Practicing Medical Skills in a Small Clinic-Chapter 136 - 112: Short Bowel Syndrome—The Most Terrifying Disease Is Poverty (Part 2)
Rigid abdomen only occurs with conditions such as acute gastrointestinal perforation, organ rupture, and acute peritonitis.
The uncle has experienced bloody stools, and it has been going on for several days.
Now the bloody stool is worsening, and abdominal pain is intensifying, all indicating the progression of the disease, and it’s coming aggressively.
"Does it hurt here?"
"Yes."
"Is it just a little pain or very painful?"
"Quite painful."
Just after the uncle answered, Li Jingsheng slightly increased the pressure.
"Ow... it hurts, it hurts!"
Li Jingsheng immediately withdrew his hand, judging that the pain location for the uncle should be in the jejunum.
The small intestine is part of the digestive tract, divided into the duodenum, jejunum, and ileum.
Interestingly, the medical separation between the upper and lower gastrointestinal tract is marked at the duodenum.
The suspensory ligament of the duodenum is also known as the ligament of Treitz.
It acts like a ’boundary marker’ between the upper and lower gastrointestinal tract.
Above the ligament of Treitz is the upper gastrointestinal tract, below it is the lower gastrointestinal tract.
The jejunum makes up about two-fifths of the small intestine’s length, slightly shorter than the ileum.
The current pain location is in the ileum, further diagnosis requires more information.
"Alright, the examination is finished, you can get up! Is the color of the blood in your stool bright red or dark red?"
This is very important.
It can help Li Jingsheng roughly infer the intestinal section of the bleeding point.
Rectal bleeding is usually bright red, the further up, the darker the color of the bleeding.
Because it takes time from bleeding to exiting the body.
The longer this time, the darker the color of the fresh blood will be.
"Hmm... it seems to be dark red! I noticed blood on the paper when wiping, and the color is quite dark. But I’m sure it’s blood."
"Is the amount of bleeding large?"
"These past few days it feels a bit much, and the stool looks a bit like jelly, with some whiteness, and it’s very smelly. Kind of like the smell of rotten meat."
The uncle described the condition of his stool.
"Doctor, is my illness very serious? Is it treatable? How much will it cost to cure?"
"Don’t worry for now, let’s talk outside!"
Li Jingsheng walked while pondering what exactly is the uncle’s illness?
From the uncle’s description of his bowel movements, there should be fat diarrhea accompanied by pus and blood in the stool.
The uncle had undergone intestinal resection surgery, and his entire look reveals rough skin, yellowed hair, and a thin body, clearly indicating long-term malnutrition.
He is currently experiencing abdominal pain, with the pain point located at the ileum, has undergone surgery, and has had bloody stools for several days...
When Li Jingsheng’s gastrointestinal diagnosis had just ascended to the Master Level, he felt that any patient with gastrointestinal diseases would be easy to handle, with diagnoses easily reached.
At this moment, he feels a bit like a frog in a well, overly confident.
Diagnosing this uncle, due to the lack of examination evidence, is particularly challenging.
To compensate for the lack of examination evidence, his diagnostic skills need to be one or two levels higher than those of doctors in large hospitals to barely match them. 𝐟𝕣𝕖𝐞𝐰𝕖𝚋𝐧𝗼𝚟𝐞𝕝.𝗰𝐨𝐦
Large hospitals, because they can conduct various examinations, might only require the skills of a senior resident to diagnose the uncle’s illness.
Li Jingsheng, although possessing the diagnostic ability of a junior attending physician, still finds it very strenuous.
This is an unavoidable situation.
Without enough instruments, one can only rely on skills.
That being said, once he improves all his diagnostic skills to a very high level, when he goes to a large hospital in the future, he can immediately ’dominate kindergartens and nursing homes.’ He will undoubtedly be able to outperform the majority of doctors in big hospitals.
This is somewhat like the difference between wild and domesticated animals.
A wild wolf can easily hunt a domestic dog of equal size.
Li Jingsheng belongs to the self-taught one, with simple conditions, but the honed skills are particularly solid.
"Apart from bloody stools, do you also have diarrhea now?"
"Yes!"
"How many times do you have diarrhea a day?"
"A few days ago, it was about two to three times a day, today it has been four times."
The uncle is experiencing diarrhea, with the jelly-like white liquid excreted being intestinal mucus.
"Do you know which part of the intestine was removed?"
"They said they removed part of the small intestine, but what’s it called... I’ve forgotten."
"Is it called the jejunum or the ileum?"
Li Jingsheng gave some hints to the uncle.
The small intestine has only three parts, an internal hernia strangulation usually means cutting either the jejunum or the ileum.
"Yes, yes, it was the jejunum that was cut, I remember now."
With this further accurate information, Li Jingsheng finally has a direction for diagnosis.
Combining the patient’s medical history, symptoms, pain location, and partial small intestine resection information, the uncle is likely suffering from short bowel syndrome.
This is a rather tricky condition in clinical practice.
The total length of an adult’s small intestine is about 4-6 meters, cutting a little doesn’t cause major problems.
Of course, the premise is that the surgeon’s skills are solid, avoiding anastomotic leakage or strictures in intestinal anastomosis.
If too much of the intestine is removed, it will certainly affect the absorption of nutrients.
The small intestine is the body’s main organ for nutrient absorption.
Excessive removal can easily lead to short bowel syndrome.
"After my diagnosis, it’s very likely that your illness is short bowel syndrome. It’s better to go to a large hospital for further examination and treatment. Especially now that you have fat diarrhea accompanied by pus and blood stool, if left untreated, it can be life-threatening."
Li Jingsheng is cautious and dares not to treat such a serious condition.
This illness varies in severity.
The uncle’s symptoms are clearly severe. Even a tertiary hospital of the Second Hospital’s caliber would take the case very seriously upon reception.
