Gou is practicing medicine in the clinic

Chapter 198 This is not a tumor, it turns out to be an intussusception
After the patient lay down, his face was still very painful.

To be honest, this kind of severe abdominal pain should not go to his small clinic, but to a big hospital.

At least his clinic is not equipped to deal with most abdominal pain diseases now.

Even for a large hospital, it is just a minor operation for appendicitis, he can't solve it here.

Sister Ou's illness was cured here, so he took it for granted that Li Jingsheng's medical skills were as good as those of big hospitals.Then I saw that my colleague's husband was sick and he was a neighbor, so I introduced him.

It was out of good intentions.

It's just that she doesn't understand the difference between a clinic and a hospital.

Now that the patients are all here, no matter whether Li Jingsheng can be cured or not, he must have them checked.

"Where does it hurt?"

Li Jingsheng began to observe the patient's abdomen.

"It's the belly button."

The patient points with his finger.

The early stage of appendicitis pain is pain in the upper abdomen or around the navel, which shifts to the right lower abdomen a few hours later.

The patient's stomach pain started yesterday, and it has been hurting for more than 24 hours.Based on experience, it should not be appendicitis.

"Has it always hurt here?"

Li Jingsheng has already tried to palpate the patient's abdomen.It is usually very gentle palpation at first.

"Yes, it's always hurting here! Aw... it hurts, it hurts, take it easy!"

Li Jingsheng pressed the area around the patient's navel, and immediately let out a scream.

His face was distorted in pain, and a thin layer of sweat appeared on his forehead.

Li Jingsheng did not stop palpation, but continued to press other parts of the patient's abdomen.

At the beginning, he still remembered that when he was in the training rotation of anorectal surgery, a senior resident doctor gave a digital anal examination to a patient.As a result, he directly got an anal fissure, and the hospital came forward and paid more than 1 yuan.

Since then, he has taken special care in examining patients.

"Pain, pain!"

When Li Jingsheng pressed to the lower abdominal cavity, the patient cried out again.

But this time the pain might not be as strong.

Li Jingsheng's expression became serious, because he felt a large lump in the lower abdominal cavity.

"Did you urinate?"

He asked the patient, and at first he suspected that the patient's bladder was enlarged.

Sometimes it is impossible to urinate.

For example, the prostate is the most prone to problems in middle-aged men. If it goes wrong, there will be problems such as frequent urination, urgency, painful urination, burning of the urethra, incomplete urination, difficulty urinating, and frequent urination at night.

After reaching middle age, many people will find that they have to get up two or three times in the middle of the night to urinate. At this time, they should be alert to whether there is a problem with the prostate.

The current patient is in his 50s, which is the age at which prostate problems are prone to occur.

When Li Jingsheng was rotating in the Department of Respiratory Medicine, what he was most afraid of was meeting an elderly man who needed a urinary catheter.

Because their prostates are generally enlarged, it is difficult to successfully catheterize them.

A very high technical level is required.

And because there is no anesthesia, the process of inserting the urinary catheter is very painful for the patient.

In this case, the patient will start to scold her mother if she does not succeed after a few more troubles.

If the patient has no way to swear, the family members will definitely speak up next to them.

Because in general, the situation of patients who need to insert a urinary catheter is generally not optimistic.

"Twice in line, but not too many!"

replied the patient.

"Now you have a lump in your lower abdomen. I initially suspected that it might be an enlarged bladder or an intestinal problem. This is not a small problem, so I suggest you go to a big hospital for treatment."

Li Jingsheng said to the patients and their families.

Hearing that the doctor felt a mass in the abdominal cavity, the family members and patients suddenly became a little nervous.

"Then what's wrong with me?"

The patient lay still.

It can be seen that he has a high degree of trust in Sunshine Clinic and Li Jingsheng.Maybe you want to understand the condition first, so that you can know it even if you go to a big hospital.

"Dr. Li, we know that you are a good doctor with good medical ethics. Please tell us the truth. We are willing to pay for the consultation."

The patient's wife followed suit.

There is a lump in the stomach, and the family members are very afraid that it is a tumor.If it is a malignant tumor, this problem is serious.

Ms. Ou watched from the side without speaking.

