Healing Doctor

Chapter 669 Abdominal Pain Caused by High Blood Pressure

"Director Lu, we do not recommend surgery," the consulting experts from the hepatobiliary surgery and gastrointestinal surgery departments said in unison.

They exchanged a glance, then looked at Lu Gang at the same time.

The opinion is clear: the surgeons feel this is a false accusation, so none of them want to take the blame.

Similar cases have occurred in clinical practice, although not very frequently.

In cases of acute abdominal pain, if you open the abdomen only to find nothing wrong, it will be embarrassing for whoever performed the surgery.

What if I can't find the problem? Should I just close it?

If the patient experiences pain again after the procedure, how do you explain this to the patient's family?

Therefore, in such situations, the only option is to organize a consultation on stage.

Faced with patients whose abdomens are opened, doctors in the operating room are at a loss. They can't really do what the jokes say, just put a zipper on the patient's stomach and unzip it whenever they want to look.

However, without opening it for a look, current examinations do not support the diagnosis of internal diseases.

That's where the disagreement lies.

Lu Gang frowned and sighed. "I'll call Director Bai and ask for his opinion."

The meaning is quite clear: if they want to go up on stage for a quick look, the medical affairs department must take the blame to reassure the clinical surgeons.

"Director Lu, fellow doctors, there's a detail about the patient that I don't know if you've noticed." Ji Xiang suddenly broke the awkward silence.

"What details?" Lu Gang had already taken out his phone, ready to call Director Bai. He asked while searching for Director Bai's number.

Although Ji Xiang started rambling on and on, he did not stop Lu Gang's actions.

"The patient recovered on his own during the first two hospitalizations. Once, he almost didn't need surgery. Before the surgery, the patient refused because his abdominal pain had subsided. Later, after he fully recovered, he was discharged on his own."

"I know, I just said that." Lu Gang started pressing buttons on his phone to dial Director Bai's number.

"Each time the patient was hospitalized, his blood pressure was very high, and he was given antihypertensive medication via infusion pump. The patient had a history of hypertension for 2 years, during which time he did not take oral antihypertensive medication; the only way to lower his blood pressure was through the infusion pump during his hospitalization."

Lu Gang pressed the last button, his finger hovering in mid-air.

"High blood pressure and abdominal pain are unrelated. If it were an aortic dissection, the patient would probably be long gone by now," said the gastroenterologist.

"I think it's related. The timing for this blood pressure medication infusion is about right, and I just asked the patient, and he said his abdominal pain has been slightly relieved."

"It could also be numbness from the pain?" the gastroenterologist said.

He looked down on Ji Xiang.

Director Lu was clearly preparing to consult Director Bai of the Medical Affairs Department, which proves that Director Lu is inclined to perform surgery and exploratory laparotomy.

Ji Xiang suddenly jumped out to block him, leaving the difficult patient to himself. Wasn't this just asking for trouble?

He stared coldly at Ji Xiang, believing that whatever Ji Xiang said was wrong.

Although his tone was unfriendly, Ji Xiang didn't care. Instead, he smiled slightly and said, "According to the medication dosage, my blood pressure should drop to around 150 in half an hour, and the pain should be relieved by then."

"Xiao Ji, don't talk nonsense," Lu Gang said in a low voice. "Acute abdominal pain caused by high blood pressure? Do you think your diagnosis makes any sense?"

"Director Lu, yes, we do." Ji Xiang also lowered his voice, as if whispering to Lu Gang.

The office was quite quiet, but you could still hear what they were saying if you listened carefully.

Is there a connection between high blood pressure and abdominal pain?

If Ji Xiang were just an ordinary resident physician, he would probably have been kicked to the Department of Science and Education by his department and wouldn't even be issued a residency certificate.

"What kind of logic is that! You're kidding me." Lu Gang was a little unhappy, but unlike when he spoke to other doctors, he didn't directly resort to sarcasm.

"An overactive sympathetic nervous system and increased release of vasoconstrictive substances such as renin and angiotensin II lead to a sharp rise in blood pressure, spasm of small blood vessels throughout the body, and a decrease in circulating blood volume. This reflexively activates vasoconstrictive substances, resulting in further vasoconstriction and the production of inflammatory factors."

"At the same time, elevated blood pressure leads to damage to the vascular endothelium. The combined effect of the above factors results in a significant increase in tissue exudation, leading to ascites and perirenal effusion. With effective control of blood pressure, the polyserosal effusions disappeared, the abdominal signs disappeared, and diagnostic treatment ruled out surgical diseases of the abdominal organs."

"Anyway, if the blood pressure is too high during surgery, anesthesia can't be administered. The anesthesiology department will have to wait until the blood pressure drops a bit before proceeding. Let's just wait and see."

Ji Xiang said it in a relaxed and carefree manner.

The door was pushed open at some point, and Lin Jiu walked in and stood in the corner, staring blankly at Ji Xiang.

Ji Xiang's points were all reasonable, but Lin Jiu, in his ten years of clinical work, had never encountered a similar case.

This logic seems clear, but it actually only exists in theory.

It's not that it's unreasonable, but rather that it's too idealistic.

However, Ji Xiang's last sentence was correct—the patient's blood pressure was too high, and the anesthesiology department had to wait until the blood pressure was under control before going on stage.

suddenly!

A thought popped into Lin Jiu's mind—the patient had backed out at the last minute during his second hospitalization and was about to have surgery when the pain suddenly subsided.

Could it be that the patient's blood pressure went down and the abdominal pain stopped?

Although Ji Xiang's judgment was unfounded and seemed "untenable," his connection to the patient's actual situation felt remarkably accurate.

"Hmm? Let's wait and see?" Lu Gang asked.

"I suspect the acute renal failure is also related to hypertension, but fortunately the patient did not develop complications such as aortic dissection due to malignant hypertension." Ji Xiang smiled and said, "Let's wait and see. The anesthesiologists haven't arrived yet, and even if they do, they won't take the patient."

That's right.

Thanks to Ji Xiang's "muddying the waters," the internal medicine and surgery departments reached a basic consensus—to lower blood pressure first.

Regardless of whether surgery is performed or not, lowering blood pressure is essential.

Lin Jiu looked puzzled and silently watched Ji Xiang, pondering Ji Xiang's words in his mind.

These words... sound like a joke, like trying to smooth things over, but they don't sound like medicine at all.

But Lin Jiu had a feeling that the patient's stomach pain might really stop once his blood pressure went down.

Time flies.

Forty minutes later, everyone arrived at the ward together.

The patient's blood pressure was 155/80 mmHg, and there were signs of relief in the board-like abdomen; it no longer felt as hard as a board to the touch.

Moreover, the patient reported that his symptoms had improved, and just like during his previous hospitalization, he expressed significant dissatisfaction with the surgery.

From the patient's perspective, if some medicine can solve the problem, why go through open surgery?

After observing the patient's condition and conducting a thorough physical examination, and ordering all the necessary tests to be performed at the bedside, Lu Gang tidied up the strand of hair that had fallen out.

"No surgery needed, go back to your office."

(End of this chapter)