Gou is practicing medicine in the clinic

Chapter 279 Compass in Diagnosis, Malabsorption Syndrome

That is to say, the patient is ignorant, otherwise he should have found a more authoritative large hospital for diagnosis and treatment.

Some diseases are most afraid of procrastination.

It may have been just a minor illness at first, but as time went on, all kinds of complications appeared, and it turned into a serious or serious illness that even experts would frown upon.

Li Jingsheng subconsciously checked several routine examination reports of the patient again.

I have already seen the fecal routine, and even the examination items such as fecal occult blood and parasites have given direct answers.

"Could it be infectious diarrhea?"

Li Jingsheng looked at Xiao Linlin who was also thinking hard.

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

This reminded him of the director of the People's Hospital who was scolded by his family as an expert who could only check feces.

However, in this difficult case of diarrhea, fecal bacterial culture is necessary.

"OK!"

Xiao Linlin now basically obeys his opinions.

After applying, the test results come out almost instantly.

Explain that the receiving doctor also checked this item when examining the patient.

"Fecal bacterial culture was negative."

Xiao Linlin reported the results to him.

"That means there is no infectious diarrhea."

Based on this result, Li Jingsheng ruled out many suspected diseases at once.

His eyes looked at the blood test report again.

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

Because the patient's cause is indeed complex.

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

Both of these are excluded.

Then we can only investigate in other directions.

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

After reading it, Li Jingsheng found a number of anomalies in the data.

A blood test is a routine test that many patients do after being admitted to the hospital.

It is not a required test, but basically seven out of ten patients require blood tests.

Some patients don't understand and think this is the hospital making dirty money.

Some patients even believed the rumors, saying that the hospital deliberately took blood from patients and sold it for money.

It really makes people speechless.

Occasionally in some special cases, it is indeed possible to draw more blood samples for medical research experiments.

But when it comes to drawing blood from patients and selling it, I really don’t know how those who spread rumors can come up with such big ideas.

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

In terms of the pathogenesis of diarrhea, it can be roughly divided into four types.

The first type is secretory diarrhea.

This kind of diarrhea is caused by an increase in secretagogues, which causes excessive secretion of water and electrolytes in the intestines or weakens absorption, eventually causing diarrhea.

More common.

The second type is exudative diarrhea.

The integrity of the intestinal mucosa is destroyed due to inflammation, erosion, ulcers and other lesions, resulting in massive exudation and diarrhea.

The most common is enteritis and diarrhea.

Catching a cold or eating unclean food or spicy food may cause stomach pain and diarrhea.

Usually after having diarrhea, the stomach pain is gone and the disease is cured.

This kind of diarrhea sometimes seems to doctors to be a kind of self-repair and healing of the body.

It can excrete large amounts of harmful substances and germs from the body in the form of diarrhea, reducing the burden on the body's immune system.

This is also the reason why the disease is cured after having diarrhea.

The third type is osmotic diarrhea.

This can easily be confused with exudative diarrhea.

In fact, they are two completely different disease-preventing mechanisms.

Osmotic diarrhea is caused by poor intestinal digestion and absorption, or the ingestion of solutes that cannot be absorbed, which leads to an increase in the osmotic pressure in the intestinal lumen, and a large amount of liquid passively penetrates from the intestinal wall into the intestinal lumen, eventually causing diarrhea.

It can be understood as forcibly squeezing out the body fluids in the intestinal wall and entering the intestinal cavity.

Then it causes diarrhea.

Doctors even developed the enema method based on this disease-controlling mechanism.

A variety of diseases can be treated with this method.

For example, it helps the intestines to excrete toxic and harmful substances.Patients who commit suicide by drinking pesticides sometimes resort to more than just inducing vomiting and gastric lavage.In fact, there are many other methods such as enema and hemodialysis.

Before a colonoscopy, an enema is also given to ensure a smooth colonoscopy.

Just fasting and fasting will not make the intestines cleaner.

During a colonoscopy, there is a high probability that feces and other contents will be encountered.

It's just that enema was later learned by teachers from the island country, and they don't know what it is used for.

Osmotic diarrhea has one characteristic: the total stool volume per day is usually less than one liter, and the stool is thin and watery without pus and blood.

And if the sugar is poorly absorbed, it will also have a sour smell.

When fat and protein are poorly absorbed, they will have a foul odor.

A strange profession that has emerged in recent years is called a smell sniffer, which specializes in smelling other people's stinky farts to determine whether there are some diseases.

This has some similarities with the auscultation of traditional Chinese medicine.The smell of feces can indeed help doctors diagnose many diseases.

However, auscultation in traditional Chinese medicine is not just smelling, but also includes auscultation.

All I can say is that Chinese culture is vast and profound, and one word can have multiple meanings and interpretations.

Li Jingsheng thought about this and began to identify the patient's cause as osmotic diarrhea.

Although secretory diarrhea also has various causes of diarrhea such as endogenous secretagogues and bacterial enterotoxins, this patient's stool characteristics and diarrhea are not consistent with this diarrhea mechanism.