"If it's just a general examination, I don't charge for it. If you really want to know more about the condition, then I suggest that I take an X-ray to see the abdominal image. The nature of this mass can also be more clear .For an X-ray examination, I charge 100 yuan here, and no film will be produced.”

Li Jingsheng said to family members and patients.

"It's absolutely fine, please take a picture of my husband to see!"

Women's family circumstances should not be bad.

Probably similar to Ms. Ou, they are both from a well-to-do family.

They think it is very worthwhile to spend 100 yuan to roughly find out what the disease is.

At this point, the big hospital is probably already off work.

It is likely to have to wait until the next day to get effective diagnosis and treatment.

After the family member scanned the QR code and paid 100 yuan, Li Jingsheng took the patient into the medical laboratory and checked the patient's abdominal X-ray.

Did not choose to take B-ultrasound.

For the diagnosis of some diseases, more information can be obtained by checking X-rays, and it will be more helpful for diagnosis.

It took a lot of effort to find out.

Abdominal X-ray showed a small amount of gas in the colon, but no gas in the small intestine.

The mass in the lower abdomen was soft with clear boundaries, and the tenderness was more obvious when the patient was palpated on the abdomen.

Li Jingsheng even suspected that it was a mass formed after the bladder swelled.

There may be a lot of urine in it.

"I'll check that lump for you again, it may hurt a little, bear with it a little bit."

Li Jingsheng decided to check again out of the doctor's sense of responsibility.

The lump felt relatively soft when pressed, and it could still move.Fortunately, its boundary is clear, and it does not feel as hard as a tumor, so the possibility of a tumor can be ruled out in the initial diagnosis.

"Have you ever vomited?"

Li Jingsheng asked the patient.

"no!"

The patient shook his head slightly.

Li Jingsheng couldn't help frowning and pondering, the lump didn't look like a swollen bladder with fluid.

If so much urine accumulates after an enlarged bladder, its weight must be heavy when moving.

But at the moment it feels very light to him.

Therefore, he believes that the possibility of urinary bladder swelling is very small.

So what exactly is this lump?

Also, the site where the patient experienced severe pain was not at the mass, but around the umbilical cord.

This is really strange.

According to common sense, such patients often experience abdominal pain transfer, but this phenomenon has never occurred in this patient.

Many suspicious points were constantly arranged in his mind, and then combined with the patient's medical history, symptoms, and body temperature, blood pressure, X-ray abdominal images and other examination results, a comprehensive diagnosis was made.

The Xiaocheng-level gastroenterology diagnosis and the actual ability of the senior attending physician made it not particularly difficult for him to diagnose this case.

Diseases matching the above symptoms kept flashing in his mind, and then he ruled them out.

"Did you have a bowel movement from yesterday to today?"

Li Jingsheng suddenly thought of an important question.

Ask the patient on the spot.

I thought that the mass might be due to the accumulation of urine after the enlarged bladder. I only asked the patient about his urination, but ignored his stool.

Doctors are human beings too, and negligence often occurs in diagnosis.

This is why when encountering difficult cases, when the attending doctor is not sure, he will ask other doctors to help with consultation.

Brainstorming can minimize misdiagnosis and missed diagnosis.

"No. Maybe it's because I didn't eat much after my stomach hurt yesterday!"

The patient explained weakly.

Li Jingsheng just nodded, not thinking so in his heart.

After food is eaten into the stomach, stool will not form immediately.It will go through a relatively long process.

The shortest is about eight to ten hours, and the longest is more than 24 hours.

It depends on the individual's gastrointestinal digestion ability.

"Well, let me listen to your bowel sounds again! You lie down and don't move."

Li Jingsheng had only done abdominal palpation outside before, and briefly asked about the patient's symptoms and medical history.Didn't do too much detailed inspection.

Now, out of trust, they spent another 100 yuan, and they only want a first-diagnosis result.

Then we must try our best.

He took off the stethoscope around his neck on the spot, put it on, and pressed the probe on the patient's abdomen.

Bowel sounds can be heard clearly and are quite active.

It's just that the bowel sounds are a little low, giving people a feeling of weakness.

It's like a dancing girl who is obviously sick, but she still dances hard to please the critics.

