Practicing Medical Skills in a Small Clinic-Chapter 80: The Most Silent Organ

Clinics, hospitals, and pharmacies are rather unique places of business; without a specific purpose, few people wander into them.

Unlike supermarkets and clothing stores, which are bustling with customers from dawn to dusk.

"Oh, so you’re an acquaintance of Sister Ou’s! She’s a regular customer at our clinic. She’s incredibly warm-hearted and often helps promote our little clinic for free,"

Li Jingsheng stood up to pour a glass of water for the man.

Then he poured three more glasses for the family of three buying health supplements. The little boy wanted to drink, but his mother wouldn’t allow it.

Maybe she was worried that the number of patients in the clinic might lead to the spread of viruses and bacteria.

Whether they drink or not is one thing, but Li Jingsheng couldn’t avoid offering them water.

Otherwise, it might create a psychological gap for the customers, making them feel like they are being treated differently.

They might not come back next time.

"Dr. Li, I’ve been experiencing a bloated stomach recently and feeling a bit weak. Should I be taking some digestive tablets?" The man, after drinking two sips of water, finally stated his intention.

"How long has this been going on?"

Currently, Li Jingsheng’s skills in gastroenterology are at a proficient level, equivalent to that of a senior resident doctor.

For diagnosing common digestive tract diseases, it’s quite sufficient.

Currently, his life points had accumulated from 204 yesterday to 227.

When treating ordinary patients, his life points increase relatively slowly.

Having this much "surplus food" at home, he’s not worried at all.

At worst, he could use up a few dozen life points and level up his gastroenterology skills.

He also discovered an interesting phenomenon.

For instance, when prescribing medicine for a cold patient, it immediately adds 1 life point. Then, once the patient recovers, it adds at least another 1 point.

If he could receive a good review, that would be even better, granting a direct bonus of 10 life points.

The best feeling is when a patient presents him with a silk banner in gratitude, which rewards him with 100 life points.

But such occurrences are rare and can’t be forced.

"I can’t quite remember when it started. Maybe half a year ago. Initially, after meals, I occasionally felt a bit bloated. Recently, it seems to have worsened. I don’t know if it’s because I gained weight, so I came to seek your advice."

As he spoke, the man pulled out a pack of blue Furongwang cigarettes and offered one to Li Jingsheng.

"Thank you, but I don’t smoke. Smoking isn’t allowed in the clinic, so please be considerate."

Li Jingsheng politely declined.

He also advised the man not to smoke inside the clinic.

The man wore a Rolex watch and smoked cigarettes of some quality, indicating he was well-off.

"Does the bloating occur every time after eating, or is it irregular?"

Seeing the man putting the cigarette back, Li Jingsheng continued his inquiry.

"Hmm... sometimes it’s right after a meal, and sometimes it’s three or four hours later; there’s no pattern. Lately, as soon as I sit down, I feel uncomfortable here."

The man pointed to his stomach.

Close to the upper abdominal area.

Li Jingsheng had already started observing this man’s condition closely; his complexion appeared somewhat yellowish, approaching a waxy yellow color. The sclera were also slightly yellowed.

In Li Jingsheng’s view, this was somewhat abnormal.

He seemed a bit overweight, with an estimated height of around 1.7 meters and likely weighing over 70 kilograms.

"Did you measure your weight last year?"

Li Jingsheng’s clinic didn’t have a scale. When he opened, he intended to buy one, but was short on funds, and since it wasn’t essential, he hadn’t bought it yet.

President Qiu from Best Medicine had promised to send him a scale with the next shipment.

All the more reason not to buy one.

Who doesn’t love free stuff?

"Last year, I weighed around 67 kilograms, now I’m 71 kilograms, so I’ve gained quite a bit."

The man answered directly.

"Alright, please lie down on the bed inside, let me palpate your abdomen."

"Sure! Please, take your time."

The man lay down on a bed in the infusion room inside, and Li Jingsheng asked him to unzip his jacket and lift his shirt to expose his entire abdomen.

Slightly bulging, but not excessively so.

