After the patient lay down, his face was still in pain.
To be honest, people with severe abdominal pain should not go to his small clinic but to a big hospital.
At least his clinic isn't equipped to handle most abdominal pain conditions right now.
Even if it's just a minor surgery for appendicitis in a big hospital, he can't solve it here.
Sister Ou's illness was cured by him, so he naturally believed that Li Jingsheng's medical skills were as good as those of major 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 have come here, Li Jingsheng must check them regardless of whether they can be cured or not.
"Which part does it hurt?"
Li Jingsheng began to observe the patient's abdomen.
"It's just the belly button."
The patient pointed.
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 started having stomach pain yesterday and has been having pain until now. It has lasted for more than 24 hours. Based on experience, it should not be appendicitis.
"Does it always hurt here?"
Li Jingsheng has already tried to palpate the patient's abdomen. In the beginning, it is usually very gentle palpation.
"Yes, it always hurts here! Ouch...it hurts, it hurts, be gentle!"
The patient's navel area was slightly pressed by Li Jingsheng, and he immediately screamed.
His face was twisted in pain, and a thin layer of sweat broke out on his forehead.
Li Jingsheng did not stop palpation, but continued to press other parts of the patient's abdomen.
He still remembers that during his training rotation in anorectal surgery, a senior resident physician performed a digital anal examination on a patient. As a result, the patient suffered an anal fissure, and the hospital paid more than 10,000 yuan in compensation.
From then on, he took special care when examining his patients.
"It hurts, it hurts!"
When Li Jingsheng pressed to the lower abdominal cavity, the patient cried out in pain again.
But the pain may not be that intense this time.
Li Jingsheng's expression became solemn because he felt a larger mass in his lower abdominal cavity.
"Have you urinated?"
He asked the patient and initially suspected that the patient had an enlarged bladder.
This happens sometimes when you can't pass urine.
For example, middle-aged and older men are most likely to have problems with their prostate. Problems with the prostate may lead to frequent urination, urgency, painful urination, burning of the urethra, incomplete urination, difficulty urinating, and excessive nocturia.
After many people reach middle age, they will find that they have to get up two or three times in the middle of the night to urinate. At this time, they need to be alert to whether there is a problem with the prostate.
The current patient is in his fifties, which is the age when 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 elderly men who needed catheterization.
Because their prostates are generally enlarged, it will be difficult to successfully insert a urinary catheter.
Requires extremely high technical level.
And because there is no anesthesia, the process of inserting a urinary catheter is very painful for the patient.
In this case, if the patient fails to succeed after trying a few times, the patient will start to curse.
If the patient is unable to curse out loud, his family members will definitely speak up.
Because the situation of patients who need urinary catheter insertion is generally not optimistic.
“I’ve been in line twice, but not too much!”
replied the patient.
"I feel a lump in your lower abdomen. I initially suspect that it may be an enlarged bladder or an intestinal problem. This is not a small problem, so I suggest you go to a large hospital for treatment."
Li Jingsheng said to the patients and their families.
When they heard that the doctor felt a mass in the abdominal cavity, the family members and the patient suddenly became a little nervous.
"Then what's my problem?"
The patient lay motionless.
It can be seen that he has a high degree of trust in Sunshine Clinic and Li Jingsheng. You may want to understand your condition first so that you can be aware of it even if you go to a big hospital.
"Dr. Li, we know that you are a good doctor with both medical ethics and medical ethics. Please tell us the truth. We are willing to pay for the consultation."
The patient's wife also expressed her opinion beside her.
There is a mass in the stomach, and the family is very afraid that it is a tumor. If it is a malignant tumor, the problem will be serious.
Ms. Ou watched from the side and said nothing.
"If you just do a general examination, there is no charge here. If you really want to know more about the condition, then I suggest you get an X-ray and an abdominal image here. The nature of this mass can also be more clear. . For an X-ray examination, I charge 100 yuan, and no film is produced."
