Li Jingsheng's eyes narrowed slightly and his expression became serious.
Blood in the stool often means gastrointestinal bleeding.
If it is upper gastrointestinal bleeding, black stool is often passed. Because after the blood is absorbed by the lower digestive tract, it has turned black by the time it is excreted and is mixed in the stool.
Routine stool examination at this time can often reveal positive fecal occult blood.
In fact, you can see it visually.
The uncle is just an ordinary person, not a doctor. He found blood in the stool he pulled out. Nine times out of ten, it was not black stool, but directly containing blood.
Based on this information, Li Jingsheng’s expert-level gastroenterology diagnosis initially diagnosed that the patient was likely to have lower gastrointestinal bleeding.
As for where the bleeding is, imaging examination is a good choice.
The conditions of small clinics are limited. Plain abdominal X-ray can detect some intestinal bleeding, but its accuracy is far less than abdominal CT. If conditions permit, barium angiography or colonoscopy may even be required.
Li Jingsheng immediately gave up the idea of doing an abdominal ultrasound or plain X-ray for the patient.
That 'grandpa'-level X-ray detector is capable of detecting bone injuries and other significant lesions.
It is really difficult for it to detect lower gastrointestinal bleeding.
Judging from the way this uncle was scratching his head, he would probably have a hard time agreeing to a $100 imaging examination fee.
The main reason is that it doesn’t mean much to do this test.
Even the X-ray detector in a large hospital can only detect intestinal paralysis or mild or moderate intestinal dilation at best. If you want to confirm the bleeding site and get more detailed information, you have to do CT and barium imaging.
"How long have you had blood in your stool?"
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 proficiency in diagnostic medical skills, but the accumulation of knowledge still requires his own hard work.
Goldfinger could not create a medical skill out of thin air for him, or give him knowledge.
The most is to help him better apply the theoretical knowledge he has learned and apply it skillfully in clinical practice.
"I'm afraid it's been more than ten days! It's gotten worse in the past two days, and my stomach pain is severe. There was occasionally blood in the stools a few days ago, but not much, and my stomach only hurts for a while from time to time."
My uncle had been bleeding for so many days and never went to the hospital for a checkup.
The main reason is the fear of spending money.
People are poor and life is cheap, it is the same in every era.
If it wasn't for the unbearable pain, I probably wouldn't even come to the clinic.
"In this case, you go and lie down on the treatment bed inside, and I will check your abdomen."
Li Jingsheng decided to check the uncle's abdominal tenderness first, so that he could at least locate the approximate lesion area.
For example, appendicitis usually causes pain in the right lower abdomen.
Upper abdominal pain may be caused by the jejunum, ileum, or even the liver. The pain in each part, as well as the different depths, can directly reflect which organs or tissues the lesions are.
"Does this examination cost money?"
The uncle hesitated and asked.
"No charge."
Among the patients Li Jingsheng treats, there are many who care about money, but there are still very few who care about money like this uncle.
After all, after getting sick, almost all patients just want to be relieved of their pain as soon as possible.
As long as the treatment fee is not too expensive to bear, it generally doesn't matter much.
He secretly deduced that either the uncle's finances were in trouble, or he was naturally careless and stingy in everything he did.
There are not many such men, but there are.
She is pickier than women when buying clothes, trying every means to bargain and take advantage of them.
After guiding the uncle to the treatment room inside, Li Jingsheng asked him to lie down and lifted up his clothes to examine 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 any surgery recently?"
"Oh, don't mention it. About six or seven months ago, I was working one day when I suddenly had a terrible stomachache. After I fell to the ground, I fainted from the pain. After my coworker sent me to the hospital for examination, he said it was some kind of intestinal tract infection. ...I had internal strangulation, and then I had surgery to cut out part of my intestines. To this day, I can’t work.”
When the uncle mentioned this matter, he shook his head and sighed, with a sad look on his face.
