Practicing Medical Skills in a Small Clinic-Chapter 68: The Dangers of Valvular Insufficiency Combined with Diarrhea
This is a bit like solving a math problem.
When you first start learning, you can only do simple addition.
Later, you learn subtraction, and even multiplication and division, allowing you to tackle comprehensive problems. You think holistically from multiple angles and perform comprehensive calculations.
This is a significant improvement in diagnostic thinking ability.
Attending Level and resident physician—seemingly only one level apart, yet there is a significant gap in clinical ability and diagnostic level.
An attending physician can already handle things independently, whereas a resident physician still has a strong dependency.
Even a senior resident physician needs to constantly consult their superior during clinical diagnosis and treatment, and it’s difficult for them to handle cases with slightly higher risk or complex diseases independently.
In normal circumstances, an attending physician can relieve the chief physician or group leader of their burdens in the wards.
Only some particularly tricky issues need consultation with a chief physician.
Most of the time, even when it comes to patient rescue, the attending physician can lead the resident physicians, training students, and interns independently, completing the rescue task with the cooperation of nurses.
At this moment, Li Jingsheng, in the field of Cardiovascular Medicine, has already preliminarily reached the level and capability of an Attending Level physician.
Of course, merely being good at diagnosis is not enough; he must also improve drug efficacy and pharmacokinetics to truly possess the diagnostic and treatment capabilities of an Attending Level physician.
For now, he only has the diagnostic ability of the Attending Level.
"The patient’s valve insufficiency is certainly not congenital. Because it was asked earlier, the patient had undergone physical examinations and never had heart disease. Hearing cardiac murmurs can basically ascertain it’s due to valve insufficiency, but the specific valve causing it still cannot be diagnosed."
Damn, this medical skill improvement is like a nesting dolls game, it’s so enthralling.
With each level up, there’s significant gain and higher proficiency, but still some helplessness when faced with certain difficult complex cases.
His current doctor level is a senior resident physician, which limits his medical skills to reach only Master Level.
Because medical skills can only be one level higher than the doctor level.
In this regard, the attribute panel imposes strict restrictions.
This restriction is quite reasonable.
Otherwise, if an intern could have chief-level medical skills, it would be terrifying.
It’s like a baby wielding a big knife.
Even if an intern genuinely possesses chief-level medical skills, due to a weak foundation and lack of comprehensive medical knowledge, they cannot fully utilize the level of chief-level medical skills.
The enhancement of a doctor’s level should be a comprehensive improvement in overall ability, not merely in a single technique.
"Unable to determine which valve has insufficiency by heart sound, then leave it aside for now. Anyway, my goal is to pinpoint the cause, the specific treatment, and diagnosis will be the concern of doctors from big hospitals."
Li Jingsheng decided to stop fixating on it.
The heart has four valves: mitral valve, tricuspid valve, pulmonary valve, and aortic valve.
Leave aside which specific valve is insufficient for now.
"There are many causes for valve insufficiency, the more common acquired heart disease cause is cardiac enlargement."
To give an analogy, a valve is akin to a door.
The heart is the house.
Due to certain special reasons, the volume of the house increases, but the door remains the original size, which very likely leads to the door being improperly closed.
Gaps may appear.
The heart’s function is to pump blood, it acts as a kinetic station for all arterial and venous blood.
It sends arterial blood throughout the body to provide oxygen and nutrients, and then recycles venous blood.
This creates a continual cycle, forming the body’s blood circulation.
Considering this patient frequently stays up late working overtime, sitting for long periods, it easily leads to cardiac enlargement.
Because when a person is seated, the load on the heart increases.
As for the belief that standing increases the heart’s load, that’s incorrect.
The calf’s gastrocnemius muscle is the body’s second heart, when walking, it functions. This significantly reduces the burden on the heart.
Therefore, it’s not only when lying flat that the heart’s burden is minimized.
When walking upright, the heart’s burden should be at its lowest.
This is somewhat similar to a horse resting standing; it always has one leg relaxed, frequently rotating among its four legs.
The gastrocnemius muscle of the human calf helps the heart easily complete the recovery of distal venous blood and the delivery of distal arterial blood. This somewhat places the heart in a relaxed semi-resting state.
Doctors often recommend exercising more, which embodies this principle.
Of course, the benefits of exercise are not limited to this.
If office workers, especially those who sit for long periods, need a simple method to prevent lower limb venous thrombosis.
It’s to flex the toes.
Vigorously flex the toes backward.
This might initially pull at ligaments and cause some pain, but if one persists in this action, it greatly benefits the body.
"The patient likely has cardiac enlargement leading to valve insufficiency, hence the abnormal heart sound. But theoretically, valve insufficiency shouldn’t cause diarrhea symptoms..."
