After Li Jingsheng found a tender point, he did not stop checking, but continued to press her abdomen.
Pressing along the right side of the abdominal cavity, she continued to cry out in pain.
When approaching the pubic bone, the patient's tenderness reaction is still strong.
"Finished!"
After saying that, Li Jingsheng took the lead to leave the infusion room. Han Siying helped her get out of bed and then followed.
"Aside from diarrhea, do you usually have blood in your stool?"
"It seems a little bit, but it's not serious. It's a little bloodshot."
"Do you have a lot of abdominal pain?"
"I've been having abdominal pain a lot lately, but the pain will go away on its own after a while."
After all, she was studying medicine, and her answer was quite detailed.
"Is it a dull pain or a sharp pain?"
"It's a dull pain!"
"I'll give you an ultrasound to check the condition of your abdominal cavity."
"OK!"
When she agreed, she took out her mobile phone to scan the charge code on the consultation table.
"Is it a hundred dollars?"
It seems that she already asked Han Siying yesterday.
"Aren't you Siying's classmate? This examination fee is waived! Anyway, for our clinic, it is all ready-made equipment, and there is no big loss."
That electricity bill is almost negligible.
When Li Jingsheng examined her just now, he found that her underwear had been washed to pieces and the clothes she was wearing were extremely simple. Although the collar and cuffs were cleaned very well, the linting and threading were quite severe.
There are black hairpins in her short ear-length hair. You can buy many of them for one dollar.
Girls nowadays love beauty, and her age is the best years of a girl's life. Dressing so plainly can only mean one thing, she has no money.
If the economic conditions were a little better, I would not wear my underwear to that extent and be reluctant to throw it away.
Li Jingsheng himself also went through a period of extreme poverty, and he knew very well that a penny is too much for a hero.
She was so seriously ill but was unwilling to go to a large hospital for examination. It was not because she did not understand medicine, but because she was worried that she would not be able to afford medical treatment.
She was lucky to meet Li Jingsheng.
"How can I be embarrassed if I don't give you money?"
"It's okay, it's okay. I really don't need to pay for the examination. I always treat acquaintances like this when they come. If I can help you find out the cause of your disease later, and if I can cure it here, you can just pay for the medicine."
Li Jingsheng tried his best to preserve her dignity.
Even the acquaintances who came here were not treated like this.
He charges 100 yuan for filming.
After all, this is a clinic, not a charity hall.
"Okay then! Thanks, boss!"
She smiled and agreed.
After giving her an abdominal ultrasound, it was concluded that the intestinal wall was significantly thickened.
There was significant thickening of the intestinal walls of the ascending, transverse, and descending colon.
The colon pouch disappeared, the mucosa was mainly thickened, and the intestinal wall layers remained.
The thickened intestinal wall has abundant blood flow, which indicates that the disease is in the acute active stage.
"Okay, put on your clothes and pants!"
After Li Jingsheng checked her B-ultrasound, he breathed a sigh of relief.
The biggest concern is colorectal cancer.
Because when she was examined for tenderness, she complained of pain around the right side of her abdominal cavity.
And it extends all the way to the posterior wall of the pelvic cavity.
This means there must be something wrong with the colon, and probably with the rectum as well.
The human colon is M-shaped and is located just outside the abdominal cavity.
The colon and rectum are the most susceptible parts to cancer. In addition, she had long-term low-grade fever, diarrhea, and a certain degree of bloody stools. This was very similar to the symptoms of colorectal cancer.
Fortunately, after the ultrasound, no obvious tumors were found.
He has also been worried that cystic tumors or solid tumors will appear during B-ultrasound. After checking, he was relieved.
Sometimes it is true that bad luck seeks out those who are suffering, and the hemp rope breaks at the thinnest places.
It is not easy for a poor family to train a graduate student.
This girl is probably the hope and pride of the entire family.
When she finishes her PhD and gets out, her destiny will probably change.
Poverty is only temporary.
He began to think about the cause of the girl's illness.
Now the lesion has been basically identified, it is a colon lesion, and the mesentery may also be involved.
She had significant colon mucosal problems.
No local abscess was found, indicating that intestinal perforation can basically be ruled out.
It shouldn't be a big problem.
Depending on the patient's symptoms and ultrasound findings, there are many possible diseases that may be consistent with it.
For example, chronic bacillary dysentery requires routine stool and stool culture to be diagnosed.
