.

The film of this migrant worker showed diffuse ground glass density shadows in both lungs, with fine grids inside.

Deng Wei also thought to himself:

"This person doesn't cough, and there are no dry or wet rales in the lungs. How can this be the case on the CT scan?"

In fact, Zhang Yi had already noticed the abnormality of the patient's lungs at the beginning.

That's why he insisted on having a lung CT scan.

At this moment, while everyone was puzzled, Zhang Yi stood up.

"When I listened to the stethoscope, I noticed something was wrong. It sounded like a clear sound, but it didn't sound like it, but it wasn't dry or wet rales.

That's why I insisted on doing the test.

Now the results are out, which shows that my insistence was indeed right.

The patient's lungs had no dry or wet rales when auscultated, and pancreatitis was very clear.

It also further shows that the shadow on this CT film is a lesion in the interstitial lungs, not the alveoli.

So, I think this patient should have interstitial pneumonia in addition to the diagnosis of pancreatitis!"

"Ah? Interstitial pneumonia?"

"Pancreatic Inflammation combined with interstitial pneumonia? It's rare. "

Xiao Zhiwen hesitated for a moment and asked:

"It's not that serious, right? ! If you say it's interstitial pneumonia, why doesn't the patient have any respiratory symptoms?"

Deng Wei also doubted:

"It's just suppurative pancreatitis, and the area of ​​the glass density shadow in the lungs is also very small. The patient has no symptoms, neither hypoxia nor coughing. How can you be so sure?"

Seeing everyone's doubts, Zhang Yi was also prepared. He said:

"It may sound a bit far-fetched, but it's true.

This old man did not have any respiratory symptoms. Symptoms of shortness of breath or hypoxia may be because it is still in the early stage.

If you come to the hospital later, or one day later, the shadows on the lung CT may become denser.

Another point is that the cause of this interstitial pneumonia is actually related to pancreatitis.

During the onset of pancreatitis, the body will produce a large number of inflammatory cytokines and inflammatory mediators.

Its degradation products can easily cause drastic contraction of the capillaries in the lungs, leading to increased permeability of vascular endothelial cells, causing poor lung perfusion, and thus cell damage and dysfunction in the lungs.

It is just that it is in the early stage, and the patient's symptoms are very mild, or there are no obvious symptoms yet.

In addition, pancreatitis is also included in the many causes of ARDS.

And its occurrence mechanism is also very similar to interstitial pneumonia.

Both are caused by lung damage caused by inflammatory cytokines and inflammatory mediators.

But the reason why I ruled out ARDS is that ARDS will definitely have respiratory symptoms.

But interstitial pneumonia will not have them in the early stage, so in addition to drugs such as octreotide and omeprazole for the treatment of pancreatitis, glucocorticoids and diuretics should also be used. "

The words fell.

Everyone in the office stared at Zhang Yi in a daze.

Especially Deng Wei and Xiao Zhiwen.

This guy...

How did he realize so quickly that lung inflammation was caused by pancreatitis? ?

And!

Regarding auscultation of the lungs, Deng Wei had been practicing medicine for decades and he had never heard anything abnormal.

But this guy heard it right away!!

For a moment, Deng Wei felt that he had goose bumps on his arms!!

This guy's observation and judgment are really too strong!

Just now, the two of them were thinking about getting back at the pancreatitis...

Unexpectedly...

Killed by Zhang Yi again!

In patients with severe pancreatitis or low immunity, this kind of disease in which inflammatory cytokines damage the lungs does occur.

But the probability is very, very small.

It is so small that it is difficult for ordinary doctors to find that the cause of the lung problem is pancreatitis.

Either they will suspect that it is a sequelae left by previous lung diseases, or they will suspect that it is a viral infection of the lungs.

Anyway, it is difficult to associate the shadows on the lung CT with pancreatitis.

Oh...

I have to say that this young man Zhang Yi is really amazing.

He is so amazing that Deng Wei is a little tempted!

I wonder why Zhang Yi wants to stay in such a small place?

If he is recruited to West China, will he go? ?

After a period of silence, Zhang Yi wrote a medical order under the watchful eyes of the doctors.

At this time, the nurse in the emergency room also ran over and said:

"I don't know what happened to the patient with pancreatitis just now. I feel that he is breathing a little fast? And the fingertip oxygen saturation is 85%. Do you want to give him oxygen?

In addition, he still has a slight fever, the body temperature is 38.1℃, and other vital signs are normal."

Zhang Yi quickly replied:

"Yes, give him high-flow oxygen for one hour, and switch to low-flow oxygen when the oxygen saturation reaches 90%."

"Okay!"

The nurse responded and turned around to get busy.

In the office, the doctors of this hospital all looked at Zhang Yi with admiration.

Oh my, the boss is worthy of being the boss!

He just said there were no symptoms, but the patient's symptoms came immediately!

It's amazing!

Zhang Yi really deserves the position of assistant director~

Soon, the migrant worker's body temperature dropped after the infusion.

The amylase index was re-checked and also dropped.

Surgery should be scheduled next.

For purulent pancreatitis and free fluid, it is necessary to drain and remove the purulent and necrotic pancreatic tissue.

Originally, I was supposed to return to West China in the afternoon after I came to Tianhe to give a speech.

But the director of the emergency department told Zhang Yi to perform the surgery.

Deng Wei immediately became interested!

Zhang Yi is so good at suturing and clinical observation!

So...how about the operation in the operating room?

Deng Wei is very curious!

So, he said to Qian Zhenggang:

"Dean Qian, since we have been here for so long today, why don't I go up and observe the operation later?"

Qian Zhenggang smiled politely:

"It's just for observation. It's okay. Professor Deng doesn't need to be so polite! After all, the pile of milk tea and fruits in our department were all invited by you."

While talking, Qian Zhenggang also looked at the pile of milk tea and fruits in the doctor's office.

Each department was given nearly thirty cups of milk tea and some cut watermelon and mango.

After spending so much money, what's the point of having an operation?

The smile on Deng Wei's face suddenly solidified.

You bad old man, you are deliberately trying to make me happy, right?