Chapter 1053: Chapter 1053: Urine Occult Blood
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(Thanks to "I’m just looking, not talking," caohuiyun8110, Tianyue Lone Star, lufengnian, Lu Tiezhu, Yiyi Myth, Ronghe, Langru Tie83 for the monthly vote encouragement)
"Teacher Wang, actually I also wanted to go to Director Xu to learn, but there have been too many things lately," Liu Banxia said with a smile.
"I need to understand what’s in my own bowl first, then I can think about what’s in others’. Did you just come to do rounds right after surgery?"
Wang Bo nodded with a smile, "Just sent a patient back to the ward, so I came to check on him. Discovered it very timely, it hasn’t affected growth, that’s great."
"We were just thanking Director Liu earlier, you said it was discovered so timely," the patient’s father also spoke up.
"Please don’t praise me anymore, it took a long time to diagnose," Liu Banxia quickly said.
He’s really hesitant to accept such praise from the patient’s family and Wang Bo, the diagnosis was timely but the surgery is the critical part. Moreover, in front of Wang Bo, he’s still a student and dare not act arrogantly.
Wang Bo also just came down from surgery, he needs to eat and rest. After saying a few words, he directly left. Liu Banxia and Wu Mingyu stayed slightly longer and accompanied him for a round.
"How’s orthopedics doing recently?" Liu Banxia asked.
Wu Mingyu nodded, "Not bad, having so many interns has been a great help. Of course, if you could bring in more, that would be even better."
"And for the attending doctors, can we push harder? There have been more trauma patients recently. Some fracture fixations and tendon sutures you can help with, but some we can’t handle."
"Hang in there, the interns will be selected, we need to train them ourselves," Liu Banxia said with a smile.
"Just like in general surgery, these six can hold half the fort. By the way, what’s the use of telling me this? Talk to Director Chen."
"Sigh...as if talking would help, it’s the same," Wu Mingyu said.
"You all need to work hard, handle as much as you can. We often run to the operating room, it’s tough."
Liu Banxia patted his shoulder, providing only spiritual support.
Currently, in the emergency center, a high proportion of trauma patients are car accident victims, often needing orthopedic consultations.
Even if the six interns or others can manage the initial treatment, they still need an orthopedic doctor to review and confirm there were no diagnostic errors.
This makes orthopedic doctors busier; the more patients they receive, the greater their workload.
There are still some issues they don’t need to handle, otherwise, they’d be even busier, and the current staff isn’t enough.
This brief chat with Wu Mingyu gave him a good understanding of the orthopedic situation.
In general surgery, adding an operation is straightforward, but not in orthopedics. For this patient’s surgery, Wu Mingyu couldn’t lead.
Back in the main hall, more patients arrived for consultations. Mornings are usually the busiest as everyone tries to come early, and peak hours often cause issues.
"Teacher Liu, all the tests are done, and all are negative. Only the urinalysis showed occult blood with two plus signs," Xu Yino reported after a while.
"There’s blood in the urine, could it be a kidney issue? Did you pay attention to the kidneys during the examination?" Liu Banxia asked.
"I did, and during the ultrasound, I carefully looked at the condition of the kidney stones on both sides. Although there are stones, they’re small and not blocking the ureter," Xu Yino replied.
"I’ve asked the patient to complete the admission procedures; at least we’ve identified some abnormalities, which should help, right?"
Liu Banxia nodded, "I’ll think over it. The cause of urinary occult blood is varied, and deciding what to check after admission is the issue."
Urinary occult blood is a complex condition with many causes. Generally benign situations are due to exercise-induced hematuria.
It’s like people say being tired results in urinating blood—resting well resolves it.
Another possibility is medication-induced hematuria, related to the drugs. Adjusting or stopping medication without kidney damage is manageable.
Excluding these, kidney diseases or urinary tract infections are considered.
As Xu Yino mentioned, stones and some tumors can also cause this symptom.
With two plus signs for occult blood, it’s a serious level. With three, it becomes visible hematuria.
That’s why the patient didn’t notice, as it hadn’t reached that level.
"By the way, did you ask the patient? Is it during their menstrual period?" Liu Banxia asked.
"I asked already, it’s not her menstrual period," Xu Yino said.