There are also diseases such as chronic amoebic enteritis, Crohn's disease, irritable bowel syndrome, colitis, schistosomiasis, intestinal tuberculosis, etc.
Li Jingsheng eliminated these diseases one by one.
His current gastrointestinal diagnosis is at Xiaocheng level, which is really the level of a senior attending physician. In addition, there are proficient-level general surgical diagnosis, internal and external auxiliary diagnosis, and mutual support.
This makes his diagnostic ability better than that of ordinary senior doctors.
Chronic amoebic enteritis mainly affects the right colon, with deep ulcers and sneaking edges, which is highly consistent with this patient.
However, considering the patient's medical history and intestinal mucosal manifestations, he finally ruled out this highly consistent disease.
The mucous membranes in this disease are often normal.
As for bacillary dysentery, there is often a history of acute bacillary dysentery illness, which this girl did not have.
Therefore it is also excluded.
…
Ultimately, he thought colitis was more likely.
But common colitis usually has mild symptoms, but this girl's symptoms were more severe. Considering the long course of her disease and the B-ultrasound imaging results, he was ultimately more inclined to think that the girl had ulcerative colitis.
Now that the cause has been diagnosed, treatment is easier.
Neither colitis nor ulcerative colitis is difficult to treat.
At least with his current level of prescriptions, he should be able to cure the disease.
"Boss, have you found out what's wrong with me?"
She stood up and put on her pants, and asked a little uneasily after arranging her clothes.
"Don't worry, it's not a serious illness. It's possible that the colon is inflamed, and it lasts a little longer, so the symptoms are more severe. There may be colon ulcers at the moment. I'll prescribe some medicine for you. You can cooperate with the treatment yourself, control your diet, and pay attention. Rest and you should feel better soon."
Li Jingsheng comforted her.
"Really! Thank God, thank God!"
When she heard that it was just colitis and ulcer, her malnourished face burst into a joyful smile.
The worry between his brows disappeared in an instant.
She must be suffering a lot these days.
I am a medical student, so I know a little bit about it. I am definitely worried about a serious illness, especially cancer.
Now that she knows it's just colitis, it's like a new lease of life for her.
"It shouldn't be wrong! Of course, if you suspect that my diagnosis is wrong, you can go to a large hospital to do a few more tests to confirm."
Li Jingsheng smiled and said to her.
"No, no, that's not what I meant. I saw reports about Sunshine Clinic in newspapers and news, and then I learned that Han Siying works here, so I thought I would look for you based on this acquaintance. I I have no doubts about your medical skills.”
She quickly waved her hands to explain to Li Jingsheng.
"Haha, I can see that you must have trusted me before you came to me. Otherwise, you wouldn't have come twice."
Li Jingsheng smiled and nodded.
Judging from her performance, she is an inexperienced girl.
High academic qualifications sometimes do not mean deep social experience. Many young people with high academic qualifications actually have no social experience and are as pure as a blank sheet of paper.
"I will prescribe medicine for you right away. Your diet must be consistent with the treatment. You must not touch milk or dairy products. You must eat foods that are easy to digest, low in fiber, and rich in nutrients. Then after you take the medicine here, you will see It depends on the effect. If the effect is not good or the diarrhea is still severe, you may need to fast to cooperate with the treatment."
It makes no sense to say that ulcerative colitis is a minor illness.
It is a relatively common disease in clinical practice.
Her abdominal pain and diarrhea were both severe, and atropine was actually a good medication choice.
Unfortunately, the outpatient clinic is no longer allowed to sell it.
Prubenzine, compound phenylephrine, and loperamide can all replace this medicine. It’s just that these drugs cannot be used in large quantities, let alone for long periods of time.
Li Jingsheng prescribed her the cheapest one, which can be used in small doses for a short period of time.
The above-mentioned drugs have a side effect and can easily cause toxic intestinal dilation.
If its efficacy and pharmacodynamics do not reach Xiaocheng level, we would not dare to prescribe this medicine to such patients.
Next, he prescribed aminosalicylic acid drugs in combination with two other drugs.
It doesn’t take a lot of medicine, as long as you use it correctly, it will be effective.
"If you don't get good results after taking these drugs, or if the pain in the rectum or sigmoid colon is still severe, then I will prescribe you another suppository. Enema is not recommended as the first choice."
Li Jingsheng considered that the clinic's conditions were limited and manpower was tight.
