Practicing Medical Skills in a Small Clinic novel Chapter 604

Chapter 604: Chapter 277: Severe Symptoms, Mild Biopsy Results. A Stubborn Gain

This patient is so sick yet doesn’t dare to go to the hospital, which is also a true reflection of most ordinary people.

This indicates that there is still much room for improvement and enhancement in healthcare coverage.

Li Jingsheng continues to look further.

The patient self-reports that starting more than a month ago, they began experiencing chest and abdominal pain. Upon immediate examination by the doctor, it was actually pain below the xiphoid process. After eating, there was persistent dull pain accompanied by abdominal bloating and decreased appetite.

No fever or diarrhea symptoms.

The patient’s weight began to steadily decline, losing about 5 kilograms within a month.

But has not gone to the hospital for diagnosis and treatment.

Losing this much weight within a month is considered rapid weight loss in a short time. Such a phenomenon needs to be taken very seriously, and the patient should immediately go to the hospital for examination to determine the cause.

However, the patient did not go to the hospital.

On one hand, afraid of spending money; on the other, possibly thinking that at their age, if it is a serious illness, they wouldn’t treat it.

Four hours before being admitted, the patient suddenly felt nauseous and then vomited dark red liquid four times, each time about one hundred and fifty milliliters.

Simultaneously experiencing dizziness and palpitations.

But no cough or sputum production.

Just thinking about it is scary—vomiting so much blood—and it’s not until four hours later that the patient hurries to the hospital for treatment.

Really don’t know if it’s ignorance or fearlessness.

The patient’s temperature is 36.5 degrees, pulse 80 beats/minute, respiration 21 breaths/minute.

Blood pressure 120/80 mmHg.

Consciousness is clear, but mental status is relatively poor.

No jaundice of the skin or mucous membranes, superficial lymph nodes are not palpable, no swelling.

Eyes are normal, only conjunctiva appear slightly pale.

After vomiting so much blood, it would be strange if they weren’t pale.

No congestion in the pharynx, neck is supple; heart and lungs present no abnormalities.

Abdomen is soft, slight tenderness under the xiphoid process, bowel sounds are active, approximately seven to eight times a minute.

Rectal examination showed no abnormalities.

Complete blood count result indicates hemoglobin 69g/L, red blood cells 2.6 times ten to the twelfth per liter, white blood cells 6.6 times ten to the ninth per liter, platelets 155 times ten to the ninth per liter, erythrocyte sedimentation rate 10MM/H.

Urinalysis is normal.

Fecal occult blood test is positive.

This indicates there is gastrointestinal bleeding and it has been going on for some time.

Generally speaking, after upper gastrointestinal bleeding, it takes at least a few hours to detect positive occult blood in stool.

The patient probably started with minor bleeding and paid no attention.

Later, it was repeated episodes of massive vomiting of blood before considering seeking medical help.

Aside from the tests mentioned above, no other test data was provided by the organizers.

It seems that contestants need to apply for themselves.

Li Jingsheng couldn’t help but think, if this case is currently being treated, what if the tests the contestants apply for haven’t been done by the patient?

The organizers might, as they did last time, directly send messages to inquire with the applying doctors.

As long as the applying doctor provides a reasonable explanation, the organizers will arrange it immediately.

"Director Xiao, I suspect the lesion is likely in the upper gastrointestinal tract. The patient’s vomited blood is dark red, in large quantities, and they continually vomited blood for four hours, so I estimate the likelihood of esophageal or pharyngeal bleeding is extremely low. It’s most likely gastric bleeding, so I suggest we immediately apply for an endoscopy."

In such emergency cases, timeliness is very important.

If the attending doctor is slow in diagnosing, the patient might wait until death for the last-arriving test results.

In extraordinary circumstances, extraordinary measures must be taken.

This is Li Jingsheng’s approach to treating such emergency and critical cases.

If the patient’s hemorrhage is not quickly identified and stopped, there’s a high likelihood of excessive blood loss leading to shock.

"Okay!"

Xiao Linlin is extremely trusting of him now, and she herself isn’t completely without skill.

She also has her own analysis and insights into the diagnosis of digestive tract diseases.

It’s just that her clinical practice level might not be as proficient as Li Jingsheng.

After all, Li Jingsheng’s gastrointestinal diagnosis has reached mastery, equivalent to the level of a top deputy chief physician in a major hospital.

"Wow, looks like you’re right again; the results came out directly."

She said happily.

Li Jingsheng leaned forward to check the results.

Gastroscopy shows nodular elevation of the antral mucosa with scattered superficial ulcers on the surface, poor motility, and easy bleeding upon touch. The duodenal bulb is normal.

After reading the gastroscopy results, he was stunned for a moment.

To be honest, it was a bit unexpected.

Originally, he imagined directly finding serious major lesions in the stomach or even cancerous lesions.

Now the feeling is that the expectation was too high, and the examination results are much milder than anticipated.

"No, whether it’s the patient losing ten pounds in a month, the positive occult blood test in stool, vomiting blood, or continuous pain, these all seem like symptoms that cancer alone could display."

This examination result is like a punch to the cotton, making him somewhat uncomfortable.

"Apply for a pathological biopsy!"

Li Jingsheng muttered a few words with a frown.

Actually, he should not use such a tone and expression while talking to Xiao Linlin.

Because she is a chief physician, the head of the gastroenterology department, and holds a position significantly higher than Li Jingsheng.

Fortunately, she doesn’t mind.

Moreover, she knows that it’s normal for Li Jingsheng to show such a focused expression when encountering problematic diagnoses.

Most doctors behave like this when facing issues.

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