Gou is practicing medicine in the clinic

Chapter 112 Short bowel syndrome, the most frightening thing is poor disease

Li Jingsheng's eyes narrowed slightly, his expression became serious.

Blood in the stool often means gastrointestinal bleeding.

If it is upper gastrointestinal bleeding, black stools are often discharged.Because the blood produced has been absorbed by the lower digestive tract, and when it is discharged, it has turned black and is mixed in the stool.

At this time, routine stool examination can often give a positive result of fecal occult blood.

In fact, it can be seen visually.

The uncle is just an ordinary person, not a doctor. He found that there was blood in the stool he pulled out. In all likelihood, it was not black stool, but blood directly.

Based on this information, Li Jingsheng's proficient level of gastroenterology diagnosis preliminarily diagnosed that the patient was likely to have lower gastrointestinal bleeding.

As for which part of the bleeding, imaging examination is a good choice.

The conditions of small clinics are limited. X-ray abdominal plain films can detect some intestinal bleeding, but its accuracy is far inferior to abdominal CT.If conditions permit, barium contrast or colonoscopy may even be required.

Li Jingsheng directly dismissed the idea of ​​doing an abdominal ultrasound or X-ray for the patient.

That 'grandfather'-level X-ray detector is also capable of checking for bone injuries and other obvious lesions.

It is really difficult for it to detect lower gastrointestinal bleeding.

Judging by the way this uncle looks, even if it is a 100 yuan video inspection fee, he may find it difficult to agree.

The main reason is that it doesn't make much sense to do this inspection.

Even if it is an X-ray detector in a large hospital, it can only see intestinal paralysis at most, or mild or moderate intestinal dilation.If you want to confirm the bleeding site and get more detailed information, you have to do CT and barium contrast.

"Have you had blood in your stool for a long time?"

Although Li Jingsheng had given up the idea of ​​treating this patient, he still took this opportunity to accumulate more practical experience.

The attribute panel can increase the proficiency of diagnosis and medical skills, but the accumulation of knowledge still needs to be studied hard by himself.

Goldfinger can't create something out of nothing, generate a medical skill for him out of thin air, or give him knowledge.

The most is to help him better use the theoretical knowledge he has learned and use it skillfully in clinical practice.

"I'm afraid it has been more than ten days! It has become more serious in the past two days, and my stomach hurts badly. The stool I pulled out a few days ago occasionally had blood, but not much, and my stomach just hurts from time to time. It's fine."

The uncle has been drawing blood for so many days and has not been checked in the hospital.

The main reason is the fear of spending money.

People are poor and cheap, it is the same in any era.

Now if it weren't for the unbearable pain, I probably wouldn't even come to the clinic.

"In this way, you lie down on the treatment bed inside, and I will check your abdomen."

Li Jingsheng decided to give the uncle an abdominal tenderness examination first, at least to be able to pinpoint the approximate lesion area.

Appendicitis, for example, is usually pain in the lower right abdomen.

Upper abdominal pain may be caused by the jejunum, ileum, or even the liver.The pain at each site, as well as the different depths, can more directly reflect which organs or tissues the lesion is roughly located in.

"Does this inspection cost money?"

The uncle hesitated for a moment and asked.

"No charge."

Among the patients treated by Li Jingsheng, there are quite a few who are fussy about money, but few are as fussy as this uncle.

After all, after being ill, almost all patients just want to relieve the pain quickly.

As long as the treatment fee is not so expensive that it is unaffordable, it is generally not too fussy.

He secretly deduced that either the uncle's finances were already in trouble, or he was born with such a nature that he usually cares about every detail and is stingy in everything he does.

There are not many such men, but there are.

He is even more picky than women when it comes to buying clothes, trying to bargain for the price, taking advantage of all kinds of things.

After guiding the uncle to the treatment room inside, Li Jingsheng let the uncle lie down, lifted up his clothes and checked his abdomen.

I saw a long wound on the uncle's abdomen.

The suture marks are still relatively clear, indicating that the operation time should be within half a year.

"Have you had surgery recently?"

"Oh, don't mention it, about six or seven months ago, I was working one day, and suddenly my stomach hurt so badly. After I fell to the ground, I fainted from the pain. After the workers sent me to the hospital for examination, they said it was something intestinal. ...strangulated, and then I had an operation to cut off part of my intestines. Until now, I can’t work.”

When the uncle mentioned this matter, he shook his head and sighed again and again, with a sad face on his face.