Li Jingsheng said to the family members and patients.
"That's absolutely fine. Please take a picture of my husband!"
The woman's family background should not be bad.
Probably similar to Ms. Ou, they both come from well-off families.
Spending a hundred yuan can roughly find out what the disease is, and they think it is well worth it.
By this time, it's probably already off work when you arrive at a big hospital.
It is likely that you will have to wait until the next day to receive effective diagnosis and treatment.
After the family members scanned the QR code and paid 100 yuan, Li Jingsheng took the patient into the medical technology room and examined the patient's abdominal X-ray.
I didn’t choose to take an ultrasound.
For the diagnosis of some diseases, more information can be obtained from x-rays, which will be more helpful in diagnosis.
It took a lot of effort to find out.
The abdominal X-ray showed a small amount of pneumatosis in the colon, but no pneumatosis was found in the small intestine.
The mass in the lower abdomen was soft in texture and had clear borders. In addition, the tenderness was more obvious when the patient was palpating the abdomen.
Li Jingsheng even more suspected that it was a mass formed after the bladder was enlarged.
There may be a lot of urine accumulated in it.
"I'll check that lump for you again. It may hurt a little, so please be patient."
Li Jingsheng decided to check again out of his sense of responsibility as a doctor.
The lump is relatively soft when pressed, and it can move. Fortunately, its borders are clear and it does not feel as hard as a tumor. The initial diagnosis can rule out the possibility of a tumor.
"Have you ever vomited?"
Li Jingsheng asked the patient.
"No!"
The patient shook his head slightly.
Li Jingsheng couldn't help frowning and thinking. Judging from the feel, this mass didn't look like an enlarged bladder with fluid accumulation.
If the bladder is enlarged and accumulates so much urine, it will definitely weigh a lot when moving.
But the feeling given to him at this moment was very light.
Therefore, he believed that the possibility of urinary bladder enlargement was very small.
So what exactly is this lump?
Also, the location where the patient experienced severe pain was not at the mass, but around the umbilicus.
This is really strange.
According to common sense, this type of patients often experience abdominal pain transfer, but this patient never experienced this phenomenon.
Many doubts were constantly arranged in his mind, and then he made a comprehensive diagnosis based on the patient's medical history, symptoms, and examination results such as body temperature, blood pressure, and X-ray abdominal imaging.
Xiaocheng's level of gastroenterology diagnosis coupled with the practical ability of the senior attending physician made it easy for him to diagnose this case without any difficulty.
Diseases consistent with the above symptoms kept flashing in his mind, and then he dismissed them.
"Did you have a bowel movement yesterday to today?"
Li Jingsheng suddenly thought of an important question.
Ask the patient on the spot.
Previously, I thought that the mass was probably due to the accumulation of urine after the bladder was enlarged. I only asked the patient about his urinary condition, but ignored his stool condition.
Doctors are also human beings, and they often make some oversights during diagnosis.
This is why when the attending doctor is unsure about a more difficult case, he will ask other doctors to help with consultation.
Brainstorming can help avoid misdiagnosis and missed diagnosis to the greatest extent.
"No. Maybe it's because I didn't eat much after having a stomachache 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.
It can take as short as eight to ten hours, or as long as more than twenty-four hours.
This depends on the individual's gastrointestinal digestion capacity.
"In this case, I'll listen to the bowel sounds again for you! Just lie down and don't move."
Li Jingsheng only performed abdominal palpation outside before and briefly asked about the patient's symptoms and medical history. Didn't do too many detailed checks.
Now, out of trust, they spent another hundred yuan, and they just wanted a first-diagnosis result.
Then you must try your best.
He took off the stethoscope from his neck on the spot, put it on, and pressed the probe on the patient's abdomen.
Clear bowel sounds can be heard and they 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 still dances hard in order to please the judges.
But because I am sick, I still feel weak no matter how hard I work.
