Practicing Medical Skills in a Small Clinic

Chapter 608: Chapter 279: Diagnostic Compass, Malabsorption Syndrome

The patient is ignorant; otherwise, he should have sought a more authoritative hospital for diagnosis and treatment long ago.

Some diseases are most feared when delayed.

Originally, it might have been a minor illness, but the longer it drags on, various complications emerge, turning it into a severe condition that even experts frown upon.

Li Jingsheng instinctively reexamined the patient’s several routine test reports.

The stool routine has already been reviewed, and even tests for occult blood, parasites have given direct answers.

"Could it be infectious diarrhea?"

Li Jingsheng looked towards Xiao Linlin, who was also pondering deeply.

"Director Xiao, should we apply for a stool bacterial culture for the patient?"

This reminded him of Director Yang from the People’s Hospital, who was criticized as an expert only good at examining stool by the patient’s family.

However, in the face of such tricky diarrhea, a stool bacterial culture is very necessary.

"OK!"

Xiao Linlin now almost always complies with his suggestions.

After the application, the test results were released almost instantly.

Indicating that the attending physician had also checked this item when examining the patient.

"Stool bacterial culture is negative."

Xiao Linlin reported the results to him.

"That indicates there’s no infectious diarrhea."

Li Jingsheng used this result to rule out many suspected diseases.

His gaze shifted once again to the blood test report.

Hemoglobin, serum protein, electrolytes, calcium, phosphorus... and several other items were examined and tested.

Because the patient’s etiology is indeed very complex.

Parasites and bacterial infections are the most common causes of diarrhea.

Both have been ruled out.

Then it can only be examined from other directions.

The patient’s hemoglobin is 90g/l, total serum protein 54g/l, albumin 35g/l, serum potassium 1.4mmol/l, sodium 139mmol/l...

After looking, Li Jingsheng found multiple abnormalities in these data.

Blood tests are one of the routine checks done for many patients upon admission.

It’s not a mandatory check, but basically, seven out of ten patients undergo blood tests.

Some patients don’t understand and think the hospital is making a profit unfairly.

Some even believe rumors, saying the hospital intentionally draws the patient’s blood and sells it.

Really, it leaves one speechless.

Occasionally encountering special cases, drawing more blood samples for medical research indeed exists.

But to say that patient’s blood is drawn for sale, it’s astonishing how rumor-makers can think so creatively.

After viewing the blood test results, Li Jingsheng began to re-analyze the type of diarrhea.

Diarrhea can be classified into four types based on the mechanism of onset.

The first type is secretory diarrhea.

This diarrhea results from increased secretory substances, causing excessive secretion or weakened absorption of water and electrolytes in the intestine, ultimately leading to diarrhea.

It’s relatively common.

The second type is exudative diarrhea.

The integrity of the intestinal mucosa is compromised due to inflammation, erosion, ulceration, and other lesions, causing a large amount of exudate, leading to diarrhea.

The most common is enteritis diarrhea.

Getting cold, eating unsanitary food or stimulatory meals can lead to stomachaches and diarrhea.

Usually, after diarrhea, the stomachache disappears, and the illness is cured.

Sometimes these diarrhea cases, viewed by doctors, also demonstrate a form of self-repair and healing by the body.

It expels harmful substances and bacteria massively through diarrhea, alleviating the body’s immune system burden.

This is why after diarrhea, the illness is cured.

The third type is osmotic diarrhea.

This can easily be confused with exudative diarrhea.

Actually, they are completely different pathological mechanisms.

Osmotic diarrhea is due to poor digestion and absorption, or ingesting indigestible solutes, which raises the osmotic pressure in the intestinal cavity, causing a large amount of fluid to passively move from the intestinal wall to the cavity, eventually resulting in diarrhea.

It can be understood as forcibly squeezing fluid from the intestinal wall into the intestinal cavity.

Then causing diarrhea.

Even doctors developed an enema method based on this pathological mechanism.

This method can treat various diseases.

For instance, helping the intestines expel toxic and harmful substances. In cases of pesticide poisoning, sometimes not only vomiting, or gastric lavage are used. Enema and blood dialysis are also viable methods.

And before a colonoscopy, to ensure a smooth examination, enemas are also conducted.

Simply fasting and staying hydrated aren’t enough to clean the intestines thoroughly.

During a colonoscopy, contents like feces are likely encountered.

However, the enema method was later adopted by island country teachers, for unknown purposes.

Osmotic diarrhea has a characteristic; the daily stool volume usually totals less than a liter, with watery stools free of pus or blood.

If carbohydrate absorption is poor, it has a sour odor.

Poor absorption of fats and proteins leads to a foul odor.

Recently, a peculiar profession called odor testers has emerged, specializing in smelling others’ flatulence to determine if certain diseases exist.

This has some similar effects as the traditional Chinese medical method of olfactory diagnosis.

The smell of feces can indeed help doctors diagnose many diseases.

However, olfactory diagnosis in traditional Chinese medicine involves not only the sense of smell but also auscultation.

In short, Chinese culture is extensive and profound; a single word can have a variety of meanings and interpretations.