But because his body was sick, no matter how hard he tried, he still seemed weak.

At this moment, the patient's bowel sounds give him this feeling.

He was obviously very active, but the movements he made seemed low-key.

"Could it be an intestinal obstruction?"

After finding this, Li Jingsheng immediately had a clearer diagnosis direction.

But he quickly ruled out that diagnosis.

The lump was soft to the touch.

If it's an intestinal obstruction, and it's been happening for so long, it should be hard.

Even if the intestinal tract is obstructed, its absorption function will continue to function.This causes the feces trapped in the bowel to become drier and harder.

It definitely feels harder to the touch than this one.

And the patient did not vomit.

In most cases, patients with intestinal obstruction will vomit.

There will also be bloating, abdominal cramps, etc.

One disease after another was ruled out by Li Jingsheng, and his diagnosis was not in trouble.

Because the current level of doctors has reached the level of senior attending physicians, their thinking has become more open in diagnosis.

"Could it be intestinal polyps?"

That thing really feels like a piece of fat to the touch.

In other words, it looks like swollen soft intestines.

This idea was quickly rejected by him.

An intestinal polyp with a diameter of 1 cm is already very scary, and the volume of that mass far exceeds the maximum diameter of the intestinal tract.

Such a large intestinal polyp?
It's too shocking.

There is really such a large polyp that the patient's intestines were blocked 800 years ago.

Since it's not a polyp, what exactly is that mass?

Li Jingsheng believes that as long as the nature of the mass is clarified, all doubts will be easily resolved.

Tumors, intestinal obstruction, swollen bladder, and intestinal polyps were all ruled out.

The possibility of appendicitis was ruled out very early.

He couldn't think of a disease that matched his symptoms for a while.

"This patient's disease is certainly not a common intestinal disease, it is likely to be a rare intestinal disease."

After careful consideration, he came to this conclusion.

Rare intestinal diseases are more than enough.

Moreover, his current level and ability are limited, and the rare diseases he has mastered are really not many.

At least one has to upgrade the doctor level to the deputy chief physician or above, and then gradually master a large number of rare diseases and intractable diseases.

The cause of this patient has been diagnosed to this point, so he will not give up easily.

If a puncture can be performed and the specimens in the mass can be taken for testing, then these problems will not exist.

Of course, the risk is enormous.

Judging from all the current signs, the mass is likely to be a lesion in the intestine.

Didn't the puncture puncture the intestines?

At this time, Li Jingsheng suddenly thought of a possibility.Since it is a rare disease, why didn't you think of intussusception?

Intussusception is relatively rare in clinical abdominal pain disorders.

This patient's symptoms have many similarities to intussusception, especially the mass.

Soft, mobile, and light, these are some of the clinical symptoms of intussusception.

The more Li Jingsheng thought about it, the more likely it was.

After intussusception, because the bowel is mobile, it is very easy to twist.

This is a good explanation why the patient's severe pain is located around the umbilicus instead of the mass in the lower abdomen.

Because when the intestinal tract is twisted, it will spread to the far end like a rope twisted.

However, the intestinal tract has a frenulum and a fixed mesentery. When the intestinal tract turns, this force is equivalent to tearing the frenulum. It is no wonder that the patient does not feel pain.

After sorting out these pathological mechanisms, Li Jingsheng has basically diagnosed this case.

Doctor level experience +50, gastrointestinal diagnosis skill proficiency +10, general surgery diagnosis skill proficiency +5, HP +100.

This is the diagnosis he has gained the most since he was promoted to a senior attending physician.

The proficiency of general surgery diagnosis has also increased so much, which can be regarded as the light of gastrointestinal diagnosis.

It's like two people fighting against the enemy, the gastrointestinal diagnosis is the main attack, and the general surgery diagnosis is raising a flag to wave the flag behind.At the end of the war, those who waved the flag and cheered also got a lot of military exploits.

Before he knew it, his gastrointestinal diagnosis had reached a small score of 727/1000.

Only less than [-] points of proficiency can be promoted to the next level.

When opening a clinic, the patients who see the most patients are the two major departments of internal medicine and gastroenterology.There are also some high blood pressure, diabetes, and more chronic diseases.