Emergency surgery was required to remove part of the intestine, which may be due to intestinal hernia and strangulation.
This disease occurs less frequently, but is more likely 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 right after eating.
There are also cases where you suddenly exert too much force while working, etc., which can easily lead to intestinal hernia or intestinal volvulus.
If not treated in time, intestinal necrosis will occur, which can be fatal.
Now I finally understand why this uncle had to ask many times whether there was a fee for a check-up 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 little savings.
It costs a lot of money to treat the disease, and you should have to have re-examinations and take medicines in the next seven months, which is also a long-term consumption.
Sit back and eat nothing.
The uncle is probably at the end of his rope now.
"I'll check your abdomen. You try to relax."
Li Jingsheng began to press the painful area of the uncle's abdomen and found that there was a certain degree of abdominal ankylosis.
During abdominal palpation examination, the abdominal wall is obviously tense, stiff, and as hard as a board, which is not good.
Abdominal ankylosis will occur only when acute gastrointestinal perforation, organ rupture, acute peritonitis and other diseases occur.
The uncle has blood in his stool and has had blood in his stool for many days.
Now the blood in the stool is getting worse and the abdominal pain is getting worse, which shows that the disease is progressing and is approaching menacingly.
"Does it hurt here?"
"Um."
"Does it hurt just a little or a lot?"
"It hurts more."
As soon as the uncle finished answering, Li Jingsheng pressed harder.
"Ouch...it hurts, it hurts!"
Li Jingsheng immediately stopped his hand. He judged that the uncle's pain should be in the jejunum.
The small intestine is a part of the digestive tract, which is divided into three parts: duodenum, jejunum, and ileum. Thousands and thousands of people
What’s more interesting is that the medical boundary between the upper and lower digestive tracts is the duodenum.
The suspensory ligament of the duodenum is also called Treves' ligament.
It is like a 'boundary monument' between the upper and lower digestive tract.
Above Treves' ligament is the upper gastrointestinal tract. Below is the lower gastrointestinal tract.
The jejunum occupies approximately two-fifths of the length of the small intestine and is slightly shorter than the ileum.
The pain site is now in the ileum. To make a further diagnosis, more information must be obtained.
"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 located.
Rectal bleeding is usually bright red, and the color of the bleeding becomes darker as it goes up the rectum.
Because it takes time from bleeding to excretion from the body.
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. The color was darker. But it is definitely blood."
"Is there a lot of bleeding?"
"I feel a little big in the past two days, and the stool I excrete 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 defecation.
"Doctor, is my illness serious? Is there any cure? How much does it cost?"
"Don't worry, let's go out and talk!"
As Li Jingsheng walked, he thought about what disease his uncle had.
Judging from the bowel movements described by the uncle, there should be steatorrhea accompanied by bloody and purulent stools.
The uncle had undergone intestinal resection surgery. His skin looked rough, his hair was yellow, and he was thin. It is obviously a sign of long-term malnutrition.
Currently I have abdominal pain, and the pain point is in the ileum. I have had surgery and have had blood in my stool for many days...
When Li Jingsheng's gastrointestinal diagnosis had just reached the proficiency level, Li Jingsheng felt that he would be able to catch every patient with gastrointestinal diseases at his fingertips. The cause can be easily diagnosed.
At this moment, he felt that he was looking at the sky from a well and was overconfident.
When diagnosing this uncle, it was particularly difficult due to the lack of various examination evidence.
In order to make up for the disadvantage of lack of examination basis, his diagnostic level needs to be at least one or two levels higher than that of doctors in large hospitals to barely be on par.
Since large hospitals can perform multiple examinations, in order to diagnose the cause of this uncle's disease, it may only require a senior resident physician to be enough.
Li Jingsheng now clearly has the diagnostic ability of a junior attending physician, but he is still struggling.
There is nothing we can do about this.
There are not enough instruments and equipment, so we can only make do with technology.