Li Jingsheng, upon pondering this, began to narrow down the cause of the patient’s illness to osmotic diarrhea.

Although secretory diarrhea also has causes like endogenous secretagogues and bacterial enterotoxins, the patient’s stool characteristics and diarrhea condition do not align with this mechanism of diarrhea.

Therefore, after thorough analysis and differentiation, Li Jingsheng ultimately concluded that osmotic diarrhea was the most likely cause.

"Director Xiao, let’s apply for a 48-hour fasting experiment to observe the results. The aim is to ascertain whether the patient’s diarrhea symptoms significantly lessen after fasting."

Once Li Jingsheng had a diagnostic direction, he often worked cleanly and efficiently.

"Alright!"

Without any superfluous words, she applied directly.

The collaboration of a team requires time.

Only by understanding other team members’ temperaments, personalities, professional levels, areas of expertise, and performance in practice can a high degree of tacit understanding and a trusting relationship be established.

After cooperating with Li Jingsheng twice, Xiao Linlin almost fully accepted his examination opinions.

She would only question if there was a clear issue.

"The results are in. After fasting, the patient’s diarrhea symptoms significantly eased and eventually stopped."

This experiment isn’t understood as laypeople might think, that the diarrhea stops simply because there is no food source in the intestines after stopping eating.

This understanding isn’t wrong either.

But in the eyes of a doctor, it carries more diagnostic significance.

Based on the changes in diarrhea after fasting, one can deduce the specific type of diarrhea.

Some suspected diseases can be excluded or further confirmed.

"Exactly, the intestines are indeed causing trouble. Let’s apply for a full gastrointestinal barium follow-through for the patient."

Upon reaching a conclusion, Li Jingsheng’s eyes became brighter.

Xiao Linlin submitted the application first and then asked, "Dr. Li, are you suspecting an intestinal absorption issue?"

"I can’t be entirely certain, but I can mostly narrow it down to osmotic diarrhea. Now we need to see whether there is a malignant tumor in the patient’s intestines; however, I believe this possibility is very low. I have some confidence in curing this patient."

Even though the cause hasn’t been fully identified, Li Jingsheng already had confidence in curing the patient’s illness.

This isn’t arrogance.

Rather, it’s the most precious professional intuition a doctor has.

It can be called predictive ability.

Essentially, once at the level of attending physician, this predictive ability begins to develop.

Then, through daily practice, this ability is constantly honed and strengthened.

By the time one is promoted to associate chief physician, this predictive ability becomes very strong.

Currently, Li Jingsheng has mastered gastroenterology diagnosis, so he is fully equipped with this predictive ability, and it is quite exceptional.

"My goodness! Dr. Li, your diagnostic direction seems to be correct again. After applying for this test, the results came out almost instantly. I really envy your diagnostic ability, always maintaining the correct direction without losing track. I also wish I had a ’compass’ to guide my diagnostic direction."

She was extremely impressed with Li Jingsheng.

Having a correct diagnostic direction allows a doctor to avoid many detours.

It is an immense advantage in diagnosing complex cases.

These difficult cases share one common feature: the cause is hidden deep within a foggy forest, and doctors often easily get lost in determining the diagnostic direction.

Li Jingsheng always manages to maintain the right diagnostic direction, perhaps not even realizing it himself.

This advantage is enough to make the vast majority of doctors envious.

No wonder he has been able to help chief physicians successfully diagnose one complex case after another multiple times.

"I didn’t even realize I had such an advantage. If there really is a compass like Director Xiao mentioned, I think it must be in the daily diagnosis and learning, accumulating bit by bit, constantly enhancing this ability, and then increasing the precision of this compass."

Li Jingsheng said with a smile.

"Let me take a look at the full gastrointestinal barium follow-through results."

Xiao Linlin pushed the tablet computer towards him, making it easier for him to view.

She was clearly the leader, but the actual situation turned into Li Jingsheng taking the lead.

Pulmonary and gastroenterology were the two fields Li Jingsheng was relatively adept at.

Gastroenterology wasn’t very strong initially, but later, with the help of the attribute panel, he crazily enhanced his skills in this area. After reaching a certain level of excellence in gastrointestinal and hepatobiliary diagnostics, he managed to successfully stand out.

The patient’s small intestine showed noticeable changes.

There were segmentations in the small intestine, snowflake-like changes, and significant coarsening of the mucosa.

Some intestinal dilatation and barium shadow dilution were also present.

After reviewing the barium follow-through results, he still felt somewhat uncertain.

"Can we go a step further and perform a small intestine enteroclysis, hypotonic duodenography, and a double-contrast barium enema? This would help determine if there are any organic changes in the gastrointestinal tract."

By this point, the general area of the lesion was more or less pinpointed.

However, to identify the exact cause, further examination is necessary.

Medicine is a rigorous discipline, and clinical practice should be approached with caution to ensure no errors occur.

"No problem."

She applied on the spot.

The results were almost immediate once again.

This time, after reviewing the results, Li Jingsheng had a slight victorious expression on his face.

The cause was finally unearthed.

It can basically be determined as malabsorption syndrome.