At this moment, the patient's bowel sounds gave him this feeling.
He was obviously very active, but the movement he made seemed muffled.
"Is it an intestinal obstruction?"
After checking this, Li Jingsheng immediately had a clearer diagnosis direction.
But he quickly dismissed the diagnosis.
The lump felt soft to the touch.
If it's an intestinal obstruction and it's been happening for so long, it should be pretty hard.
Even if the intestine is blocked, its absorptive function will continue to function. This causes the feces trapped in the intestines to become drier and hardened.
It definitely feels harder than this.
And the patient did not vomit.
In most cases, patients with intestinal obstruction will vomit.
There will also be bloating, abdominal cramps, etc.
Each disease 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-minded in diagnosis.
"Could it be intestinal polyps?"
That thing really feels like a piece of fat.
In other words, it's like an enlarged, soft intestine.
This idea was quickly rejected by him.
The diameter of an intestinal polyp is 1cm, which is already very scary. The volume of the mass far exceeds the maximum diameter of the intestine.
Such a big intestinal polyp?
It's so shocking.
If there was such a large polyp, the patient's intestines would have been blocked eight hundred 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 solved.
Tumors, intestinal obstruction, bladder enlargement and fluid accumulation, and intestinal polyps were all ruled out.
The possibility of appendicitis was ruled out very early.
He couldn't think of any disease that matched the symptoms at the moment.
"This patient's disease is definitely not a common intestinal disease, but probably a rare intestinal disease."
After careful consideration, he came to this conclusion.
There are many rare intestinal diseases.
Moreover, his current level and ability are limited, and the rare diseases he has mastered are really not many.
At least the doctor's level must be upgraded to deputy chief physician or above, so that he can gradually master a large number of rare diseases and difficult and complicated diseases.
The cause of this patient's disease has been diagnosed to this stage, and he will naturally not give up easily.
If we could do a puncture and take the specimen from the mass for testing, then these problems would not exist.
Of course, this risk is huge.
Judging from the current signs, the mass is likely to be a lesion in the intestine.
If you do a puncture, won't you pierce your intestines?
At this time, Li Jingsheng suddenly thought of a possibility. Since it is a rare disease, why didn’t we think of intussusception?
Intussusception is relatively rare among clinical abdominal pain disorders.
There are many similarities between this patient's symptoms and intussusception, especially the mass.
It is soft, removable and light, which are consistent with some clinical symptoms of intussusception.
The more Li Jingsheng thought about it, the more likely he felt that this was possible.
After intussusception, because the intestines are mobile, torsion is very easy to occur.
This is a good explanation for why the patient's severe pain is located around the umbilicus instead of the mass in the lower abdomen.
Because when the intestine twists and turns, it will spread to the far end like a rope twisting.
However, the intestinal tract is fixed by the frenulum and mesentery. When the intestinal tract rotates, the force is equivalent to tearing the intestinal frenulum, and it would be strange for the patient not to die in pain.
After clarifying these pathological mechanisms, Li Jingsheng has basically diagnosed this case.
Doctor level experience +50, gastrointestinal diagnosis skill proficiency +10, general surgical diagnosis skill proficiency +5, HP +100.
This was his most rewarding diagnosis since he was promoted to senior attending physician.
The proficiency of general surgical diagnosis has also increased so much, which can be regarded as the glory of gastrointestinal diagnosis.
It's like two people going into battle against the enemy. Gastrointestinal diagnosis is the main attack, and general surgery diagnosis is raising a flag and waving the flag from behind. After the war ended, the flag-wavers also received a lot of military exploits.
Before he knew it, his gastrointestinal diagnosis had reached 727/1000.
There is only less than 300 proficiency points left to be promoted to the next level.
When a clinic is opened, the two major departments that receive the most patients are respiratory medicine and gastroenterology. There are also some chronic diseases such as high blood pressure and diabetes.
