Practicing Medical Skills in a Small Clinic-Chapter 173 - 124: This Person Is in Trouble, Solving the Mystery of Infant Diarrhea (Part 3)
After enhancing medical skills, using them to save lives is the best way to make full use of them, that has true meaning.
Li Jingsheng has a new understanding of the value of life.
Calculating too much makes one easily become a ’Miser’.
Now with a balance of as high as 378 life points, upgrading gastroenterology diagnosis is not a problem.
It was an unexpected turn of events, it completed him.
Without much hesitation, he directly increased the proficiency in gastroenterology diagnosis to 500 points.
Gastroenterology proficiency 136.7/500, instantly increased to Gastroenterology Minor Achievement 500.7/1000.
This diagnostic skill also finally reached the level of high-attending physician.
He joyfully feels the brand-new gastroenterology diagnostic and treatment abilities.
If at the low-attending level, he already has a slight ability to analyze problems independently and has begun to learn to take charge, then after upgrading to high-attending physician level, he has directly gained capabilities to independently diagnose and treat.
Facing various difficult and urgent diseases in the gastroenterology field, he now has the true ability to handle them independently.
At the low-attending level, at most, he would be a lieutenant, needing to consult senior physicians for many matters.
High-attending physicians already possess comprehensive capabilities as a general.
"Finally, I have the first diagnostic skill at the high-attending physician level, let’s get started!"
Li Jingsheng was eagerly waiting for this moment.
The grandmother and mother of the baby with diarrhea are surely anxious after going home.
After all, the child’s illness has not improved, getting thinner day by day, how could the parents not be anxious?
They haven’t left Li Jingsheng’s clinic for long.
If the cause can be diagnosed now, there might still be a chance.
If it goes on longer, they would surely take the child to other hospitals for treatment.
No matter how optimistic they are, they wouldn’t wait at home for a small clinic doctor’s news.
Li Jingsheng hurriedly analyzes the cause of the infant’s diarrhea again.
This time, with gastroenterology diagnostic skills at a high-attending level, it clearly reaches a higher level.
"The baby’s stool culture is negative, smears show no fungus, stool pH value is 7.5..."
Some overlooked details of examination results resurface in his mind and gain his attention this time.
Stool pH normal values are generally between 6.9 and 7.2.
This child’s pH value is slightly above normal.
Generally, infant stool pH value is around 7, and if purely breastfed, it can even stay between 5 to 6.
After adding complementary foods, stool pH value gradually rises.
So, the child’s stool pH value of 7.5 doesn’t necessarily mean abnormal, it mostly indicates that the child’s diet mainly consists of complementary foods.
Li Jingsheng continues to sort through the baby’s examination results.
Fortunately, he had kept a backup plan, photographing and preserving some data.
It’s relatively convenient now to directly browse through them on his phone.
Otherwise, it’s impossible to remember all examination data with mere memory.
The infant had previously experienced abdominal bloating, which was quite severe, and after the first treatment, the bloating was resolved.
But during today’s check-up, Li Jingsheng found the baby still shows signs of bloating.
Not particularly severe, but worth vigilance.
Linking this to the baby’s reduced food intake, Li Jingsheng suspects possibly intestinal intussusception.
But soon, this was ruled out.
Because the attending physician at People’s Hospital might have suspected this too, an emergency air enema was performed on the child, resulting in smooth intestinal passage. 𝒻𝑟ℯℯ𝑤𝑒𝑏𝑛𝘰𝓋𝑒𝓁.𝒸𝑜𝘮
Indicating the impossibility of intestinal obstruction or intussusception.
"To identify the true cause, one must think from a certain height. Since intussusception and obstruction can be ruled out, apart from diarrhea, reduced eating, low fever, and bloating, no other symptoms have yet appeared. Could we possibly start from infectious and non-infectious diseases?"
With improved gastroenterology diagnostic skills, the advantages are immense.
He feels like a bit of a general now when diagnosing causes.
"If it is an infectious disease, bacterial dysentery and intestinal amebiasis should be the primary suspected objects."
Since a stool smear was done, so was a stool culture, and both results were normal.
Intestinal amebiasis can be first ruled out.
Stools from this disease are fruit jam-colored or directly blood-like, but the infant’s stool color wasn’t either of these, furthermore, ruling out this disease.
What about the possibility of dysentery?
In earlier years, many young children had been infected with dysentery.
It even claimed the lives of some small children.
This disease was notably notorious.
But today, antibiotics and anti-infection drugs are already quite advanced, with a full spectrum, this disease is no longer considered much.
The child’s stool culture is negative, essentially ruling out this disease.
Children’s Hospital, particularly People’s Hospital, used a large number of anti-infection drugs on this baby, with poor treatment results.
Almost no effect.
This further rules out the possibility of dysentery.
"The possibility of infectious disease has basically been ruled out. Only the last possibility, non-infectious diseases, remains."
Li Jingsheng thoroughly enjoys this powerful diagnosis capability now.
Perhaps not on par with deputy chief physicians and chief physicians, but compared to his past self, his current gastroenterology diagnostic abilities aren’t far behind attending levels at major hospitals.
"Non-infectious disease, Crohn’s Disease? Ulcerative colitis? Food allergy?"
He exhausted his thinking over symptoms, age, and conditions aligning with non-infectious diseases for this baby.
Crohn’s Disease is quite terrifying, with an extremely long course and no cure to date.
Also, its symptoms are bizarre, especially prolonged low fever coupled with diarrhea, which can easily associate with this disease.
After thoughtful consideration, Li Jingsheng ruled out this disease.
First, the baby’s illness persisted for about a month, compared to Crohn’s disease’s one to two-year onset, it’s comparable to a minor issue.
Moreover, the child hasn’t shown bloody stools.
No obvious masses were felt during the abdominal exam.
So, Li Jingsheng directly ruled out Crohn’s Disease.
The other two diseases, ulcerative colitis often features abdominal pain, diarrhea, and bloody stools most commonly. The infant hasn’t had bloody stools, nor is there apparent abdominal pain.
Besides, this disease is acute.
Often arises with high fever, mucosal bloody stools, and bloating, abdominal tenderness, and this disease rarely occurs in infants.
This disease usually affects young adults.
Clinically, there are occasional cases in children with ulcerative colitis, typically above five or six years old.
This child is only more than seven months old, symptoms and age make it almost impossible.
Basically, this can be ruled out too.
That only leaves one remaining possibility, food allergy.
This child is consuming a prominent brand of milk, quality certainly guaranteed. But cow’s milk protein allergy is not uncommon among infants.
Infant intestinal functions are not yet perfected.
Repeated consumption of some easily allergenic foods can lead to allergic symptoms.
