Chapter 175 Mechanical Intestinal Obstruction (Two Chapters in One)

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 in hand, her emerald green eyes flickering slightly as she looked at Elder Wood, then at Grete. Later, they fell more on Grete.

Gretel glanced at her, and Selina nodded slightly at him, with a smile in her eyes. Then, he pointed at the girl on the bed and made a mouth shape silently. A pair of beautiful eyes full of tears, obviously asking: What disease is it? 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 Grete, what do you think?"

"I..." Grete opened his mouth to tell 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. Grete jumped up immediately:

"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 half of the notebook had already been memorized. He flipped to the latest page, looked at the girl on the bed, and gave him 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 so big in the first place?"

"of course not!"

"Does your stomach hurt?"

"A bit..."

"Does it hurt all the time or does it come and go?"

"In a moment..."

"Is it bloated?"

"A-a little bit..."

"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. Grete raised his head helplessly, extended his hand to Elder Wood, and continued to write rapidly:

"03.12

Iris Mainland, female, 17 years old.

The abdomen is 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 anymore. 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, and was stunned on the spot:

"You have to ask all these questions?"

"Ask everyone."

"Do you really have to ask?" The female knight tapped 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!" Grete put down the pen, clasped his 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. Gretel quickly picked up the stool and rolled it up. He consciously avoided the curtain and waved to call out the two elders. He sat down against the curtain with his notebook in his arms, raised 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 is no improvement - what the hell is this medical record? If you put it back, people will laugh to death!"

Complaints are complaints, but records should still be recorded. Thank God, this is an outpatient clinic - Grete took it upon himself to classify the patient as an outpatient clinic - so there is no need to write medical records in the inpatient format. Otherwise, just two or three pieces of paper would not be enough to write the admission record.

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...

There were whispers in the curtain for a while, and then the female knight opened the curtain and came out, her cheeks slightly red, and she threw the paper into his hand. Gretel hurriedly scanned it and saw that it was similar to what he had dictated. He only added a few sentences before closing the book and walking 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 asked eagerly. Grete nodded helplessly:

"It must be like this. I have to verify something - not rely on eyesight, ears hearing, divine magic or magic detection, but must touch and press with hands."

This is how treating a female patient is like... palpation and other normal methods in medical diagnosis and treatment, and the consent of the parents and the patient must be obtained first. Grete sighed secretly. If possible, he didn't want to cause such trouble - but the patient was right in front of him, and it was 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 while:

"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 Grete:

"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 motionless curtain, then at Elder Wood, lowering his head in thought. Elder Wood avoided his gaze and muttered quietly 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 and press it a few times with your hands, it doesn't matter, it won't hurt!"

"I..." The girl's snow-white cheeks had turned red, 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 let out a "hmm" sound like a mosquito.

Gretel: "..."

This won't work! Even though you are shy, you can't help but let me see you during the inspection!

"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, the whites of my eyes were not red at the same time...

Grete tried hard to recall the skin he had seen before, and wrote: "The skin and sclera are not jaundiced." Very good, liver lesions have been roughly ruled out, and the treatment pressure has been reduced by more than half. Next, start palpating!

He waved the female knight out, lowered his voice and whispered:

"Will you accompany her to the bathroom first?"

He also dragged the female knight in to accompany and testify, and in a soft voice explained to the girl what was to be done next. Then he rubbed his hands together and lifted the blanket——

Physical examination, begin!

Grete tried hard to control his expression so that he looked serious, yet gentle and kind. He lifted the blanket on the girl's abdomen, carefully observed and 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 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 that he was not very familiar with, so he had to think carefully about how to write them. Gretel's explanation has caught up:

"When you sit up or lie down, the shape of the bulging belly does not change significantly, 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. A puddle. Come on, exhale, inhale, exhale again, inhale again - remember, the bulge does not move with breathing. It means it is not caused by organs or masses under the diaphragm."

