Gou is practicing medicine in the clinic

It lasted for about 3 minutes and still no bowel sounds were heard.

Li Jingsheng flicked the patient's abdomen with his fingers.

Continue auscultation.

When encountering such a situation where bowel sounds cannot be heard, experienced doctors will tap or tap the patient's abdomen.This is to promote intestinal motility in patients.

After listening for another minute, I still didn't hear any sound.

This must be extremely abnormal.

The patient appeared to be in a normal mental state and had a natural expression, except that his abdominal bulge was high.

This is because the patient already has a large beer belly.

When you press your abdomen with your hands, you can feel the thick abdominal fat.

No matter how thick the abdominal fat layer is, it cannot completely block the transmission of bowel sounds.

This indicates that the patient has symptoms of disappearance of bowel sounds.

Coupled with the patient's reaction to abdominal distension, Li Jingsheng first suspected intestinal obstruction.

Just for ordinary intestinal obstruction, the bowel sounds will become very active, more than ten times a minute.The sound is loud, high-pitched, and sometimes even metallic.

This is usually a mechanical intestinal obstruction.

This patient's bowel sounds completely disappeared and his abdomen was distended. These two points alone cannot be used to diagnose intestinal obstruction.

The patient's defecation is still normal, indicating that the intestines have always been unobstructed.

"When was the last time you had a bowel movement?"

Li Jingsheng asked the patient.

"Morning! I basically go to the toilet after getting up in the morning."

The patient's answer seemed to remind the doctors once again that his intestines were clear and there was no intestinal obstruction.

What could be the problem?

There are many reasons why bowel sounds may diminish or disappear.

It is not yet possible to confirm that the patient's bowel sounds have completely disappeared.Maybe it's just that the bowel sounds are less frequent and weakened.

Some patients may not hear bowel sounds for several minutes.

If bowel sounds are reduced, the most common diseases include constipation, peritonitis, hypokalemia, etc.

Decreased gastrointestinal motility may also cause decreased bowel sounds.

If the bowel sounds completely disappear, there are more possible diseases.

Electrolyte disorders, acute peritonitis, paralytic intestinal obstruction, etc.If you have had major abdominal surgery, bowel sounds may disappear.

No matter what the situation is, it's not a good thing.

"Is your body temperature normal?"

Li Jingsheng decided to start from the simplest place.

If peritonitis is present, the body temperature will definitely rise.

"The body temperature appears normal."

The answer came from one of the young female doctors.

Judging from her childlike face, she must have just entered the hospital for internship not long ago.

"You haven't had any symptoms like vomiting, right?"

Li Jingsheng asked the patient this time.

Intestinal obstruction can occur anywhere.

If it occurs in a high position, such as the jejunum or duodenum, the patient will have obvious vomiting reaction.

This is also a self-protection mechanism of the body.

Vomitus from intestinal obstruction can also be used by professional doctors to determine the patient's approximate location of obstruction.

For example, if the vomitus is gastric contents, it can basically be concluded that it is high intestinal obstruction, in the jejunum and duodenum.

If there is low intestinal obstruction, the initial vomitus will also be gastric contents.

What is vomited later is the intestinal contents.

After food enters the intestines, it will ferment.

The contents of the ileum are vomited out and are obviously different from the contents of the stomach.The odor will also be very noticeable.You can figure this out on your own, it looks like feces, which is naturally disgusting.

"No."

Patients and family members responded in unison.

This made Li Jingsheng, who was originally planning to follow this clue, begin to deny the cause of intestinal obstruction.

Li Jingsheng picked up the patient's abdominal CT to check.

This time I made some useful discoveries.

The patient had intestinal dilation in the ileocecal part of the intestine, which was not serious.

Thickening of the intestinal wall in the ileum was also detected.

But there were no problems such as bowel inflation.

After intestinal obstruction occurs, the intestines will be stretched because the contents cannot pass through, which is the cause of intestinal dilation.

Many people do abdominal CT scans and see intestinal dilation but don’t understand the cause.

Most intestinal dilation is related to tumors and intestinal obstruction.

This patient had intestinal dilation and intestinal wall thickening at the same time. Now he could not hear bowel sounds. Li Jingsheng naturally had reason to suspect that the patient had intestinal obstruction.

There are many causes of intestinal wall thickening.

The most common thing is that after intestinal obstruction, the intraintestinal pressure increases, which causes edema in the intestinal wall.

Therefore, during imaging examinations, intestinal wall thickening will appear.

After intestinal obstruction occurs, the gas produced by the fermentation of intestinal contents cannot be discharged and accumulates in the intestine, resulting in aeration.The entire intestine will look particularly full.

Normally, intestinal obstruction can be diagnosed when intestinal dilatation, intestinal inflation, and intestinal wall thickening occur.

Imaging tests can be used to determine the specific location where it occurs.

Li Jingsheng quickly screened the patient's cause of illness in his mind.

There are many reasons for the disappearance of bowel sounds.Intestinal perforation and vascular embolism can also cause bowel sounds to disappear.

However, the symptoms of these causes are obvious, and the patients do not have these symptoms, so they can basically be ruled out.

Just as Li Jingsheng was preparing to discuss with Xiao Linlin, he accidentally heard the patient's bowel sounds.It was weak, but he was sure it was bowel sounds.

This shows that the bowel sounds have not completely disappeared.

Although the patient has a bowel movement in the morning, if the intestinal obstruction is at a higher level, the intestinal feces below the obstruction can still be passed out.

"Director Xiao, I suspect that the patient may have intestinal obstruction."

Li Jingsheng has a good relationship with Xiao Linlin, so if you have any questions, just talk to them directly.

