The Enhanced Doctor-Chapter 527: Intestinal obstruction caused by constipation?
"Teacher Liu, all the test results for the recent patient are in. Blood test normal, urine test normal, kidney function normal, head CT normal, ultrasound normal. However, his temperature is slightly elevated, and he has completely lost sensation in his legs."
As soon as the test results were available, Su Wenhao hurried over to report.
Liu Banxia frowned; this was becoming a serious problem.
He had initially thought the muscle weakness might be due to a brain tumor or rhabdomyolysis, but the current test results had ruled out both possibilities.
DING! Task Issued: The Curious Case of the Runner’s Paralysis
Open-ended Task: A patient gradually lost sensation in their legs after falling while running. The host is required to conduct further diagnosis. Task rewards will be issued based on the diagnostic results.
"Dr. Liu, what’s going on? He’s worse than when we arrived! He can’t feel anything in his legs; he doesn’t even notice when I pinch him," the patient’s father said.
"Did you hit your head when you fell? Or, do you feel any discomfort in your neck or spine?" Liu Banxia asked.
The patient shook his head. "I feel fine now, except that I can’t feel my legs."
"Recently, have you experienced any physical impact on your neck or spine?" Liu Banxia continued.
The patient still shook his head. "I’ve just been staying home during the New Year holiday, not going out anywhere."
"Given your current situation, I suspect neurological factors are at play," Liu Banxia said after a moment’s thought.
"At first, I considered that you might have some symptoms of a stroke. However, your thinking is clear, your speech is articulate, and the lack of sensation is in both legs, so I ruled that out."
"Now, I suspect you may have unknowingly injured your cervical or thoracic spine in the past. The impact might not have been significant at the time, but today’s fall has likely aggravated that old injury."
"What we can do now is examine your spine and neck. If there are no issues there, we’ll need to perform a lumbar puncture to check for any inflammation in the brain."
"Inflammation can sometimes cause the brain to send incorrect signals, leading to the current symptoms. However, these are just my current hypotheses; further tests are needed for confirmation."
The patient’s father nodded. Liu Banxia had explained things very clearly. For a family like theirs, undergoing some instrumental examinations wasn’t a concern. The key was to identify the illness.
Losing all feeling in both legs was clearly a sign of a serious illness.
After the patient left for further examinations, Liu Banxia started to worry.
This patient had been brought in by his father-in-law. If he jumped through all sorts of hoops and still couldn’t find anything wrong, it wasn’t so much about losing face, but he still wanted to keep his father-in-law happy.
"Teacher Liu, there’s a patient with abdominal pain here for a consultation," Liu Yiqing came over and said.
Liu Banxia nodded, temporarily setting aside his thoughts, and walked over to the examination bed with Liu Yiqing.
"A 29-year-old male, presenting with symptoms of gastric colic. Rapid tests for appendicitis and cholecystitis were negative. His abdomen is tense, with tenderness in the epigastric region and around the umbilicus," Liu Yiqing quickly summarized the patient’s condition.
"An abdominal ultrasound was just performed, revealing severe intestinal gas accumulation. My preliminary diagnosis suggests an abdominal CT scan to check for intestinal obstruction."
Liu Banxia nodded and looked at the patient. "How long has this been going on? Have you had any other gastrointestinal issues in the past?"
"I’m usually fine. But after eating today, I started feeling some pain and bloating," the patient said, glancing at Liu Yiqing. "I thought burping a few times would help, but it just kept getting more painful."
"Alright, let’s arrange a CT scan first to see if there’s an intestinal obstruction. If there is, we’ll discuss treatment options then," Liu Banxia said.
The young man nodded.
Liu Banxia immediately called a nurse to take him for the scan. Payment could be sorted out later; this definitely qualified as a genuine emergency.
"Kiddo, what kind of illness do you think would cause someone to suddenly feel their legs go weak while running, fall, exhibit muscle weakness, and then progress to paralysis in both legs?" Liu Banxia asked.
Liu Yiqing paused, then shook her head. "Unless there was an injury to the cervical or thoracic spine causing nerve compression?"
"Sigh... that’s what I was thinking too. We’ve sent the patient for a CT scan now to get a clearer picture," Liu Banxia said.
"And regarding the previous patient, do you have anything to add? This is also a test of your observation skills. Think carefully."
Liu Yiqing thought hard but then shook her head, looking blank.
"I suspect he definitely has other conditions he hasn’t mentioned," Liu Banxia said with a smile.
"When I questioned him, he glanced at you. That can be one of the awkward aspects when a female doctor examines a male patient. Patients might feel embarrassed about certain symptoms and be reluctant to mention them."
