Krafft's Notes on Anomalies

"Name?"

"Gris."

"No, I mean the child's name. How old is he?" Kraft quickly filled in Gris's name in the family column, indicating the patient's father.

They were sitting in an empty classroom. Lucius was sent to find two blankets. The patient would inevitably feel uncomfortable lying on the hard bench. The students who followed were stopped behind and given enough space.

The paper in his hand was pulled from the copy paper, with the second volume of "Human Structure" underneath it. The student next to him handed him an ink bottle with a wink. The tip of the pen quickly sketched on the paper, and the written words formed a string.

Although Kraft's handwriting is indeed good, the consultation records he writes are always crooked. I wonder if it is affected by some mysterious force.

"Liz, her name is Liz." Gris was a little frightened and answered Kraft's question quietly and quickly, as if Kraft would let it go if he was slower, "She is three years old this year."

The large group of men in black robes put a lot of pressure on him. They had already stepped back a little as requested, but it still felt like there was a bit more of an eerie atmosphere in the bright classroom.

"What's wrong?" Kraft asked while turning his head to look at the child lying on the chair. It's really hard to tell the gender of a child of this age without telling him. If he thought about it carefully, he would indeed see this child sometimes in the pub, but a pair of nondescript clothes made him always think he was a boy.

When this topic came up, Gris looked like he was about to cry, his eyes were red, but he still controlled his emotions and described the situation he knew in the clearest way possible.

"She seems to have eaten something two days ago and has been suffering from diarrhea. She thought she would get better in a few days, but she didn't expect her stomach to hurt even more this morning. She was so painful that she couldn't say a few words.

I took her to the church to get some holy water, and I also went to the clinic and drank herbal soup, but it was of no use. "

"What herb?" Kraft asked. He knew that holy water was just purified water that had gone through some strange rituals. It was not that he had never drank it when he was a child. As a placebo, it was harmless to say the least.

It’s hard to say about herbs. Few of the doctors who open clinics outside are college graduates, and all kinds of folk remedies are rampant, and they dare to add anything to the medicine soup.

This is not the kind of syndrome differentiation and treatment method of traditional Chinese medicine. The treatment method of Wendenggang amateur doctors is not so much for human use, but more similar to some green-skinned things that grow out of the ground. The main guiding ideology is " I'm thinking about it."

"Sorry, I don't know..." Gris was at a loss. "The priest said it was because I didn't believe in the Lord wholeheartedly. Shouldn't I let her drink those herbs?"

The nearly middle-aged man scratched his head in pain and almost pulled out his hair. In his eyes, this was a sign of death, and he might lose his only child.

"I didn't mean that." Kraft held his shoulders and tried to calm him down. "It doesn't matter if you don't remember. I have other questions to ask you."

…

…

It must be said that Gris is the kind of parent that doctors like most. In the panic and fear about his daughter's condition, he was quite calm, allowing Kraft to quickly ask for relatively complete information.

The patient is Gris' three-year-old daughter Liz. She suddenly developed fever and diarrhea two days ago, and her stool was as thin as water.

This is not an uncommon thing. It is completely normal for children of this age to have a bad stomach for no reason. Most of the time, parents don't care too much.

As a father who pays close attention to his children, Gris even took time to go to church to pray and brought her back some holy water.

But one day after drinking the holy water, Little Liz's condition did not improve, so the worried Gris took her to a nearby clinic and asked the doctor to prescribe a dose of herbal decoction.

Seeing that the color of the decoction was not normal, Gris decided to let Liz try it, but she died after trying it. Early this morning, Liz's abdominal pain, which was not serious at first, rapidly worsened. The stool she passed was not much, but it was bloody.

Anxious Gris took Liz to the church and clinic, but the priest just said that in this situation, he could only pray devoutly and wait for God's will. The doctor at the clinic had no choice but to take it out.

As someone who has owned a tavern next to the college for a long time, the last thing Gris could think of was to ask for help from people he knew in the college. Otherwise, he could only wait for Liz to miraculously recover on her own.

"I need to do a test, can I?" Kraft finished writing down the medical history and basic information on the paper. There are only a few details about the past history and family history. It is only known that Liz's mother also died of a sudden illness. Gris couldn't tell what the illness was, but Liz did not suffer from any serious illness since she was born.

"Okay, thank you." Gris nodded quickly. He didn't understand why he had to ask him for instructions, but judging from Kraft's attitude, he should take over.

"I mean a comprehensive examination that involves touching the entire belly, including the top of the thighs." Kraft glanced at the group of students behind him and felt that he had to explain it first, "I don't think this is suitable for too many people to watch. Mr. Guys, can you avoid it for a while? You can take this time to review why I have to ask so many questions."