Emergency surgery is needed to cut off part of the intestine, which should be internal hernia strangulation.

This disease occurs rarely, but it is prone to occur in middle-aged and elderly people.

Especially some middle-aged men who do heavy physical work, sometimes do not rest after meals, in order to do more work, they do heavy work as soon as they are full.

There is also a sudden excessive force when working, etc., which is prone to internal hernia or intestinal volvulus.

If not treated in time, intestinal necrosis will occur and be fatal.

Now I finally understand why this uncle had to ask many times whether to charge for the inspection and how much it would cost.

I haven't worked for more than half a year, and I am just an ordinary casual worker, usually with no savings.

It costs a lot of money to treat the disease, and there should be reexamination and medication in these seven months, which is also a long-term consumption.

Sitting and eating mountain empty.

Uncle is probably at the end of his rope now.

"Let me check your abdomen and try to relax."

Li Jingsheng began to press the uncle's abdominal pain area, and found that there was a certain degree of abdominal rigidity.

The abdominal wall is obviously tense, rigid, and hard as a board during abdominal palpation, which is not good.

Because only acute gastrointestinal perforation, organ rupture, acute peritonitis and other diseases will cause abdominal rigidity.

The uncle has blood in the stool, and has had blood in the stool for many days.

Now the blood in the stool is getting worse, and the abdominal pain is getting worse, which means that the condition is progressing and the condition is menacing.

"Is it painful here?"

"Ah."

"Just a little pain or a lot of pain?"

"It hurts."

As soon as the uncle finished answering, Li Jingsheng increased his strength a little.

"Aw... it hurts, it hurts!"

Li Jingsheng immediately withdrew his hand, he judged that the uncle's pain should be in the jejunum.

The small intestine is a part of the digestive tract that is divided into three parts: the duodenum, jejunum, and ileum.

What is more interesting is that in medicine, the boundary line that distinguishes the upper and lower digestive tracts is in the duodenum.

The suspensory ligament of the duodenum is also known as Trevor's ligament.

It acts like a 'boundary marker' for the upper and lower digestive tracts.

Above the ligament of Trevor, is the upper gastrointestinal tract.Below is the lower gastrointestinal tract.

The jejunum occupies about two-fifths of the length of the small intestine and is slightly shorter than the ileum.

Now the painful part is the ileum, further diagnosis needs to obtain more information.

"Okay, the examination is over, get up! When you defecate, is the color of the blood bright red or dark red?"

This is very important.

It can help Li Jingsheng roughly infer the intestinal segment where the bleeding point is.

Rectal bleeding is usually bright red, and the bleeding gets darker the higher you go.

Because it takes time from bleeding to excretion.

The longer this time is, the darker the color of the blood will be.

"Hmm... it seems to be dark red! When I wiped my butt, I found blood on the paper, and the color was darker. But it's definitely blood."

"Is there a lot of bleeding?"

"I feel a little big in the past two days, and the stool I pull out is a bit like jelly, a little white, and very smelly. It's a bit like the smell of rotting meat."

The uncle described the situation of the stool.

"Doctor, is my disease serious? Is there still treatment? How much will it cost?"

"Don't worry, let's go out and talk!"

As Li Jingsheng walked, he thought about what kind of disease the uncle had?

Judging from the defecation situation described by the uncle, there should be steatorrhea accompanied by pus and blood in the stool.

The uncle had undergone bowel resection, and he looked rough, with yellow hair, and a thin body.Clearly a sign of chronic malnutrition.

At present, I have abdominal pain, and the pain point is in the ileum, I have undergone surgery, and I have had blood in the stool for many days...

When Li Jingsheng's gastrointestinal diagnosis was just upgraded to the proficient level, Li Jingsheng felt that he would be able to easily catch all patients with gastrointestinal diseases in the future.The cause can be easily diagnosed.

At this moment, he felt that he was a little on the sidelines and overconfident.

When diagnosing this uncle, it was particularly difficult because of the lack of various inspection basis.

In order to make up for the lack of inspection basis, his diagnostic level needs to be at least one or two levels higher than that of doctors in large hospitals to barely equalize.

Because large hospitals can do medical examinations, if you want to diagnose the cause of this uncle, you may only need a senior resident physician level to suffice.

Li Jingsheng now obviously has the diagnostic ability of a junior attending physician, but he is still struggling.

This is also impossible.