"I also suspected that it was intestinal obstruction. The strange thing is that he had no vomiting symptoms, and he could eat and defecate normally at noon, so there was no way to confirm the diagnosis."

Xiao Linlin is a very cautious person in practicing medicine.

When encountering such doubtful cases, she usually chooses to hospitalize the patient for observation.

This is basically an 'occupational disease' among physicians.

Physicians are more logical and have a gentler approach to solving illnesses.

Few qualified physicians pursue a single dose of medicine that directly resolves the disease.In most cases, you will try some medicine first. If the effect is significant, then continue taking the medicine.

If the effect is not good, then adjust it quickly, or re-examine the cause and re-diagnose.

The job of a physician is to constantly search and pursue the truth about disease.

Including pathological mechanisms, causes, etc.

"It's better not to be hospitalized for observation. I estimate that he will have new symptoms tonight at most."

Li Jingsheng was basically certain that it was intestinal obstruction.

It just happened for a short time and the disease progressed slowly.

If it is acute intestinal obstruction, the patient will have severe stomach pain, vomiting, and be very busy.Now the patient still looks calm and calm, like a normal person.

Under such circumstances, even the family members may not agree to send the patient to surgery.

After Xiao Linlin informed the doctor in charge of the bed, she and Li Jingsheng left the ward.

"There must be something going on when you come to me. Tell me, what is it?"

Xiao Linlin understands him very well.

Basically all the doctors who are close friends with Li Jingsheng understand him.Nothing happens, I rarely contact you.

At most, you can see the updates in your circle of friends and give a like or make a joke.

Usually I will contact you when something happens.

There is no way, he is usually too busy and really has no time to chat.

The few breaks he had had to be used to manage personal life-long affairs.Spend time with your girlfriend and develop a relationship together.

"Let's talk in your office!"

The two entered the office, and Li Jingsheng said, "I have formed a medical team to handle more advanced colonoscopy services. Patients require colonoscopy to be safe and detailed, and my team can provide this service. Some intestinal conditions are not Ideally, if ordinary doctors think that the risk of colonoscopy is too high or too difficult, I can accept it. If Sister Xiao encounters such patients, she can recommend them to me.

There are no major benefits to successfully recommending someone, but the money for a cup of milk tea is definitely there.

The risk is mine and you don't have to bear any risk. "

Briefly told her the purpose.

"Hey, that's good. Are you finally thinking about going it alone? With your ability, as long as you follow this path, you will definitely make a lot of money."

She smiled and poured Li Jingsheng a cup of tea.

"I have no problem here at all. After all, she is your sister, so the milk tea fee is waived. Anyway, I can't feed those patients in my own department. It's good to recommend her to you directly as the money won't go to outsiders."

In this society of acquaintance relationships, having a wide network of contacts is different.

Li Jingsheng simply stated her request, and she agreed without even thinking about it.

What if it were someone else who negotiated this business?
I'm afraid I can't even get through the door.

Just look at the medical representatives and salesmen who run the business.It's really not an ordinary difficulty to get into the department director's office.

"My sister Xiao is nice to me! I knew you would agree to help me! Thank you in advance!"

Li Jingsheng was very happy that the negotiation was concluded so easily.

"Why are you thanking me! Seeing others!" She said with some annoyance. "By the way, I'll say one more thing. You'd better talk to the director about this matter. You are also a famous doctor in our Second Hospital now, and you are also a key training target. Every word and deed is closely related to the Second Hospital."

"I've already passed the gas. If the dean doesn't agree, I don't dare to do it!"

Li Jingsheng said with a smile.

"Haha, it seems that I have been worrying too much. You have always been steady and mature in doing things. If there is nothing else, just go and do your work! If I meet any suitable patients here, I will recommend them to you."

Xiao Linlin was somewhat curious about the medical team formed by Li Jingsheng.

She didn't know that Li Jingsheng's endoscopic skills had improved qualitatively.

"Thank you, Sister Xiao! Oh, one more thing. I don't have a venue for colonoscopy now. When I receive business, I usually go to the People's Hospital to borrow the venue. But it always feels right to bring the patients here to the People's Hospital. Don't stay in the second hospital.

As you just said, the good news should not flow to outsiders.

Can I sign an agreement with your gastroenterology department and pay a fee every time I borrow your endoscopy room?

If it is found that the patient has a problem with his intestines and needs surgery, he can also be directly transferred to the general surgery department or related departments of the second hospital. "

Li Jingsheng has a strong sense of belonging to the Second Hospital.

He is even more grateful to the Second Hospital for being where he is today.

Now that I have some strength, I naturally can’t forget my roots.

"You signed a similar agreement with the People's Hospital?"

"I haven't signed it yet. I'm going to sign one. I won't hide it from you. The People's Hospital has already agreed." Li Jingsheng said honestly.

"You really belong to the People's Hospital. The People's Hospital is the top three in our Jiangli City! They are actually willing to sign this kind of agreement with you, which shows that you are really great. There is no problem at all on my side, but I have to ask the director for permission, and then I’ll give you an answer again.”

Xiao Linlin was shocked when she heard that the Gastroenterology Department of People's Hospital agreed to sign such a service agreement with Li Jingsheng.

Secretly I was shocked by Li Jingsheng's ability.

Even though she is the director of the gastroenterology department of the Second Hospital, when she goes to the People's Hospital, she is nothing.

No one will buy her fault.

After Li Jingsheng settled the matter, he came out of the Second Hospital with great ambitions.

Another advanced business channel has been established.

Director Xiao went to ask the hospital leaders for instructions, and there was probably no problem.

Dean Fu has agreed that Vice Dean Jin's nephew is Li Jingsheng's student, and it is even more impossible to hinder Li Jingsheng's development. (End of chapter)