"Teacher Liu, surely not? He’s in so much pain, and he’d still hide something?" Liu Yiqing asked in disbelief.
"What’s so impossible about it? Sometimes, we need to consider the patient’s dignity. We’ll have to adjust things slightly later. When we’re not too busy, we should try to have patients seen by doctors of the same gender if possible," Liu Banxia said.
"Actually, it’s somewhat easier for female doctors to treat male patients. The main issue is often male doctors examining female patients; it can be less convenient. Of course, unless we’re swamped, then it’s just whoever is available."
Liu Yiqing nodded.
"You know, as doctors, we often consider problems from our own perspective," Liu Banxia continued. "More often, however, we need to stand in the patient’s shoes. That’s how we can provide them with better service."
"Once the CT results for that patient come back, if there are no signs of intestinal necrosis and it’s not caused by a foreign body, then proceed directly with an enema."
"Okay, I’ll let you know if anything else comes up," Liu Yiqing said.
"Don’t rush off. I still need your help mulling over this paralyzed patient," Liu Banxia said.
"Another symptom is a slight fever, but his temperature isn’t very high. I feel that if it were something like meningitis, at least the white blood cell count should show some indication, right?"
"The patient is usually quite active, from what it seems. Blood tests are normal, kidney function is normal, ruling out rhabdomyolysis. The head CT is also normal, ruling out cerebral embolism."
"The patient drove from Linyu Villa to here after the onset, and his condition didn’t change much during that time. He only underwent a short round of tests here, and then his symptoms progressed to paralysis in both legs."
"Doesn’t that seem completely illogical? Did his condition only start progressing after he arrived at the hospital?"
The last question was directed at Liu Yiqing.
Liu Yiqing glanced at him blankly. He had just been muttering his analysis of the symptoms aloud. But Liu Yiqing also knew that Teacher Liu was in diagnostic mode; she didn’t need to respond.
"If the patient’s condition only progressed after arriving at the hospital, what could have caused it?" Liu Banxia continued, mostly to himself.
"I’ve already asked him; he said he hadn’t injured his cervical or thoracic spine. He’s young, and his calcium levels are normal, so it can’t be osteoporosis. The two scans I just ordered might turn out to be useless."
"I should also reconsider the circumstances of the onset. He fell while jogging. His legs gave out, and he fell. But it’s not a stroke. There’s something strange about this. If Yuanfang were here, he’d probably be able to help me."
Liu Yiqing rolled her eyes.
"Now, let’s get back to your patient. What do you think might have caused his intestinal obstruction?" Liu Banxia asked again.
"Ah? That... surely it couldn’t be a foreign object? If it were a foreign object, he shouldn’t be experiencing upper abdominal pain like this," Liu Yiqing said.
Liu Banxia nodded. "That’s what I was thinking too, but a CT scan is needed for confirmation. Keep guessing. Go on."
Liu Yiqing was stumped. She could guess, of course, but how could she make an educated one? There were far too many potential causes of intestinal obstruction.
Neurogenic issues, circulatory problems, blunt trauma, complications from other diseases... The list felt endless.
Just as she was about to give up, she saw Liu Banxia’s faint smile and held back what she was about to say.
Liu Banxia’s expression suggested he already had a theory or a diagnosis. What on earth could it be?
"Ah! Teacher Liu, do you think his intestinal obstruction was caused by constipation? Are his intestines currently packed with feces?"
After thinking hard for a moment, Liu Yiqing exclaimed, her voice a bit louder than intended.
"Your reasoning?" Liu Banxia asked.
"Well, the patient didn’t fully explain his symptoms, did he? So, besides a foreign object, constipation is a possibility, right? That’s why I thought of it," Liu Yiqing said.
Liu Banxia nodded. "That’s my assessment as well. For people prone to constipation, if they also eat fewer vegetables during the New Year period, it can easily lead to problems."
Just then, Liu Banxia’s phone rang. He glanced at it and answered immediately. "Su Wenhao, go ahead."
"Teacher Liu, the patient has regained sensation in his legs!" Su Wenhao’s voice was tinged with excitement.
"How was it discovered? Describe the process," Liu Banxia asked, frowning.
"We were doing the cervical CT. After a few images came out, Teacher Wu saw that his cervical spine was fine. I informed the patient first to ease his worries," Su Wenhao said quickly.
"Then, while we were scanning his thoracic spine, the patient mentioned he could feel his feet. Teacher Wu asked him to try moving them, and he was able to lift both legs. Could it be that the patient was overly nervous or fatigued, and that’s why he’s only recovering now?"
Liu Banxia frowned. "Wait for me there. Something about this isn’t right."