However, many patients with these chronic diseases come in to have their blood pressure measured for free.
Then buy some medicine and go back to take it.
"Young man, how is my illness? It's okay. Tell me the truth. I'm already this age and I can bear it."
The patient saw Li Jingsheng's solemn expression and had been painstakingly examining him.
He realized that it was probably a serious illness.
Li Jingsheng turned his head and saw the patient's face ashen, with the expression of a righteous man going to the guillotine, and couldn't help but grin.
"Don't think too much about it. This is not a serious disease that cannot be cured. Even if I tell you, I don't understand. I can't cure this disease here, but big hospitals can easily solve it for you. I will write the diagnosis ideas to you later. Then take it to a big hospital for treatment. If you're lucky, you should be admitted to the hospital today and be scheduled for surgery tomorrow."
Li Jingsheng was originally unwilling to go into such detail.
He said this after seeing the patient's expression that he thought he had a terminal illness.
"No...it's not cancer? Do you need surgery?"
When the patient heard the diagnostic opinions given by Li Jingsheng, he instantly felt much more relaxed.
While waiting for the diagnosis results just now, he must have thought a lot, and he was even more prepared to be sentenced to death.
"Who told you it was a terminal illness? You're just thinking!"
Li Jingsheng scolded him.
Of course, he knew well that when he scolded the patient like this, instead of being angry, the patient was very happy.
"Hey, I heard that you found a mass during the examination. In addition, I have been having difficulty defecating recently and feeling a little uncomfortable in my stomach. I thought it was intestinal cancer. It seems to be a false alarm."
The man clearly felt pain in his abdomen, but he couldn't help but laugh.
That's how human nature is.
I thought it was cancer, but it turned out to be an ordinary disease, so I must be happy!
Li Jingsheng took the patient out of the medical technology room, then wrote down his diagnostic ideas and handed them to the patient.
"My diagnosis may not be correct, but if you go to the emergency department of a large hospital now and show this to the doctor, it should be helpful to the doctor's diagnosis. It will also allow you to get treatment quickly."
The patient's wife took it.
Seeing her husband's smiling face, I knew that the diagnosis would definitely not be bad.
She took it and looked at it.
"Dr. Li, what disease are you writing about intussusception and volvulus?"
"It is 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 to check it out and ask the doctor Let’s solve it for you once and for all.”
Li Jingsheng gave her a simple explanation.
"As long as it's not cancer! Thank God!"
After hearing this, the family members were somewhat worried.
But his expression has become much more relaxed.
"We're going to the hospital for emergency treatment now, right?"
"That's right! Go quickly! Although this disease is not particularly serious, it cannot be delayed, otherwise it will cause large-scale necrosis of the intestines, which will be life-threatening."
Li Jingsheng warned family members and patients.
After thanking them, they took a taxi and left with satisfaction.
The largest hospital nearby is the Second Hospital. Just look at how the taxi turned around and headed in the direction of the scenic spot?
Patients and families should listen to him.
There is only one possibility in that direction: I don't want to go to the second hospital.
To be honest, although the Second Hospital is the only major hospital in the south of the city, patients cannot be forced to go there for treatment.
Patients have their own choices.
This is also the freedom of ordinary people.
Li Jingsheng looked at the time and saw it was past six o'clock.
"Let's get off work early today! I have to finish the work on the clinic's facade."
he said to three employees.
"But I also made an appointment with two important clients. They were busy during the day and said they would have to come later." Xiao Gao said to Li Jingsheng.
"I also want to stay and take a look at today's medical records. Especially the uncle who had abdominal pain just now, I feel that it is particularly difficult to diagnose the cause of his illness. I also want to have the same diagnostic level as my boss earlier."
Han Siying also didn't want to get off work so early.
The clinic's facade crisis has also made several employees cherish their job and the fate of being together even more.
In addition, the boss Li Jingsheng has a charming personality that attracts them, which makes the three of them cherish him even more.
