Practicing Medical Skills in a Small Clinic novel Chapter 776

Chapter 776: Chapter 361: The Doctor Is Anxious, But the Family Is Not—Persuading the Family

Yesterday, when he first examined the child, he suspected it might be appendicitis.

But today, while pressing down on the child’s abdomen, the tenderness wasn’t obvious. Especially in the right lower abdomen, the tenderness had noticeably reduced.

Could it be that the child’s condition improved after treatment at the hospital yesterday?

Today, measuring the child’s temperature, although there was still a fever, it had dropped to 38.2 degrees. This indicated that the fever was beginning to subside.

If the anti-infection and anti-inflammatory treatments are effective, and the local lesion is controlled, the pain would indeed reduce.

However, there was no change in the child’s blood pressure compared to yesterday.

He started suspecting that the child’s hypertension was not directly related to this illness.

If diagnosed separately, it would obviously be much easier.

The progression of the child’s symptoms seemed to him to align more with acute appendicitis.

If it truly is acute appendicitis and such a young child, the chance of perforation is extremely high.

If not treated promptly, it can lead to acute peritonitis, septicemia, etc., which are fatal.

He decided to investigate this case further.

After arriving at the hospital, he parked his bike and directly called Xiao Linlin.

"Sister Xiao, a child came to my clinic yesterday, and later went for a consultation in your department. A three-year-old boy, showing symptoms of hypertension, abdominal pain, vomiting, fever..."

He conveyed the child’s situation to Xiao Linlin.

"What’s the child’s name? I didn’t know about this child’s situation; it must have been handled by another doctor."

"The child is named Chen Huan, and he should be visiting your gastroenterology department soon for a consultation. I suspect the child has acute appendicitis, but when he came for a check-up at my clinic this morning, the abdominal pain had noticeably decreased. If possible, doing a rectal examination might be beneficial."

Li Jingsheng briefly explained the situation.

"Alright, I’ll ask around. Since you personally made the introduction, I know how to handle it, don’t worry."

Conversing with a mature and smart woman is just that easy.

Many things don’t even need Li Jingsheng to explicitly express.

...

Around noon, Li Jingsheng was still busy treating patients when Xiao Linlin proactively called him.

"Dr. Li, could you come over to the inpatient department in gastroenterology after lunch? The child has already been admitted and a rectal exam was performed, where a mass was palpated in the right anterior position, with a very significant tenderness response. Your diagnosis is likely correct; the child may not have acute gastroenteritis but acute appendicitis. The condition is rapidly progressing, and I’m a bit worried about issues arising.

Moreover, the cause of the child’s high blood pressure has not been identified.

Given your experience in cardiovascular diagnoses, it would be great if you could come over and take a look."

Through the rectal examination, Xiao Linlin felt a mass in the right anterior region, which exhibited obvious tenderness; the issue had essentially been identified.

In agreement with Li Jingsheng’s initial diagnosis, it can basically be concluded as appendicitis.

Early symptoms and signs of pediatric appendicitis are similar to mesenteric lymphadenitis and acute gastroenteritis, making misdiagnosis and mistreatment easy.

"I’ll come by shortly. Since a mass was palpated in the right anterior region, and the condition continues to deteriorate, perhaps we should consider performing an abdominal puncture to assess the situation?"

Li Jingsheng felt that Xiao Linlin should probably consider this as well.

Clinically, the intestinal perforation rate for children under five years old with appendicitis is as high as 44.5%.

In practice, it’s even higher than the clinically recorded rate of 38%-44%.

During the examination yesterday, the tenderness was severe; in today’s examination, the tenderness was not as evident.

It could possibly be because perforation has already occurred.

When the appendix is swollen, abdominal pain is intense. Following perforation, the pressure within the appendiceal cavity is relieved, causing the abdominal pain to temporarily decrease.

However, under these circumstances, the range of abdominal pain will expand.

Li Jingsheng was unwilling to treat the child at his clinic precisely for this reason.

If the child had indeed experienced appendix perforation, it would mean peritonitis has already developed.

At this point, the danger to life would become increasingly urgent.

"That’s why you need to come over! I’ve had enough of the two guardians; the nurses and intern doctors have talked themselves hoarse, yet they refuse to consent to this abdominal puncture. Watching the child’s condition progress and worsen makes me extremely anxious, while the guardians seem oblivious; I’ve really been stressed to the point of a stomach ache."

Xiao Linlin was venting putanguish concerning the two guardians.

If Li Jingsheng hadn’t personally made an introduction, she might not have wanted to deal with this matter.

"These muddled guardians, I’ll come over right away. Sister Xiao, please have your lunch first. This child will likely be transferred to general surgery for an operation soon; don’t let yourself get too upset."

Li Jingsheng truly felt like cursing those muddled guardians.

"Is this really how you console someone?" she jokingly scolded.

After they ended the call, Li Jingsheng continued attending to outpatient cases.

Thankfully, the last one involved an ankle sprain and displacement, accompanied by a minor fracture of the navicular bone. After reduction, it was enough for a student to apply the cast.

He hurriedly went to the canteen for lunch.

Thankfully, Ou Qinglan had already prepared his meal.

Whenever she helps with the meals, she always picks the best meat dishes, claiming it’s to bulk Li Jingsheng up a bit. She also states she likes men with some meat on them.

Li Jingsheng knows very well she’s just expressing her concern in a different way.

Only during mealtime does he have time to check messages on his phone.

"Jingsheng, the son of Secretary Bei has turned the corner. Several directors in critical care and neurology said the child is incredibly lucky; the fatality rate for acute viral encephalitis is extremely high. This time, it was a fungal cryptococcus infection, which is difficult to timely pinpoint the actual cause. If the cause were even slightly delayed in being discovered, the prognosis for the child could have been very poor."

Director Lian Tao from the People’s Hospital conveyed the good news.

The mortality rate for acute encephalitis is extremely high.

For children with this condition, the mortality rate is even higher.

Li Jingsheng played a significant role in saving Secretary Bei’s child.

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