Then again, when he improves all diagnostic and medical skills to a very high level, when he comes to a big hospital, he will be able to "step on kindergartens and punch nursing homes" immediately. It can definitely defeat most doctors in big hospitals.
It's a bit like the difference between wild animals and domestic animals.
A wild wolf can easily hunt a domestic dog of equal size.
Li Jingsheng belongs to the wild side and has simple conditions, but the skills he has honed will be particularly strong.
"In addition to blood in your stool, do you also have diarrhea?"
"right!"
"How many times do you have diarrhea a day?"
"I probably had diarrhea two or three times a day in the past few days, but today I've had it four times."
My uncle had diarrhea, and the jelly-like white liquid he pulled out was 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. What is that intestine called? I forgot."
"Is it called the jejunum or the ileum?"
Li Jingsheng gave the uncle some tips.
There are only three parts of the small intestine. In intestinal hernia and strangulation, usually either the jejunum or the ileum is cut.
"Yes, yes, the jejunum was cut, I remembered."
With this further accurate information, Li Jingsheng finally had a diagnostic direction.
Based on the patient's medical history, symptoms, location of pain, surgical resection of part of the small intestine and other information, the uncle should have short bowel syndrome.
This is a relatively troublesome disease clinically.
The total length of the adult's small intestine is about 4-6 meters, so it's not a big deal to remove a little bit.
Of course, the premise is that the doctor's surgical skills are excellent and there should be no problems such as anastomotic leakage or anastomotic stenosis when performing intestinal anastomosis.
If too much intestine is removed, it will definitely affect the body's absorption of nutrients.
The small intestine is the body's main nutrient absorption organ.
Excessive resection can easily lead to short bowel syndrome.
"After my diagnosis, your disease is probably 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 bloody stools. If left unchecked, there will be consequences. Life is in danger.”
Li Jingsheng is too timid to treat such a serious disease.
This disease may be mild or severe.
The uncle's symptoms were obviously severe, and even a tertiary hospital like the Second Hospital would pay great attention to him after receiving him.
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 ability, and "patients" who may burst their stomachs will not eat.
The uncle was silent after hearing his diagnosis.
Although he said that he would be cured if he asked for too much money, who would want to die if he could live?
As the saying goes, it is better to die than live.
It can be seen that the uncle does not want to die.
"Can you prescribe some medicine for me to take home?"
The uncle was silent for a minute or two, then he raised his head and asked.
His face was already a little pale due to malnutrition, and it looked even paler now.
There was a hint of hope in the empty eyes, but more of a fear and helplessness about death.
In the hospital, money can really buy life.
If you don’t have money for treatment, you can only wait for death.
At most, the hospital provides some symbolic treatment, which is often called conservative treatment.
"Your illness is very serious, and the medicine I prescribe here may not work! It is safer for you to go to a large hospital for treatment." Li Jingsheng was afraid of getting into trouble, and he was also afraid of delaying his uncle's condition.
After all, he only has a proficient level of gastrointestinal diagnosis, and without the basis for examination, there is no guarantee that the initial diagnosis results he makes will be accurate.
"Okay then! Thank you. I'll give you some money for the consultation fee. You spent so much effort to check me out!"
The uncle took out a wad of money from his pocket.
There was only one hundred-dollar bill outside, and there were dozens of yuan bills inside, as well as one-dollar and five-dollar bills.
It feels like the total will not exceed three hundred yuan.
Also taken out along with it was a very old brick mobile phone.
It looks like it's from Nokia.
The uncle's financial situation may be worse than imagined.
"No, no, no, our small clinic treats all patients free of charge, so we only sell medicine and receive some money for treatment. It's best not to delay your illness, and go get treatment now while the hospital is still working."
There was a time when Li Jingsheng's trouser pockets were cleaner than his face.
I know that a penny is enough to defeat a heroic man.
The most terrible disease in the world is not cancer, but the disease of poverty.
"That's so embarrassing! Thank you!"