However, many patients with these chronic diseases come in to measure their blood pressure for free.

Then buy some medicine and go back to eat.

"Young man, how is my illness? It's okay, tell me the truth, I'm already a few years old, and I can bear it."

Seeing Li Jingsheng's solemn expression, the patient has been bothering to check him up.

He realized that it was probably a serious illness.

Li Jingsheng turned his head and saw that the patient's face was ashen, with the expression of a righteous man going to the guillotine, so he couldn't help grinning.

"Don't think about it too much. This is not a serious illness that cannot be cured. I don't understand if I tell you. I can't cure this disease here, but a big hospital can easily solve it for you. I will write down the diagnosis idea to you later. You, then take it to a big hospital for treatment. If you are lucky, you should be admitted to the hospital today, and you can be scheduled for surgery tomorrow."

Li Jingsheng didn't want to go into such detail at first.

Seeing the patient's expression that he thought he was terminally ill, he said so.

"No...it's not cancer? Are you going to have an operation?"

When the patient heard the diagnosis opinion given by Li Jingsheng, he instantly felt a lot more relaxed.

In the process of waiting for the diagnosis result just now, he must have thought a lot, and he was even more prepared to be sentenced to death.

"Who told you it was terminally ill? Thinking about it!"

Li Jingsheng scolded him.

Of course, he knew well that when he scolded the patient like this, the other party was not only not angry, but happy.

"Hey, I heard that you have a lump in your examination. In addition, you have been feeling bad bowel movements recently, and your stomach feels a little uncomfortable. I thought it was bowel cancer. It seems to be a false alarm."

The man obviously had pain in his abdomen, but he couldn't help laughing dryly.

Human nature is like this.

I thought it was cancer, but it turned out to be a common disease, so I must be happy!

Li Jingsheng took the patient out of the medical technical room, and then wrote down his own diagnostic thinking and handed it to the patient.

"My diagnosis may not be correct, but you are now in the emergency department of a big hospital. Show this to the doctor. It should help the doctor's diagnosis. It will also allow you to get treatment quickly."

The patient's wife took it.

Seeing the happy expression on my husband's face, I knew that the diagnosis would not be too bad.

She took it and looked at it.

"Doctor Li, what kind of disease is the intussusception and volvulus you wrote about?"

"It belongs to a relatively rare intestinal disease. Considering that your husband mentioned that his stomach has been uncomfortable for a long time and his bowel movements are not smooth, it is possible that polyps have grown in the intestines. Just take this opportunity, if you find out, let the doctor Let's solve it for you all at once."

Li Jingsheng gave her a simple explanation.

"As long as it's not cancer! Thank goodness!"

After hearing this, the family members were somewhat worried.

But the expression has become a lot more relaxed.

"We're going to the emergency room at the hospital, right?"

"That's right! Hurry up! Although this disease is not a particularly serious one, it cannot be delayed, otherwise it will cause large-scale necrosis of the intestinal tract, and it will be life-threatening."

Li Jingsheng told family members and patients.

After thanking them, they took a taxi and left in satisfaction.

The largest hospital nearby is the Second Hospital. I just watched how the taxi turned around and walked in the direction of the scenery belt?

Patients and families should listen to his advice.

In that direction, there is only one possibility, unwillingness to go to the Second Hospital.

To be honest, although the Second Hospital is the only large hospital in the south of the city, patients cannot be forced to go to it for treatment.

Patients have their own choices.

This is also the freedom of the common people.

Li Jingsheng looked at the time, it was past six o'clock.

"Let's get off work early today! I have to go and get things done at the front of the clinic."

He said to three employees.

"But I also made an appointment with two important clients. They have something to do during the day, and they said they would come later." Xiao Gao said to Li Jingsheng.

"I also want to stay and look at today's medical records. Especially the uncle with the abdominal pain just now, I feel that his etiology diagnosis is very difficult. I also want to have the same diagnosis level as the boss sooner."

Han Siying also didn't want to leave work so early.

The clinic's appearance crisis this time also made several employees cherish this job and the fate of being together.

In addition, Li Jingsheng, the boss, has a charming personality that attracts them, which makes the three cherish it even more.

(End of this chapter)