Healing Doctor

Chapter 668 We must win!

Ji Xiang changed his clothes and returned to the ward, where he saw Lu Gang sitting angrily in front of the computer, looking at medical records.

"Director Lu, what's wrong?" Ji Xiang asked.

"Acute abdomen, those damn cowards in the gastrointestinal tract and liver and gallbladder departments are all unwilling to operate," Lu Gang said irritably. "Although I also think we shouldn't operate, it doesn't seem like an intestinal perforation, but the patient's condition is not right."

It was obvious that Lu Gang was a bit anxious and confused, so his words were incoherent, as if he hadn't thought them through and was just instinctively expressing his anxiety.

Especially after he had just finished criticizing the liver, gallbladder, stomach, and intestines, he turned around and said that he didn't think surgery was possible either, which almost made Zhao Zhe burst out laughing.

Ji Xiang leaned closer and glanced at the lab report.

An emergency abdominal ultrasound revealed coarse liver echoes, thickened and rough gallbladder walls, and a small amount of fluid in the abdominal cavity.

Blood gas analysis: partial pressure of oxygen 53.8 mmHg, oxygen saturation 84.6%.

Serum potassium 2.4 mmol/L; Renal function: blood urea nitrogen 22.08 mmol/L, creatinine 352 μmol/L, uric acid 428 μmol/L.

Emergency amylase level 137 U/L; complete blood count: white blood cell count 9.3 × 109⁹/L, neutrophils 0.787, hemoglobin 105 g/L.

Acute renal failure, accompanied by hypokalemia, are not serious compared to acute abdominal pain, as they can be treated with medication.

"Director Lu, how was the physical examination?"

"Blood pressure 210/148 mmHg, respiratory rate 23 breaths/min, oxygen saturation 99%, temperature 36.8℃, heart rate 105 beats/min. Coarse breath sounds in both lungs, moist rales heard in the right lung, no wheezing, heart rate 105 beats/min, regular rhythm, no pathological murmurs."

The abdomen is tense, tenderness is present throughout the abdomen, with rebound tenderness; the abdomen is board-like; bowel sounds are absent; there is no swelling of the face or limbs.

"It's a fairly typical case of acute abdomen. An upright peritoneal fluoroscopy doesn't support the possibility of gastrointestinal perforation?" Ji Xiang asked again.

This question hit the nail on the head, and Lu Gang nodded nervously.

Lin Jiu suddenly became interested, knowing from his understanding of Ji Xiang that Ji Xiang would probably go to the consultation with Director Lu Gang.

This time, I absolutely cannot lose!

He opened the drawer, took out his notebook, and held it tightly in his hand.

Lin Jiu didn't notice that his palms were a little damp; he subconsciously wiped the sweat from his palms on his white coat.

I have a basic understanding of the patient's condition. It looks like an acute abdomen. In a regular hospital, the surgeon would definitely take the patient directly to the operating table to check where the problem is.

But Director Lu kept hesitating.

There's a problem, but Lu Gang doesn't know what the problem is.

Some things are hard to explain; they're just a kind of "sixth sense" formed from seeing so many patients.

As for the "clinical manifestations," they are just like Lu Gang's current condition.

Lin Jiu knew that when faced with difficult and complicated cases, doctors often relied on years of clinical experience to make judgments, and they couldn't really give a detailed explanation.

"When will the hospital-wide consultation begin? Have you seen the patient, Director Lu?" Ji Xiang asked.

"I took a look yesterday, we'll go see it together later," Lu Gang replied naturally.

Ji Xiang reviewed the gastroenterology medical records again. "Does the patient have a family history of depression?"

"Hmm, when I see patients, I don't think they all have depression in their families. The diagnosis of this disease, heh." Lu Gang didn't continue, just chuckled.

Lin Jiu noticed this detail, and various diagnoses about abdominal pain caused by depression popped into his mind.

Depression itself does not cause abdominal pain, but chronic conditions such as abdominal epilepsy, without a definitive diagnosis, can lead to anxiety and eventually depression.

The cause and effect are exactly opposite, but clinically they often occur together, so they are also within the scope of consideration.

Abdominal epilepsy is also possible.

This time, Lin Jiu went all out. He was no longer as lazy as before. His eyes were shining, and he gripped the notebook tightly, making the ballpoint pen crackle.

He just didn't realize it.

Even his harmless expression vanished; at this moment, Lin Jiu was filled with fighting spirit.

fighting!

fighting!!

We absolutely have to win!!!

Upon arriving at the gastroenterology department, Lu Gang and Ji Xiang conducted physical examinations, while Lin Jiu stood in a corner observing their every move, as well as the patient's facial expressions and body language.

After Lu Gang and Ji Xiang left, Lin Jiu began to write and draw in his notebook.

When writing, look up to observe; then look down to write again, and look up to observe once more.

Soon, Lin Jiu fell into deep confusion.

He took this patient very seriously, much more so than he had at Massachusetts General Hospital.

Lin Jiu had already prepared his mental plan, and in a short period of time, he wrote at least ten diagnoses. However, none of these diagnoses were correct, and he even began to have deep doubts about the knowledge he had acquired.

Abdominal pain is an acute abdominal condition, not an organ problem, nor abdominal epilepsy, nor common diseases such as intestinal volvulus or intestinal spasm.

What else could it be?

Lin Jiu racked his brains trying to think.

Meanwhile, Ji Xiang was discussing the patient's condition with the patient's family, while Lu Gang began to preside over a hospital-wide consultation.

"This case is different from the previous ones. The patient's abdomen is particularly rigid, accompanied by tenderness and rebound tenderness. Acute abdomen can be clearly diagnosed. Although there is no crescent-shaped area on the upright peritoneal fluoroscopy, it may be an intestinal perforation, although not much gas has leaked out."

"This is what the gastroenterologist said after briefly introducing the patient's condition," the doctor explained.

"I remember this patient has already had his third consultation. The first two times..." said the deputy director of the gastrointestinal surgery department. "The most outrageous one was the second time. We were preparing for surgery when the patient suddenly said that the pain had lessened."

"I've also considered this. Could it be acute cholecystitis? Although the ultrasound didn't show severe cholecystitis, it can still cause intense pain and acute abdomen. Each time I'm hospitalized, I have to receive intravenous antibiotics, and it's normal for the cholecystitis to be suppressed under the action of antibiotics."

"I don't think it's that simple. Generally speaking, cholecystitis causes upper abdominal pain, and apart from cases of gallbladder perforation and bile overflowing into the abdomen, there are no signs of a board-like abdomen."

Many doctors gave their own opinions, and there was no consensus.

Lu Gang's hair drooped down, but he didn't care at all. He looked like he was thinking fast and hard, trying to figure out what was wrong with the patient.

A knock came at the door.

Ji Xiang then pushed open the door and tiptoed in.

"I don't think we can operate," the surgeon said. "The patient's pain was relieved before the previous two surgeries. What if we can't find the problem after opening it up this time, or we can only barely remove the gallbladder after searching for a long time, and the patient is still in pain after the surgery? What should we do then?"

"It's clearly an acute abdomen; these are typical signs of exploratory laparotomy!" the gastroenterologist insisted. "If we don't operate, what else can we do?"

Both sides held their own views and began arguing.

The conversation grew increasingly heated, and there were even signs that he was about to slam his fist on the table and curse.

"Keep your voices down!" Lu Gang raised his voice to silence the argument. "Can't you all talk things out properly? What are you all arguing about?"

Several doctors, feeling indignant, swallowed their words.

(End of this chapter)