The uncle seemed to have done something wrong and left with a lot of thanks.
Many simple and kind-hearted people are basically like this. Go into a clothing store, and if you don't buy something, you feel like you can't bear the warm hospitality of the clerk. Even if I don’t see clothes that I like, I will still buy one or two against my will.
When someone asks him for help, he seems to have done something bad when he refuses.
They are particularly concerned about other people's feelings and always consider others, but ignore themselves.
Li Jingsheng looked at his uncle's leaving figure and once again felt that this world was particularly cruel.
In fact, we see a lot of this kind of thing every day in hospitals.
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 handling patients.
If necessary, you can even ask Tang Ping to come over and help.
There are many therapeutic tasks that need to be performed by nurses. For example, professional nurses are needed to give injections to patients, deliver instruments, medicines, etc. when suturing wounds to patients.
I hope Xiao Gao can work hard and bring about a turnaround for the sales of health medicines at Sunshine Clinic.
The clinic’s sales of health medicines and tonics yesterday were 7,754 yuan.
From the peak of more than 15,000 yuan, the current daily sales have almost halved, and the speed of decline is so fast that people are caught off guard.
Coupled with the fact that there have been no surgical patients for several days, the clinic's income has returned to rationality.
To treat common diseases such as colds, fevers, and diarrhea, although he can now receive seven or eight patients a day, sometimes more than a dozen, he is too principled and cannot make money like Kuaikang Clinic.
Selling some medicine can actually make little 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 big and powerful enterprise or a clinic, the boss must have a certain sentiment and a long-term vision, rather than focusing on the little profit in front of him.
It was busy until 7:30, and not many people came into the clinic.
"You two should get off work! You have worked hard! Each person will receive a meal supplement of 15 yuan. You can 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 must be the first time that Xiao Gao has enjoyed meal subsidy for overtime work. 15 yuan is not much, but overtime pay and meal subsidy for overtime work make him feel like a human being for the first time.
Compared to the dark days at the Kuai Kang Clinic, it was like going from hell to heaven.
"Niuniu, you'll go home after mom changes clothes! You put your books and homework in your schoolbag first."
Tang Ping was very happy to hear that she could get off work.
Niuniu was also very happy.
"Oh! You can go home!"
She clapped her hands happily, showing a rare liveliness that a child should have.
But when she found Xiao Gao looking over, she immediately lowered her head to avoid Xiao Gao's sight.
Her character is actually quite introverted.
"Boss, this is the list of medicines sold today. The ones with the word "high" are those sold by Dr. Gao."
Tang Ping handed the daily report to Li Jingsheng.
This is a settlement basis for monthly performance commissions.
As long as Tang Ping sells medicines, in addition to ordinary therapeutic medicines, he can get commissions on other medicines.
The ones with the highest commissions are health medicines.
There is also a commission for tonics, but because the profit is lower, the commission is also much lower.
Li Jingsheng knows that there are benefits to be shared, and he is never stingy with the commissions and incentives he deserves.
He took the report from Tang Ping and looked at it.
"Hey, Xiao Gao actually sold eleven orders, and five customers bought more than three boxes at a time. Is that okay?"
Li Jingsheng looked extremely surprised, followed by joy.
Although Xiao Gao helped him get the old lady and sold three boxes of anti-aging medicine a few days ago, in Li Jingsheng's opinion, Xiao Gao should have tried his best to perform well.
Now I see that Xiao Gao came here after three o'clock in the afternoon, and it has only been more than four hours.
He actually sold eleven orders of health medicines and tonics. This young man’s business talent is beyond imagination!
"Hey, boss, thank you! It's all thanks to Sister Tang's good teaching."
Xiao Gao showed his silly signature smile and scratched his head, but he was not arrogant at all.
"Dr. Gao is indeed very talented. He can easily deal with the old ladies and men who give me a headache just looking at them. The closing rate is also very high. I say 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 of them should get along quite well.
