Practicing Medical Skills in a Small Clinic

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.

"The biopsy results are out, indicating mild chronic inflammation of the gastric antrum mucosa."

Xiao Linlin felt slightly disappointed when she saw the endoscopy results.

It wasn’t that she wanted the patient to be seriously ill, but the findings didn’t match the severity of the symptoms.

Seeing the pathology biopsy results now, she instead let out a sigh of relief.

It seems like the possibility of stomach cancer is basically excluded.

Li Jingsheng, however, still had his brows furrowed after hearing this.

He reviewed the patient’s blood work and other test data again, his brows slightly furrowed, eyes fixed on the large screen, appearing very focused.

"Should we check a chest X-ray?"

Seeing other contestants diagnosing with all their might, Xiao Linlin grew a bit anxious.

She had barely pushed her score up to second place and was particularly eager to maintain it.

Even getting a bronze medal to take home would be good!

"Don’t rush to check the chest X-ray; the patient’s lungs are fine, and no obvious abnormalities were found in the heart either. I estimate there’s little chance of liver issues. With this amount of hematemesis, it’s certainly upper gastrointestinal bleeding. The persistent postprandial pain also indicates the antrum location. In some cases, treating the wrong element can happen, but the symptoms of this case all point to the upper gastrointestinal tract. I think we should recheck the stomach."

Li Jingsheng spoke with increasing determination, his gaze becoming persistent.

"But the gastroscopy and biopsy results all indicate just gastritis in the antrum! Should we repeat the checks?"

Xiao Linlin found herself feeling weak when facing these practical cases.

She had to rely on Li Jingsheng in many aspects.

This dependence made her feel ashamed, and she resolved that after this skill competition ended, she would go back and diligently study medicine, striving not to be so weak when participating in the skill competition again in three years.

"Don’t rush, let me think again."

Li Jingsheng calmly pondered repeatedly, ruling out various cases that matched the patient’s symptoms.

"The patient’s bleeding volume is so large; if it’s just mild gastritis in the antrum, it can’t cause this. I suspect the biopsy took tissue from the superficial mucosa, so there’s a possibility of misdiagnosis or missed diagnosis."

Thinking it over, the only possibility Li Jingsheng could think of was this one.

"Apply for an endoscopic ultrasound, then apply for a biopsy of the deep tissue in the gastric antrum."

Li Jingsheng said to Xiao Linlin.

"This... shouldn’t we reconsider? We’ve already done gastroscopy and biopsy, and found no big issues; I estimate the results would be almost the same with more checks. Qiaobang Hospital’s instruments, equipment, and lab tests are known for their precision."

Xiao Linlin didn’t agree this time.

She even thought Li Jingsheng might be trying to replicate his success from the previous case using an endoscopic ultrasound.

Although, compared to ordinary endoscopy, endoscopic ultrasound is more precise; it can check up to five layers or even nine layers of the gastric wall’s sonographic image.

Ordinary endoscopy only examines the surface layer.

This is indeed a significant breakthrough in medical progress.

"Director Xiao, please trust me one more time. This is an emergency patient, and we can’t delay. The earlier we apply for this examination, the higher our score will be. Even if we fail, we’ll only lose up to 4 points."

Li Jingsheng could only persuade her gently.

In some decisions, women are generally less decisive than men.

"Alright!"

She ultimately chose to agree.

Li Jingsheng’s gaze was particularly sincere and full of confidence.

Refusing would be a blow to Li Jingsheng, and their collaboration might break down because of it.

Xiao Linlin’s thoughts were simple; second place was secured with Li Jingsheng’s help, losing it wouldn’t be too bad.

Once she stopped fearing loss, she decisively applied for an endoscopic ultrasound and biopsy of the deep pathology tissue of the gastric antrum.

"Oh my God..."

She just finished applying and was so excited she clenched her fists and let out an extremely excited shout.

This action immediately drew a lot of attention.

Medical staff from other hospitals exchanged surprised looks at her.

"Director Xiao, please mind your influence and control your emotions!"

Vice Dean Jin was genuinely surprised; he didn’t expect her—over forty-five or six years old—to still be so unsteady like a young girl.

How could this be?

She’s the leader of the second hospital’s gastroenterology department and at the helm.

She must remain composed.

Vice Dean Jin even thought of discussing it with her after the competition ends.

"Sorry, sorry, I’ll pay attention next time."

She apologized repeatedly, but couldn’t suppress the excitement and smile on her face.

Seeing her expression, Vice Dean Jin’s eyes brightened; it seems there’s another achievement here!

Good news.

"Dr. Li, you’re my hero!"

She said to Li Jingsheng.

"Ahem... um, Director Xiao, please be mindful of your influence. I’m no star, or your idol."

Li Jingsheng dared not accept her words.

"Haha, slip of the tongue. No, I mean I was overly excited. Quickly look at the results of the recheck."

She remembered the urgent matter and hurriedly urged Li Jingsheng to check.

The recheck results showed the patient indeed had stomach cancer.

This meant Li Jingsheng’s previous inference was correct.

The patient’s first gastroscopy and biopsy only examined the surface layer.

"Judging by the results and depth of the lesion infiltration, surgical resection might be curative. But it may need to be supplemented with chemo and radiotherapy."

After reviewing, Li Jingsheng’s face showed a relieved lightness.

This condition was almost missed.