She is an unmarried girl, and it would be difficult for her to accept the enema treatment given to her.
In the end, she paid thirty-seven yuan, took some medicine, and left.
You could tell when she left that she was in a very good mood.
The treatment fee was unbelievably cheap, and the cause of the disease was actually found out for her. Naturally, she was very happy.
Li Jingsheng made almost no money from her.
When he encounters such a patient, he is willing to treat him even at a loss.
Ulcerative colitis must be treated promptly.
No ulcer should be left alone.
Repeated ulcers in the digestive tract can greatly induce the risk of cancer, as even the World Health Organization has confirmed.
He checked the results of the attribute panel and found them very gratifying.
Doctor level experience +10, gastroenterology diagnosis proficiency +10, general surgical diagnosis proficiency +1, drug efficacy and pharmacokinetics proficiency +1, HP +101.
At the beginning, he would be particularly happy if he received a good review and earned 10 health points.
Earning more than 100 yuan at a time made him even more ecstatic.
Now, he is used to it.
Occasionally, you will feel happy when you earn 100 health points, but it won't be as surprising as before.
"Boss, my classmate Momo sent a message. Do you know what she said?"
Han Siying came over.
"What else can I say? Thank you!"
Li Jingsheng responded with a smile.
"Ahem...she said, Siying, your boss is a good person!"
Han Siying relayed the text messages from her female classmate in a serious manner.
After Li Jingsheng heard this, he smiled.
It’s hard to say whether he is a good person, but he is not bad-hearted.
I hope the girl named Momo can recover soon.
It was still busy in the afternoon, with patients constantly coming for treatment. Basically they are all residents or renters of the neighborhood.
As the Sunshine Clinic appeared on TV news, Li Jingsheng's reputation gradually increased.
In addition, he now has the status of an official doctor of the Second Hospital, which makes his authority even higher. Patients' trust in him has increased significantly.
The Sunshine Clinic is flooded with patients, and Boss Zhao of Kuaikang Clinic should probably cry.
There are only so many patients in this area, and only a small number are willing to go to the clinic for treatment.
Now that most of it has been taken away by Li Jingsheng, the business of Kuaikang Clinic will definitely deteriorate.
Then Sunshine Clinic's health medicine business dominated the entire old street area in the south of the city, and even those pharmacies couldn't compete with him. Not to mention Kuai Kang Clinic.
Today, Li Jingsheng’s Sunshine Clinic has directly become the second strongest medical institution in Chengnan Old Street.
My only regret is that I couldn't recruit a certified doctor to come and see me.
Otherwise, the clinic's diagnosis and treatment business should be more stable.
After all, Li Jingsheng is away from the clinic three days a week.
And as his medical skills continued to improve, he joined a large hospital, opening up the situation and providing more and more development opportunities.
His development ideas are making new adjustments little by little.
From now on, common diseases will be diagnosed and treated by other doctors in the clinic, who is responsible for solving difficult problems.
When he was busy until about four o'clock in the afternoon, his cell phone rang.
It was Lian Tao who called.
Because he was too busy, his phone received two messages, but he never had time to read them.
"Brother Lian Tao, is there any new progress in the patient's examination?"
"Yes, I found out about it after three o'clock. I sent you a message and there was no reply."
"Sorry, I've been busy treating patients. What disease did you find out?"
Li Jingsheng apologized quickly.
"Understand, understand, I am an impatient person. I guessed that you were busy, so I called you directly. You don't know, this disease has been bothering me for nearly three days. Now that I have found out, I feel really comfortable. "
Director Lian Tao's voice could not conceal his excitement and joy.
"I never would have imagined that the cause of this patient's illness was neither nasal polyps, nor tuberculosis, nor lung cancer, but cryptococcal infection in the lungs. Damn it, I have diagnosed many cases of lung disease, but I didn't expect that this little Cryptococcus is so treacherous. Director Yang and I couldn't find it out even though we worked together. Fortunately, I listened to your advice, stopped taking prednisone, and then investigated step by step.
If I had known earlier, I should have taken the specimen for biopsy as soon as possible, which caused me to take many detours. "
Speaking of the experience of diagnosing this disease, Lian Tao felt very upset.
Being manipulated by a small cryptococcus, he, the chief physician of the People's Hospital, had no place to put his face.
"Haha, clinical practice is sometimes like this, and it's often unexpected. Those diseases are clearly right under our doctors' noses, but we just can't catch them."