"Yeah... no problem." Gris hesitated but agreed, preparing to go out with the students. Perhaps it was Kraft's seriousness that won him his trust, and he did not question it.

"Gris, come back. I'm talking about them. The family members stay with them to help comfort the child." The students quickly left the scene, and Kraft pulled Gris to the side of the child and began to check.

Kraft lifted his hair and touched Liz's forehead. The temperature was not high. The child's face was full of tears. If he wasn't crying, he probably had been crying for a long time and couldn't cry anymore.

In fact, he already had some idea in his mind. This kind of thing is one of the favorite things to talk about in diagnostics - acute abdomen, which is commonly known as "Doctor, I have a stomachache." Even if Kraft didn't have an extraordinary memory, he would still be able to use its contents skillfully.

A 3-year-old child has had diarrhea and fever for two days. It should be a digestive tract infection caused by some pathogen. It is very common in Wendeng Port where seafood is everywhere.

But today's situation is probably not the cause of the worsening of infection. The sudden decrease in bowel movements and the presence of blood may be due to an obstruction.

Craft touched the abdominal wall, which looked normal, and felt no obvious tightness or stiffness when he pressed down.

This made him feel a little relieved. It seemed that it was not serious enough to cause the leakage of fluid to irritate the peritoneum. Maybe it was not serious.

Following a fixed direction, he quickly found evidence to support his point of view. It was a mass on the right lower abdomen, which felt somewhat similar to a sausage.

The situation was okay, and Kelat was completely relieved. It must be intussusception. At this location, we can make a bold guess that it is ileocecal intussusception.

At the junction of the small intestine and the large intestine, a section of the ileocecal part of the ileum was inserted into the large intestine. One layer of the wall became several layers, and it was immediately blocked. It is not uncommon for children whose intestinal function is prone to disorders, and it is one of the most common acute abdominal diseases treated by pediatric surgery.

This unlucky child may have viral diarrhea, which itself is a risk factor for intussusception, and then he drank some weird herbal decoction, which naturally led to intussusception.

This diagnosis process was quite smooth, allowing Kraft to find a bit of the feeling of responding to the teacher's questions in a case discussion class, and confidently giving answers after finding all the evidence.

Logically speaking, the next step is to confirm the diagnosis through imaging examinations, but unfortunately there is no B-ultrasound here, and we cannot do standing abdominal X-rays. Don't even think about a 100% diagnosis.

He covered the child with clothes again, picked up a pen and paper and wrote out "preliminary diagnosis" at the end of the page. He combined the words "intestine" and "introduction" in Norse, and reserved a line below. space.

When he has free time, he has to add a line of explanation below. Ever since he became a lecturer, he has to leave space for noun explanations everywhere. It has almost become an occupational disease.

He raised his head and explained to Gris: "You can understand that one section of her intestines was inserted into another section, and then it was blocked. Do you remember when she started to feel pain?"

"Probably before the bell tower rang twice, I took her to the church. I can't remember the exact time."

That was probably between an hour and a half to two hours, which was a blessing among misfortunes. If it is discovered in time, even if you go to the church first, the intestinal necrosis has not yet occurred at this time, and it can be solved with non-surgical solutions.

So what is the non-surgical solution?

"No..." Kraft murmured, and his worries that he had just put down were immediately raised again, just like when he was stuck at the last step of a high-level math problem and found that everything was fine, but the amount of calculations was not enough. Not coming out.

"What's wrong?" Gris also became nervous. Obviously Kraft had just explained the cause of the disease to him, but now things seemed to be complicated again. The most fearful thing at this time is the doctor's "smile gradually disappearing" expression.

Kraft didn't answer him. A serious question was in front of him, blocking the last way.

The standard answer he knew in this case was an air enema, which could easily resolve most early-stage acute intussusceptions like Liz's.

But this requires corresponding equipment. He is not a machine maker, and he has no idea how this thing can control the air pressure and inflate the intestines back to their original position without perforation.

Even if he knew how to make it, could he just make a machine out of thin air? To put it another way, even if the God of the church appears on the spot and creates a machine for him, how can he confirm that the reset is successful without B-ultrasound, X-ray and other imaging examinations?

The air enema plan didn't work, so the only traditional method left was that Kraft had to use surgery to get Little Lisi under the knife and use a traumatic but more direct and effective method to get the intestines back.

But air enema doesn’t work. Can the operation be performed under this condition? To perform surgery without anesthesia and without sterility, it would be better to pray to God to send an angel to send him an air enema machine.