There is not enough equipment, so we can only make up with technology.

Then again, when he has improved his diagnostic and medical skills to a very high level, when he comes to a big hospital, he will be able to 'step on a kindergarten and punch a nursing home' immediately.It can definitely beat the doctors in most large hospitals.

It's a bit like the difference between wild animals and domestic animals.

A wild wolf that can easily kill a domestic dog of equal size.

Li Jingsheng belongs to Yeluzi, the conditions are simple, but the skills honed will be particularly excellent.

"In addition to blood in your stool, do you still have diarrhea?"

"Correct!"

"How many times a day do you have diarrhea?"

"A few days ago, I probably had diarrhea two or three times a day, and today I have diarrhea four times."

The uncle has diarrhea, and the jelly-like white liquid that is pulled out is actually intestinal mucus.

"Do you know which part of the intestine you cut off?"

"It said that part of the small intestine was cut off, that is called... what kind of intestine, I forgot."

"Is it called the jejunum or the ileum?"

Li Jingsheng gave the uncle some hints.

The small intestine has only three parts, and the intestinal hernia and strangulation generally require either the jejunum or the ileum to be cut.

"Yes, yes, the jejunum was cut, I remembered."

With these further accurate information, Li Jingsheng finally had a diagnosis direction.

Judging from the patient's medical history, symptoms, pain site, and surgical resection of part of the small intestine, the uncle should have short bowel syndrome.

This is a relatively troublesome disease clinically.

The total length of the small intestine of an adult is about 4-6 meters, and it is not a big deal to remove a little bit.

Of course, the premise is that the doctor's surgical level is excellent, and there should be no anastomotic leakage or anastomotic stenosis when performing intestinal anastomosis.

If too many intestines are removed, it will definitely affect the body's absorption of nutrients.

The small intestine is the main organ of nutrient absorption in the human body.

Excessive resection is very prone to short bowel syndrome.

"After my diagnosis, your disease is likely to be short bowel syndrome. It is better to go to a large hospital for further examination and treatment. Especially now that you have steatorrhea accompanied by pus and blood in the stool, if you leave it alone, there will be serious Life is in danger."

Li Jingsheng is timid, but he dare not treat such a serious illness.

The disease can be mild or severe.

Uncle's symptoms are obviously severe, and even a tertiary hospital at the level of the second hospital will pay great attention to it.

Small clinics have limited capabilities, and cannot compare with large hospitals in terms of equipment, personnel, technology, drugs, and treatment experience.Li Jingsheng also eats according to his means, and the "patients" who may burst their stomachs are determined not to eat.

After hearing his diagnosis, the uncle remained silent.

Although it is said that it will take too much money to die, but if you can live, who wants to die?

As the saying goes, it is better to live than to die.

It can be seen that the uncle does not want to die.

"Can you prescribe me some medicine and let me take it home?"

The uncle was silent for a full or two minutes before he raised his head and asked.

His face was already a little pale due to malnutrition, but now it looks even paler.

There was a glimmer of hope in the empty eyes, and more fear and helplessness of death.

In the hospital, money can really buy life.

If you don't have money for treatment, you can only wait for death.

Hospitals give some symbolic treatment at most, which is often called conservative treatment.

"Your illness is very serious. The medicine I prescribed here may not be effective! It would be safer for you to go to a big hospital for treatment." Li Jingsheng was afraid of getting into trouble, and the other was afraid of delaying the uncle's condition.

After all, he only has a proficient level of gastrointestinal diagnosis. In the absence of inspection evidence, the results of his initial diagnosis cannot be guaranteed to be accurate.

"Okay then! Thank you, I will give you the consultation fee, it took so much effort to check for me!"

The uncle took out a wad of money from his pocket.

There is only a hundred-yuan bill on the outside, and dozens of dollars inside, and one and five dollars.

It feels like the total will not exceed 300 yuan.

Along with it, there was also a very old brick mobile phone.

Looks like it should be from Nokia.

The uncle's financial situation may be even worse than imagined.

"No, no, our small clinic treats all patients as free consultations, and only sells medicine and charges some money for treatment. You'd better not procrastinate on this illness, and go to treat it now before the hospital is off work."

Li Jingsheng also had a period of time when his trouser pockets were cleaner than his face.

I know that a penny is hard for a hero.

The most terrible disease in the world is not cancer, but poverty.

"That's so embarrassing! Thank you!"