Li Jingsheng responded with a smile.
"Isn't it! I still remember what Teacher Fu Jie said during my further study abroad. His diagnosis was similar to mine. He was also tricked by a very inconspicuous cause. He tried his best to find out but couldn't find it. . Finally, he asked an expert from another top medical center, who was also one of his teachers, to help, and then he found out. He said at the time that the first time he learned about this disease was from a textbook, the second time was from a gross body teacher, and the third time It was during that clinical practice that he said he was still too young."
I really envy Lian Tao's dazzling resume. Studying or studying abroad is a big plus.
It can indeed greatly broaden your horizons and increase your medical knowledge.
"Jingsheng, what medicine do you think is better for this patient?"
"Your level is so high, I don't dare to try your best!"
How dare Li Jingsheng act like a bully in front of him.
Although Li Jingsheng helped diagnose this case, one case cannot represent the true level of medical skills.
Lian Tao is very strong.
I just happened to encounter a 'blind spot'.
Every doctor has such blind spots, which can also be called shortcomings.
"It's pointless to talk about professional titles. I'm older than you, and my professional title is higher than yours, so what? When I encounter a case I don't understand, I still ask you for advice. That's not what medicine should look at."
Lian Tao is a more down-to-earth person who only looks at abilities and character and nothing else.
"Tell me, if you were asked to treat it, what medicine would you give this patient? We can also check each other out!"
Lian Tao urged again.
"When it comes to medication, oral fluconazole should be a better choice! This is just my personal opinion. I can only serve as a reference and cannot affect your treatment ideas."
After Li Jingsheng thought carefully, he wrote a prescription.
"Is there any other medicine?"
After hearing this, Lian Tao didn't say anything.
"One medicine should be enough."
Li Jingsheng does not think that using more medicine is a good thing.
The patient's condition seemed serious and he had a lot of scary symptoms.
In fact, as long as you use the right medicine, a simple fluconazole can do the trick.
Taking too many medicines has many side effects, which is not a good thing.
"Gentlemen really have the same opinion! Haha, I just want to hear your opinion. In my impression, many doctors in clinics like to prescribe a lot of expensive drugs that will not kill people but have no therapeutic effect. They have to make money. Ah! I didn’t expect that Jingsheng is so consistent on the inside and sticks to his original intention when it comes to medication. It’s really rare.”
Lian Tao didn't laugh this time, but praised him in a very serious tone.
"Hey, have I ever been different from what I am on the outside? Really!"
Li Jingsheng smiled proudly.
"Jingsheng, when it comes to this matter, let me give you a reference. We are good friends, so I won't beat around the bush. My original purpose of becoming a doctor was to make money, so that my family and myself could live a good life. . Now, my purpose is still this, but my interest in medicine is getting stronger and stronger. When I encounter difficult cases in my field of expertise, I can’t help but want to get to the bottom of it.”
Lian Tao really dared to say anything.
I’m afraid most of the doctors in the world study medicine in order to have a good and stable job, right?
Everyone agrees that being a doctor earns a lot of money.
It is precisely because of this that it attracts countless top students to take the medical exam, study medicine, and then become doctors.
This is a virtuous cycle.
Only when top students and top academics become doctors can we ensure the prosperity and development of medicine and the higher and higher medical level.
"I believe your purpose in opening a clinic is to make money, and at the same time gain greater freedom from the constraints of the system."
"Yes! Making money is necessary. When you have no money, even dogs will look down on you when you walk on the road."
Li Jingsheng thought of the difficult days in the past, and his desire for money has never weakened.
When he can't even pay his employees' wages, it's really difficult for him as a boss.
"Haha! I have experienced this. I remember that I had no money when I was studying. I saw a poodle on the road. I waved to it and told it to come over. It ran away without saying a word with its tail between its legs. At first I I was thinking, do I look so vicious? Later, I thought about it carefully, and then I realized that the dog smelled the smell of poverty on me and was afraid that I would stew it with dog meat."
Lian Tao originally experienced poverty when he was a student.
It seems that every strong person slowly becomes stronger after going through hard times.
"Seriously, if you want to make money, I think you can follow the model of foreign freelance doctors and nurses. They have less work, high status, and high income. It's really enviable."
Lian Tao provided Li Jingsheng with a development idea.
"Tell me, what kind of model?"
Li Jingsheng was naturally very interested when he heard about such a good thing.
(End of chapter)