"Then let me take a look at the kidney ultrasound images. However, it probably isn’t a kidney issue; otherwise, it couldn’t have been overlooked," Liu Banxia said.
Xu Yino hurriedly operated on the computer and brought up the ultrasound video.
Liu Banxia stared carefully for a long time but didn’t find anything.
"Director Liu, Doctor Xu, I’ve completed the procedures. What’s the next check-up?" At this moment, the patient, holding her abdomen, hurried back.
"You lie down for a moment while I explain the situation to you, and then we’ll discuss it," Liu Banxia said.
"Doctor Xu must have already mentioned to you that the current test result shows two plus signs for microscopic hematuria, which requires our attention. This was not discovered in your previous examinations, right?"
The patient lying on the examination bed nodded.
"Although your condition hasn’t been clearly identified yet, I think this is actually good news. We can specifically investigate the symptom of blood in urine," Liu Banxia said.
"Do I need to continue with the urine tests?" the patient asked.
Liu Banxia nodded, "I suspect the microscopic hematuria to be related to kidney conditions or possibly a urinary tract infection. Your CT scan didn’t show any abnormalities with the kidneys, but we can’t just ignore it."
"So here’s the plan: today, we’ll provide some pain management, then tomorrow we’ll check your kidney function and perform a new urine test."
"This urine test will differ slightly from the previous one. We need a mid-stream urine sample for culture and sensitivity testing. As the project name suggests, we don’t need the initial urine flow; we only collect the mid-stream."
"The aim is to reduce the possibility of sample contamination, and it’s best to collect morning urine. Our nurse will explain the sampling procedure and what preparations are needed. I won’t go into detail here."
"Now try to recall if you’ve experienced any pain during urination, or your bowel movement frequency and pattern. Essentially, do you have symptoms of frequent or urgent urination?"
The patient nodded, "Sometimes there’s a bit of pain, but it’s not very severe. I used to clean regularly. Director Liu, if it’s a urinary tract infection, shouldn’t it hurt in the urethra rather than the abdomen?"
"The urinary tract is a term for the entire system," Liu Banxia said.
"I also reviewed your blood test report; indeed, the white blood cell count is slightly higher than normal, but it’s not alarmingly high."
"Currently, we’re only considering the possibility of a urinary tract infection. Tomorrow morning’s tests will provide more clarity. We’ll also add a cystoscopy to help us better understand the blood in urine condition."
"Later, Doctor Xu will accompany you to the ward and explain the cystoscopy procedure, and the mid-stream urine collection process."
This is one of those awkward situations where a male doctor diagnoses a female patient. Even with the compassion expected of a healer, it’s best to avoid certain issues when possible.
With Xu Yino present, Liu Banxia can be more at ease. Communication among women on these matters proves more effective than if he were to handle it with a stern face.
Cystoscopy is also a type of endoscopy, and it’s not particularly comfortable. Xu Yino needs to explain it to the patient ahead of time to prepare her psychologically.
Actually, Liu Banxia has considered the possibility of a tumor but feels it’s unlikely.
For a tumor to cause this level of pain, it would have to be at least stage three, possibly stage four.
At this stage, the tumor would manifest in various signs in the patient’s body.
If these tests don’t yield a clear result, he might have to consider neurological causes.
Though it’s not impossible, such tests are more challenging, so he hasn’t discussed this with the patient yet, deciding to wait for tomorrow’s results first.
Under normal circumstances, this patient could be transferred to urology. However, since the patient specifically sought him out, transferring her might lead to misunderstanding.
Furthermore, the latest test results will only be available tomorrow. If there’s anything he’s unable to resolve, consulting Wu Wenlin would still be timely.
He stretched lazily. Despite not identifying the condition directly, he’s not discouraged.
With system support, he can navigate diagnoses more smoothly, but this doesn’t mean every condition can be diagnosed in one go.
This is why mid-stream morning urine is tested; it offers the best accuracy and minimizes deviation. He needs the test data to reduce misdiagnosis and missed diagnoses as much as possible.
Literally speaking, he still hasn’t found a clear direction for this patient.
The discrepancy between the patient’s symptoms and possible conditions persists. If the kidneys indeed had inflammation causing such pain, there should be some manifestation in the lower back.
But this patient only has abdominal pain. If it’s merely an infection, the abdominal pain shouldn’t be this severe.
