Practicing Medical Skills in a Small Clinic

Chapter 609: Chapter 280: Winning the Silver Medal, Director Yan Begins to Question His Life

However, because this disease is relatively concealed and the diagnosis is extremely difficult, the above tests alone are still insufficient for a definitive diagnosis.

Currently, the issue is basically pinpointed to the small intestine.

Moreover, the results of the second auxiliary examination basically confirm malabsorption in the small intestine.

To achieve a final diagnosis of this disease, at least a few more tests are needed, including even a pathological biopsy of the affected intestinal segment’s mucosa.

"Dr. Li, from the current examination results of the patient, it’s already certain that there are lesions in multiple segments of the small intestine. The type of diarrhea can also be determined. However, considering the patient’s long course of illness, I think it is very necessary to conduct some additional tests. For example, a fecal fat absorption test and a carbohydrate absorption test can determine the type and depth of the lesion."

Xiao Linlin’s foundational knowledge in gastroenterology, including obtaining clinical diagnosis criteria and the necessary procedures for a definitive diagnosis, is rather solid.

It’s just a matter of a bit of lack of experience and somewhat inflexible diagnostic thinking.

With more practice, she’s sure to achieve great things in the future.

"I completely agree with Director Xiao’s opinion."

Li Jingsheng’s thoughts coincided with hers.

Actually, at this point, any doctor with slightly higher competence would know what to do.

There are various methods for the fat absorption test.

The most commonly used is the fecal fat quantitative test, which is referred to as the gold standard for this examination.

Its accuracy is higher than that of the triglyceride breath test and fecal fat qualitative test.

After applying for these two tests, the results were almost immediate.

Neither of them was surprised by this.

The patient’s 24-hour measurement result was 8.3g, indicating fat malabsorption.

If this were diagnosed in Li Jingsheng’s clinic, he could tell if it was steatorrhea just by smelling the odor of the patient’s feces.

A foul odor suggests steatorrhea in ten out of ten cases.

If it’s a sour smell, it could indicate carbohydrate malabsorption.

This patient underwent the D-xylose test, and the result was around 0.4g, indicating a relatively widespread absorption dysfunction in the small intestine.

This corresponds with the imaging examination results.

At this point, a diagnosis of malabsorption syndrome can be made, with the lesion located at the small intestine mucosa.

"Dr. Li, is it necessary to further take a biopsy of the small intestine mucosa for this patient?"

Xiao Linlin felt anxious as her ranking slipped.

Li Jingsheng understood her meaning, as each additional test requested deducts one or two points, and each point is particularly important if one wants to place highly.

A loss of one or two points could directly cause her to drop to third place.

This patient has already undergone many tests.

Even though their diagnostic direction had always been correct, it still worried her a little.

"Let’s check it! This is also being responsible to the patient. Although it can now be determined as a small intestine lesion, with the patient having malabsorption syndrome, a biopsy of the small intestine mucosa is diagnostically significant. It can help differentiate adult celiac disease, Whipple’s disease, abetalipoproteinemia, folate deficiency, etc. Although ranking is important, the life and health of the patient are certainly more important."

Li Jingsheng gave his opinion.

After hesitating for a few seconds, she made a choice.

She applied for a small intestine mucosal biopsy.

The test results showed that the patient’s small intestine mucosa was thinned, the villi were shortened and thickened, some merged or even disappeared, crypts were significantly enlarged, with infiltration of chronic inflammatory cells.

No other benign or malignant intestinal lesions were found.

After viewing the results, the two exchanged a smile, both feeling a sense of relief and certainty.

The patient’s cause is very likely adult celiac disease, also known as gluten-sensitive enteropathy.

This disease is relatively rare and not easily detected, often misdiagnosed or mistreated as various intestinal diseases.

In the early days, before this disease’s medical knowledge was disseminated domestically, misdiagnoses and mistreatments occurred in several cities, counties, and even provincial hospitals. Several death cases related to it were reported.

Even today, many doctors still find this disease challenging.

Only some top-tier major hospitals nationwide have the diagnostic and treatment experience for such diseases.

"I’ve prescribed a gluten-free diet trial for the patient, and considering their extreme emaciation, I’ve strengthened nutrition and supplemented electrolytes and vitamins. Do you think there’s anything else that needs to be added?"

Xiao Linlin seemed to find confidence and gradually dominated the testing and treatment aspects.

She might have had decent competence all along.

"Great!"

Li Jingsheng felt that these treatments were completely sufficient.

To be honest, in terms of treating adult celiac disease, he might not be as skilled as Director Xiao.

His strength is in diagnosing the cause.

After Xiao Linlin submitted the diagnosis and treatment results, her ranking jumped from sixth to second place.

Currently, Lian Tao ranks first.

He’s ahead of her by just one point.

It seems that in this case’s diagnosis and treatment, Xiao Linlin had some point deductions, or some bonus points were not fully obtained.

However, this result far exceeded her expectations.

After a little over twenty minutes, the dust settled.

Xiao Linlin and Qiaobang Hospital’s Professor Mu You tied for second place, with People’s Hospital’s Lian Tao ranking first, and third place going to Luo Hou from Jiangli City Medical University Affiliated Hospital and Pang Xiangzhi from Yangyuan County Hospital of Traditional Chinese Medicine.

The difference between third and second place is also only one point.

It seems that in the field of gastroenterology, great doctors are much more numerous than imagined.

It must be mentioned that Jiangli City Medical University Affiliated Hospital initially gained its reputation through treating digestive diseases.

In earlier years, when Qiaobang Hospital’s laboratory was not yet strong, some tests had to be sent there for processing.