Therefore, after Li Jingsheng finally went through layers of analysis and syndrome differentiation, he was most likely to have osmotic diarrhea.

"Director Xiao, let's apply for a 48-hour fasting experiment to see the results. The purpose is to understand whether the patient's diarrhea symptoms are significantly reduced after fasting."

After Li Jingsheng has a diagnosis direction, he often works neatly.

"Row!"

Without any extraneous nonsense, she just applied.

The integration of a team takes time.

Only by understanding the temperament, personality, professional level, areas of expertise, and performance of other team members in actual combat can we establish a high degree of tacit understanding and trust.

After Xiao Linlin cooperated with Li Jingsheng twice, she has accepted almost all the inspection points he proposed.

Unless there is an obvious problem, she is likely to question it.

"The results came out. After fasting, the patient's diarrhea symptoms were significantly reduced and eventually stopped."

This experiment is not something that ordinary people understand. After stopping eating, there is no food source in the intestines, so there is no way to have diarrhea again.

This understanding is also correct.

But in the eyes of doctors, it has more diagnostic significance.

The subdivided types of diarrhea can be inferred based on the changes in diarrhea after fasting.

Rule out some suspected diseases or further confirm the diagnosis.

"That's right, it is indeed the intestines that are causing trouble. Then apply for a total gastrointestinal tract imaging examination for the patient."

After Li Jingsheng came to the conclusion, his eyes became brighter.

Xiao Linlin first submitted the application, and then asked, "Does Dr. Li suspect there is a problem with intestinal absorption?"

"I'm not sure, but it can basically be identified as osmotic diarrhea. Now let's see if there are malignant tumors in the patient's intestines, but I think this possibility is very low. I have some confidence in curing this patient. "

Now that the cause of the disease has not been identified, Li Jingsheng is confident that he can cure the patient's disease.

This is not arrogance.

It is a doctor’s most valuable professional judgment.

It can be called the ability to predict.

Basically, as long as you are an attending physician or above, you will start to develop your own ability to predict.

Then in daily clinics, we continue to accumulate experience and strengthen this ability.

By the time I was promoted to deputy chief physician, my predictive ability was already very strong.

Li Jingsheng's current diagnosis in gastroenterology is Dacheng, so he is fully equipped with this ability to predict.And it's quite excellent.

"Oh my god! Dr. Li, your diagnosis seems to be in the right direction again, because after applying for this examination, the results came out instantly. I really envy your diagnostic ability, you can always keep the direction correct and not lose your way. I I also want to have a 'compass' that can guide the direction of diagnosis."

She really admired Li Jingsheng.

Doctors have a correct diagnosis direction and can avoid many detours.

It has a great advantage in diagnosing difficult cases.

Those difficult cases have one thing in common: the cause is hidden in the foggy forest, and doctors often easily lose their way in diagnosis if they want to find it.

Li Jingsheng was able to keep his diagnosis in the right direction every time, perhaps without even noticing it himself.

This advantage is enough to make most doctors envious.

It’s no wonder that he has been able to help chief physicians successfully diagnose difficult cases one after another many times.

"I really haven't found that I have such an advantage. If the compass mentioned by Director Xiao really exists, I think it must be accumulated bit by bit in daily diagnosis and study, and constantly strengthen this ability, and then make this compass more accurate. The degree keeps improving.”

Li Jingsheng said with a smile.

"Let me see the results of the total gastrointestinal tract imaging."

Xiao Linlin pushed the tablet towards him on the spot so that he could view it better.

She is obviously the coach, but in reality, Li Jingsheng is the main coach.

Internal medicine and gastroenterology are two fields that Li Jingsheng is relatively good at.

Gastroenterology was not very strong before, but later he used the attribute panel to improve his skills in this field like crazy. After gastrointestinal diagnosis and hepatobiliary diagnosis reached a certain level, he was able to successfully stand out.

Significant changes can be seen in the patient's small intestine.

The small intestine is segmented, has snowflake-like changes, and the mucosa is also significantly thickened.

Partial intestinal lumen dilation and barium shadow dilution.

After reading the imaging results, he was still a little unsure.

"Is it possible to go one step further and perform air barium angiography of the small intestine, hypotonic duodenum angiography, and air barium double-contrast enema? This will help to understand whether there are organic lesions in the gastrointestinal tract."

After checking this step, the general area of ​​the lesion has been basically locked.

But to find out the real cause, further tests are needed.

Medicine is a rigorous subject, and clinical practice should be more cautious to ensure that no business trips are missed.

"no problem."

She applied on the spot.

The result came out in seconds again.

This time, after reading it, Li Jingsheng showed a look of victory on his face.

The cause was finally found out.

It can basically be concluded that it is malabsorption syndrome.

　The protagonist's fight with Wei Xianxian is not about poor medical ethics. This is the hospital's regulations.Highly qualified doctors have almost all priority.In addition to registering, patients are free to choose a doctor, but there is actually no way to choose which doctor will treat them subsequently.Maybe I'm not good enough and didn't write it down.I've been so busy these days that I'm a little worried about sudden death.

　　
　
(End of this chapter)