Healing Doctor

Chapter 657 A Seemingly Unorthodox Physical Examination

"I saw in your medical record that you have an inguinal hernia?" Ji Xiang "finally" remembered that he was a doctor and asked a question related to medicine.

But Director Bai expressed his helplessness.

Although inguinal hernia is a medical condition, it has absolutely nothing to do with postoperative bleeding after internal hemorrhoid surgery.

"Ugh, don't even mention it. I have a sports hernia, a lot of basketball players have this problem, it's said to be a problem with the core muscles. When I was younger, I even thought about surgery, but firstly, I was afraid of the pain, and secondly, I was busy with work, so I forgot about it."

Ji Xiang and the patient began to talk about the inguinal hernia, and Ji Xiang even performed a physical examination on the hernia.

If it were someone else, Director Bai would have kicked them in the butt and sent them packing.

The purpose of the consultation was to address the patient's postoperative bleeding from internal hemorrhoid surgery, not an inguinal hernia following exercise!

As the name suggests, post-exercise inguinal hernia is a condition that occurs only during strenuous exercise. It is generally reversible and can be controlled with a hernia belt, making it a relatively harmless condition.

Ji Xiang...

That's completely off-topic.

"Director Bai, hello." Lin Jiu greeted Director Bai with a notebook in his hand and an innocent expression.

His words startled the patient's family.

For five or six minutes, they didn't even notice that there was someone else standing there.

"Professor Lin, what do you think?" Director Bai looked straight ahead, not even glancing at Lin Jiuze.

As long as he didn't look at him, the dizziness lessened considerably, and Director Bai quickly found a way to deal with Lin Jiuze.

"It's strange, I don't have any opinion for now," Lin Jiu said helplessly. "I guess Dr. Ji Xiang probably doesn't have any opinion either."

Looking at Ji Xiang, who was conducting a physical examination and explaining inguinal hernia to a patient, Director Bai thought the same thing.

Are there many similar patients at Massachusetts General Hospital?

"I don't know, my profession is unrelated to this type of disease."

Director Bai didn't say anything. Everyone has their own expertise, and it's normal that Lin Jiu didn't understand.

Director Bai understood half of what Lin Jiuze had written in his notebook. It was roughly the same as what the other directors in the office had guessed, except that Lin Jiuze had also written about the treatment, which was quite detailed.

In addition, there are some very rare diseases.

Director Bai's assessment of Lin Jiuze was that his professional skills were better than those of the directors at the Second Affiliated Hospital, even though hemorrhoids were not his area of ​​expertise.

Especially in the differential diagnosis of rare diseases, his skill is truly remarkable; Lin Jiuze's technical level is beyond question.

It seems the only option is to consult with Peking Union Medical College Hospital. Director Bai is having a bit of a headache.

He generally doesn't want to use his connections with Peking Union Medical College Hospital, since they are located in different parts of the country and maintaining those connections is very troublesome.

Ji Xiang was doing something futile, but Director Bai didn't disturb him. Instead, he patiently stood at the door and watched.

"Dr. Ji Xiang's consultation is strange, Director Bai, don't you think so?" Lin Jiu suddenly spoke up.

"good."

"Your institution truly values ​​talent," Lin Jiu said, making no sense at all.

Director Bai sensed a hint of provocation in his tone.

But he still didn't say anything, nor did he look at Lin Jiuze, acting as if he didn't exist.

A few minutes later, Ji Xiang and the patient said goodbye with smiles. Although the time was short, the two seemed to have a very good relationship, almost as if they were about to chop off a chicken's head and burn yellow paper to become sworn brothers on the spot.

"I'll go and give my opinion. Don't worry, you'll be fine soon." Ji Xiang shook hands with the patient and said goodbye with reluctance.

After leaving the ward, Director Bai looked at Ji Xiang, leaving everything unsaid.

"Director Bai, the patient's inguinal hernia is very strange," Ji Xiang said as soon as he left the house.

Director Bai had a vague feeling that something was off.

He guessed that Ji Xiang had already made a clear diagnosis, but hadn't explained it clearly. Was he going to let Lin Jiuze jump out and hit him on the head?

But Lin Jiu was also a shrewd person; he didn't say a word and acted as if he had truly disappeared.

Director Bai couldn't see through Ji Xiang, nor did he know if his guess was true or false. Ji Xiang then said, "I suggest we do an ultrasound."

"You had an ultrasound done, didn't you see the results?" Director Bai reminded him, then immediately realized he might have misunderstood. "Xiao Ji, what area do you want to see?"

"I suspect the patient has chronic Budd-Chiari syndrome. I want to examine the location and length of the obstruction in the hepatic veins and inferior vena cava at the top of the diaphragm and the second hepatic hilum to determine if it is diaphragmatic."

"!!!"

"!!!"

Director Bai and Lin Jiu were both taken aback.

This diagnosis,

Unfettered imagination.

Both of them were extremely intelligent and top medical figures. After Ji Xiang explained his diagnosis, both Director Bai and Lin Jiu almost simultaneously had an epiphany.

Budd-Chiari syndrome is a type of posthepatic portal hypertension caused by obstructive lesions of the hepatic veins and the inferior vena cava above their openings due to various causes, and is often accompanied by inferior vena cava hypertension.

This disease is classified into acute, subacute, and chronic types.

Patients with chronic Budd-Chiari syndrome often exhibit cachexia or spider-like symptoms.

However, a very small number of patients do not have any specific physical signs, but may have a hernia or hemorrhoids in addition to a small amount of ascites.

Ji Xiang's single sentence connected everything, forming a perfect closed loop.

"Xiao Ji, how did you figure that out?" Director Bai asked, frowning.

"Everyone overlooked the small amount of ascites, which is normal because of its small quantity, but I don't see it that way," Ji Xiang said. "In addition, the patient has clinical symptoms of inguinal hernia and continuous bleeding after internal hemorrhoid surgery, so my initial diagnosis is Budd-Chiari syndrome."

"Upon examination, we found that the veins in the patient's lower abdomen were slightly distended, including the jugular veins. Of course, these are just my guesses; let's conduct further examinations."

Director Bai nodded, then turned and went to his office with Ji Xiang.

The moment he turned around, Director Bai felt a little dizzy, but he quickly overcame his discomfort and looked back.

Lin Jiu didn't follow them. Instead, he stood in the ward writing something in his notebook. As he wrote, he looked up at the patient.

Director Bai confirmed his suspicions and turned back to chat with Ji Xiang while correcting his crossed eyes.

"Xiao Ji, what do you estimate the accuracy rate of your diagnosis to be?" Director Bai asked.

"Eighty percent," Ji Xiang gave a reasonable answer.

"That's good, the surgery should be quite simple."

"It's very simple. It can be done by a vascular specialist or an interventional radiology specialist, depending on who has done it before. Similar cases are rare. Chronic Budd-Chiari syndrome with normal liver function is very difficult to diagnose," Ji Xiang said.

Director Bai smiled slightly and turned his head to look at Ji Xiang.

In contrast, Ji Xiang has a kind face, while Lin Jiu is like a devil.

"That's not what I meant," Ji Xiang quickly explained, sensing what Director Bai was trying to say from his gaze.

"Haha, it's alright, I know you just want to say something good about the department heads," Director Bai said. "Find an ultrasound consultation. By the way, Xiao Ji, if you have any difficulties with your work in the provincial department, just give me a call."

(End of this chapter)