He palpated around, found no tenderness or mass, preliminarily ruling out the likelihood of a large tumor.

"How does it look?"

"Feeling no mass, it means there’s no large tumor growing inside the abdomen, which is a good sign. Given your condition of having had bloating for about half a year, with irregular timing, the biggest concern is tumor growth."

Li Jingsheng signaled the man that he could get up.

They both returned to the consultation table, where Li Jingsheng helped the man measure blood pressure, heart rate, and other basic vitals.

Temperature was 36.7 degrees, perfectly normal.

Heart rate 79 beats per minute, and heart sounds were healthy.

breaths per minute, with normal lung sounds.

Blood pressure wasn’t high either, systolic pressure 130, diastolic 80mmHg.

Up until this point, apart from the slightly yellow complexion and sclera, everything else seemed normal.

"Let me see your palms!"

With experience in internal medicine, jaundiced skin and sclera inevitably raise suspicions about liver issues first.

The patient did not exhibit any noticeable spider angiomas or subcutaneous petechiae.

If liver disease were severe, some patients might show palmar erythema.

Jaundiced skin, sclera, plus palmar erythema would almost confirm liver disease.

However, after examining the man’s hands, no palmar erythema was evident.

At this point, Li Jingsheng’s diagnosis encountered difficulties.

The small clinic was limited in resources, lacking necessary lab test data and imaging studies, making diagnosis challenging.

If he could check liver function, specifically the transaminase levels, and conduct a liver ultrasound, it would be easier to diagnose.

"Feeling fatigued is not just a recent phenomenon, correct?"

Li Jingsheng asked.

"Impressive!" The man praised him with a thumbs-up. "I’ve been feeling somewhat fatigued for about a year; it’s just gotten a lot worse lately."

"And how’s your appetite? Has it decreased as well?"

Li Jingsheng continued questioning.

"How do you know so much! No wonder Sister Ou praises your medical skills. Over this past year, every time I sit at the table, I feel like I have no appetite. Recently, nothing has tasted good. My wife doesn’t understand and says I’m making excuses, probably wanting to flirt with some hussy outside. Heaven knows, at my age, having a steady job, how could I!"

The man complained rather indignantly.

Indeed, he was employed at a state-owned enterprise or institution; only in such places would one refer to their job as steady employment.

Especially those over forty, they all generally share this viewpoint.

A state job, in their eyes, is the only true secure employment.

"Haha, you don’t seem like the type to abandon your family, pursuing just pleasure."

Li Jingsheng took the opportunity to compliment the man.

"Do you experience any stomach pain, nausea, vomiting, or acid reflux?"

"No, if I had those issues, I’d have gone to the hospital long ago. It’s just that my stomach feels a bit bloated and my body feels weak. I thought it might be due to enjoying too good a diet, eating more than I can digest."

The man said.

"Pardon my bluntness, but this doesn’t sound like indigestion. It’s quite possible there’s a liver issue. The liver is different from other organs, known as the ’silent organ’ within the body. If early-stage changes occur, we feel no pain. I suggest you take the time to check your liver function at the hospital tomorrow. If there’s no problem, I have plenty of digestive tablets and stomach tonics here for you. In case there’s an issue, you won’t delay the condition."

Out of responsibility to the patient, Li Jingsheng sincerely provided his advice.

The man pondered for a few seconds after listening.

"I’ll follow your advice; I trust you won’t lead me astray. I’ll take a leave from work tomorrow and get checked at the hospital. Do you think I have cancer?" The man accepted his suggestion.

Before leaving, he was still somewhat concerned.

"It probably isn’t. Go get checked at the hospital tomorrow, and you’ll know the results. No need for psychological pressure. At least, I didn’t find any large mass in your abdomen."

Li Jingsheng could only reassure him this way.

"Alright, thank you very much."

The man shook hands with Li Jingsheng and departed.

No sooner had he left than the woman who wanted to buy calcium tablets for her daughter had been waiting aside for a moment.

She stepped forward.

"Dr. Li, I brought my daughter over. Could you please examine her?"

She made her request to Li Jingsheng.