Every time he asked the patient to do an action, he would explain the reason, which made Iris' face turn 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——"

"It's not just that much to consider." Grete smiled faintly.

Belly enlargement - medically known as abdominal distension - is divided into global abdominal distension and partial abdominal distension. Just for total abdominal distension, there are three causes: abdominal effusion (ascites), abdominal gas, and huge mass. Ascites has three major categories and fifteen subcategories, with at least 70 or 80 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 time. Elder, come and see, there are long strips of protrusions on her belly - around her navel, right? She bent down and saw it very clearly from the side. Okay, Just pat it gently..."

After the gentle patting, the long bulges on the snow-white, high-bulging belly kept squirming, rising and falling one after another. Some are forward, some are backward, in different directions. Iris moaned softly: "It hurts——"

"It'll be fine soon, just be patient." Grete comforted softly. The old magician said in surprise behind him:

"What's this?!"

"This is the intestines - or rather, this is what is blocking the lady's intestines and making her belly bloated so big."

Gretel explained confidently. He looked back at Elder Wood and gestured 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 the pen and paper, got up and was about to go out. Master Tolga grabbed him: "Why do you need so much trouble? I'll do it!"

He stretched out his hands and pulled at the void. A straight round tube immediately appeared in the air, hollow, translucent, and about the thickness of a hand. Gretel said "Ah":

Magic trick! This is void shaping using magic tricks! How could he not have thought of this before! That's right, although he can't make a stethoscope, he can still make one with a round tube! The magic trick is an apprentice-level magic. You can throw dozens of them a day, and the consumption is almost negligible!

He thanked him, took the stethoscope, and put it to his ear. Pressing one end on Iris's abdomen, her face immediately became serious, breathing evenly, and listening attentively. Flex the five fingers of your free left hand and count one by one:

"Remember, abdominal pain is accompanied by high-pitched bowel sounds, which sound like metal..." Bowel sounds can reach more than 10 times per minute, and the sound is loud, "Hyperbowel sounds."

At this point in the physical examination, the symptoms have been basically confirmed. Grete still didn't 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 and asked anxiously:

"It's just a blocked intestine, right? Give her some laxatives to clear it up, right?"

"It's not that easy..."

Gretel gave him a speechless look. Mechanical intestinal obstruction is confirmed, but where is the obstruction? Is it complete intestinal obstruction or partial obstruction? Simple or strangulating? Do you have 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 the meditation field. Soon, he frowned and his eyes were blank:

"What are you looking at?"

The old magician frowned even more than the elder. Grete shrugged: I definitely can’t understand it. I don’t understand the structure of the human body, I haven’t studied medical imaging, and I don’t know what to look at when the film is placed in front of me.

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 the page and sketched the pictures he saw in his meditation vision. First, take a lying flat picture, then let Iris stand up, activate [Detection Magic] for the second time, and then draw an upright flat picture. Relying on the skills accumulated from years of drawing and explaining to patients, the outline of the body, 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, and there is no need for the patient to queue up for X-rays. The bad thing is that as soon as the magic ends, the images in the meditation field disappear immediately. There is no way to preserve the image other than drawing it on the spot——

Hey, if conditions permit in the future, we still have to get an X-ray machine!

After taking two plain X-rays—let’s call them X-rays—then take a B-ultrasound image. After all was completed, Gretel spread out the three pictures and explained to the patient and his family:

"You see, this is a lying flat film. You can see the intestines - is it thicker than the one next to it? This is where the intestines are blocked. Here and here, the places with different brightness are small intestinal gas accumulation. Looking 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 looked at the mosquito-repellent coils. Elder Wood was still trying to identify, remember, and recite, but Master Tolga had already grabbed him with one hand and Gretel with the other. Steam was steaming from his forehead, almost smoking:

"Then how to treat it?"

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Yesterday, several readers guessed correctly that it was parasites~~~ But medical diagnosis is not that simple! There’s still a lot to consider!