As if he had done something wrong, the uncle thanked him and left.

Many simple, kind-hearted people are basically like this.When you go into a clothing store, if you don’t buy something, it seems that you are sorry for the warm hospitality of the clerk.Even if you don't see the clothes you like, you will still buy one or two against your will.

When someone asks him for help, he seems to have done something bad after refusing.

They are particularly concerned about the feelings of others and always consider others, but they ignore themselves.

Li Jingsheng looked at the back of his uncle leaving, and once again felt that this world was extremely cruel.

In fact, this kind of thing can be seen a lot every day in the hospital.

At the counter, after Xiao Gao joined, the manpower was no longer so tight.

Li Jingsheng can concentrate on sitting at the reception desk and dealing with patients.

If necessary, Tang Ping could even be called to help.

Nurses are required to perform many therapeutic tasks.For example, giving injections to patients, and delivering instruments and medicines to patients when suturing wounds, etc., all require professional nurses.

I hope that Xiao Gao can do a good job and bring a turn for the sales of health care medicines in Sunshine Clinic.

The clinic's sales of health care medicines and tonics yesterday were 7754 yuan.

From the peak of more than 5000 yuan, the current daily sales have almost halved, and the speed of the decline is so fast that people are caught off guard.

Coupled with the lack of surgical patients for several days, the income of the clinic has returned to rationality.

For the treatment of common diseases such as cold, fever and diarrhea, although he can see seven or eight patients a day, sometimes more than a dozen, but he is too principled and cannot make money like Kuaikang Clinic.

Selling some medicine, in fact, can't make much money.

But there is a saying that goes far.

He believes in sticking to the right path. Although there are vicissitudes everywhere, the future should be bright.

Whether it is a truly bigger and stronger enterprise or a clinic, the boss must have a certain sentiment and have a long-term vision instead of staring at the little profit in front of him.

Busy until 07:30, no one has entered the clinic.

"Both of you, get off work! You have worked hard! Meal supplements are 15 yuan per person. It's up to you to eat by yourself or cook at home."

Li Jingsheng took out his notebook and wrote it down for the two of them.

"thank you boss!"

This should be the first time for Xiao Gao to enjoy the meal allowance for overtime work. 15 yuan is not much, but there is overtime pay and meal allowance for overtime work, which makes him feel like a human being for the first time.

Compared to the dark days at Kuai Kang Clinic, it is like going from hell to heaven.

"Niu Niu, I'll go home after my mother finishes changing! Put your books and homework in your school bag first."

Tang Ping was very happy to hear that she could leave work.

Niuniu is also very happy.

"Oh! You can go home!"

She clapped her hands happily, showing a rare livelyness that a child should have.

But when she found that Xiao Gao was looking over, she immediately lowered her head to avoid Xiao Gao's sight.

She's actually quite introverted.

"Boss, here is the list of medicines sold today. The ones with the word "high" are sold by Dr. Gao."

Tang Ping handed over the daily report to Li Jingsheng.

This is a settlement basis for the monthly performance commission.

As long as Tang Ping sells medicines, except for ordinary therapeutic medicines, other medicines can get a commission.

The highest commission is the health care medicine.

Tonics also have a commission, but because the profit is lower, the commission is also much lower.

Li Jingsheng is well aware that profits can be shared, and he is never stingy with the incentives that should be given.

He took the report from Tang Ping and looked at it.

"Hey, Xiao Gao actually sold eleven orders, and there are five customers who bought more than three boxes at a time, okay!"

Li Jingsheng looked extremely surprised, followed by joy.

Don't look at Xiao Gao who helped him get rid of that old lady a few days ago and sold three boxes of anti-aging medicines, but in Li Jingsheng's opinion, Xiao Gao should have tried his best to perform well.

Now I see that Xiao Gao didn't come here until after three o'clock in the afternoon, and it has only been more than four hours until now.

He actually sold eleven orders of health care medicines and tonics. This young man's business talent is beyond imagination!
"Hey, the boss has praised you! It's all because of Miss Tang's good teaching."

Xiao Gao showed a silly signature smile and scratched his head, but he was not condescending at all.

"Doctor Gao is indeed very talented. He handles those old ladies and old men who give me a headache when I see them. The turnover rate is also very high. It is said that I taught him, but in fact I should learn from him."

Tang Ping walked to the door of the inner room and praised Xiao Gao with a smile.

It seems that the two should get along very well.

(End of this chapter)