Li Jingsheng contemplated, feeling that although the patient has both diarrhea and cardiac valve insufficiency, the two are unlinked.
There shouldn’t be anything dangerous for the time being.
However, the patient mentioned the abdominal pain moving upwards.
This inevitably raises concern.
"Diarrhea induces pain in the lower abdomen and mid-abdomen, which generally resolves on its own. As long as there is no intestinal obstruction or perforation, it is mostly not dangerous. But if there is pain in the upper right abdomen, then it must be considered whether the appendix is inflamed. If there is pain in other parts of the upper abdomen, it may also be an issue with the ascending colon. However, this patient has clearly described twice that there is a dull pain in the left chest area."
Li Jingsheng frowned in contemplation.
The patient held his stomach tightly, looking distressed, nearly unable to hold it in, mainly worried about defecating on himself.
If someone were to capture this scene, it would certainly be quite amusing.
Behind this, however, is a doctor at a small clinic working tirelessly to save a life.
Meticulously checking for potential dangers.
"Do you have chest congestion?"
Li Jingsheng asked the patient.
"No... can you please quickly prescribe me some anti-diarrhea medication, I need to hurry home to use the bathroom."
The patient urged somewhat awkwardly.
"I have a bathroom here, if you’re in a hurry, you can go solve it anytime. I just feel that your chest pain symptoms are very peculiar, potentially very dangerous. I just can’t figure out exactly where the problem is right now, give me a little more time. Even if you don’t buy medicine from me, I can help you eliminate some potential dangers, which is also beneficial to you."
Li Jingsheng had no choice but to try to comfort the patient.
Sincere communication is conducive to mutual trust between doctor and patient.
Communicating with these young people with higher education is often easier.
Because their comprehension ability is stronger.
The patient seemed unable to hold it in anymore, thought for about three seconds, asked for the bathroom location, and ran in while holding his stomach.
Leaving behind a folded copy of the Urban Daily, that day’s issue.
On it, one could vaguely see the report about the Sunshine Clinic and Li Jingsheng.
Nowadays, very few people subscribe to newspapers.
Some companies or public organizations have mandatory subscriptions.
Even so, newspapers cannot stop declining, being replaced by new emerging self-media.
Because news on self-media platforms is more diverse and timely.
Many news events can hit the hot search on the same day.
Regular newspapers, TV stations, and news platforms have strict review mechanisms, inevitably resulting in slower timeliness.
There’s also the content, always singing praises, which the average person gets tired of. Some more interesting and peculiar small news better suit the average person’s taste.
Li Jingsheng’s small clinic made it to the newspaper, which is a significant honor, but the promotion effect doesn’t seem as prominent as imagined.
But the promotional effect should be relatively lasting.
Keeping the heat for at least ten days to half a month shouldn’t be difficult.
Li Jingsheng is hoping that when the new health supplements and tonics arrive tomorrow, they will continue to sell well.
Rent has now become the only mountain weighing on his head.
After glancing at that folded copy of the Urban Daily, Li Jingsheng once more seriously pondered the patient’s condition.
Now it’s basically clear, the patient likely ate something unclean, leading to a viral or bacterial infection, causing diarrhea.
Additionally, due to staying up late and sitting for long periods, it caused an enlargement of the heart, resulting in valvular insufficiency.
Why does diarrhea cause chest pain?
There’s also no coughing or anything.
This definitely isn’t referred pain.
Li Jingsheng thought hard.
Could it be viral myocarditis?
This disease has a quite high fatality rate, but as long as it’s detected in time and receives regular treatment, it generally won’t cause serious consequences.
This disease commonly occurs after a cold, a serious complication post-cold.
Especially among office workers who lack exercise.
However, patients with viral myocarditis typically have prodromal symptoms before onset, manifesting as fever, muscle soreness, etc. During the acute attack period, patients would show symptoms like overall fatigue, chest tightness, heart palpitations, chest pain, which intensify as the condition progresses.
Although this patient has chest pain, the symptoms are mild, mainly intermittent pain.
Therefore, the possibility of viral myocarditis can basically be ruled out.
If not this disease, then what could it be?
Li Jingsheng noticed that after his diagnostic skills in Cardiovascular Medicine rose to Master Level, his abilities significantly improved.
During in-depth analysis and investigation of the patient’s condition, he could clearly feel great advancements.
A stark difference from before.
Chest pain, diarrhea, combined with valvular insufficiency... what exactly is the disease?
He asked the patient if there had been any chest pain before the diarrhea.
The pain started mildly on the night of the second day of diarrhea. Today is the third day, and the chest pain has obviously intensified.
Rack his brains, think deeply.
Suddenly, a flash of inspiration crossed his mind.
The dangers of valvular insufficiency are very significant; besides causing regurgitation, worsening heart function, hemoptysis, chest pain, fainting, another major danger is viral invasion.
