My Medical Skills Give Me Experience Points

Chapter 1248: Chapter 492: The Renowned Doctor’s Path of Training—What’s Up with Dr. Du?

This patient probably has more than just upper gastrointestinal bleeding; it is very likely that there is also bleeding in some part of the lower gastrointestinal tract.

Moreover, the major source of bleeding is very likely in the lower gastrointestinal tract.

When Zhou Can first diagnosed the patient, he used both his Hemostasis Skill and Level 6 Pathological Diagnosis Skill to determine that the source of bleeding was in the upper gastrointestinal tract, most likely the stomach. However, further diagnosis now reveals that the patient likely has multiple sources of bleeding.

This indicates that there was a missed diagnosis in his initial assessment.

However, even with the missed diagnosis, he gained significant insight and explored the diagnostic techniques of top-level physicians.

At most, his Hemostasis Skill and pathological diagnosis level are still at a relatively low level, with a considerable gap to the true top level.

This is why missed diagnoses occur during his practice.

Regardless, being able to roughly pinpoint a source of bleeding just through physical examination and the patient’s history and symptoms is already quite impressive.

Keep in mind, he is still just a Resident Doctor!

And only a junior resident at that, yet he is already this capable. With diligent study and practice, reaching the top level is just a matter of time.

He is much luckier than those doctors who have practiced for half their lives without even reaching a director-level competence.

"Okay, I’ll immediately arrange for gastric fluid extraction for testing. Dr. Zhou, thank you for your hard work; go grab a meal! If you have any new diagnostic ideas, feel free to let me know. Given the seriousness of the patient’s condition, I’ll first go ahead with the protocol and invite the doctors from Digestive Internal Medicine for a consultation."

Ali’s respect and concern for Zhou Can are sincere and heartfelt.

Being a fellow doctor, she knows all too well the hardships doctors endure.

Zhou Can has been busy in the operating room all morning and is now diagnosing her patient on an empty stomach, which speaks volumes about his dedication.

Ali inviting doctors from Digestive Internal Medicine for a consultation is ideal to uncover the cause, or at the very least, diffuse the risk. She is very worried that the patient’s condition might suddenly deteriorate and lead to a critical situation.

...

Seated in the cafeteria, eating, Zhou Can’s mind is still pondering the cause of this patient’s condition.

If the gastric fluid testing results are non-blood related, then the lower gastrointestinal tract will certainly need further examination.

Taking into account the patient’s high fever response and excessive bleeding leading to shock, the possibility of acute hemorrhagic necrotic enteritis is very high.

During the abdomen tenderness examination, when Zhou Can pressed under the patient’s xiphoid process and around the umbilicus, there was a clear tenderness response.

Acute hemorrhagic necrotic enteritis often presents symptoms like periumbilical and abdominal colic, bloody watery stools, and sometimes necrotic mucosal tissue in the stool, making it particularly foul-smelling.

Among these symptoms, the patient only has gastrointestinal bleeding and periumbilical pain, while other symptoms haven’t been observed yet.

Therefore, acute hemorrhagic necrotic enteritis cannot be ruled out, nor can it be completely confirmed.

At most, there’s a 50% probability of confirmation.

This will require further observation and stool testing.

If this disease can be ruled out, then what could it be?

At this moment, Zhou Can profoundly felt the regret of not having enough knowledge when needed.

He mentally combed through all the cases he had studied, along with knowledge related to digestive tract diseases.

He is, in fact, quite skilled, at least much more so than those medical students who, despite having a wealth of medical knowledge, find their minds blank when it comes to clinical practice.

There are quite a few of these doctors who excel on paper, scoring high marks in exams, but falter as soon as they start clinical work.

Everyone goes through this journey.

Gradually, with practical experience, comes the understanding of how to apply theoretical knowledge.

After a year of internship, three years of standardized training, and nearly two years as a resident doctor, Zhou Can’s practical experience is quite substantial. He is fully capable of applying what he’s learned.

At this time, he thought of another disease with symptoms very similar to the patient’s.

Ulcerative colitis.

This is a nonspecific inflammatory bowel disease that typically has a slow onset.

The patient’s onset is also very slow, having lasted over a month. This matches perfectly.

The lesion location aligns as well.

The lower gastrointestinal tract includes the colon.

Moreover, after learning that the patient’s anemia symptoms did not improve after hemostatic medication and a 1000 ml blood transfusion, Zhou Can highly suspects the possibility of bleeding in the small intestine or upper colon is extremely high.

Ulcerative colitis is often accompanied by diarrhea, abdominal pain, bloody stools, or even pus-filled bloody stools, along with fever and weight loss.

Among these symptoms, the patient has abdominal pain, bloody stools, fever, and weight loss, all of which match.

The slow disease progression also matches.

Therefore, the possibility of ulcerative colitis is very high.

Zhou Can has thought of two potential diseases, yet he is not satisfied with that.

A truly top-level doctor continually expands their diagnostic thinking, considering all possible causes.

The more comprehensive, the better.

In diagnosing illnesses, a doctor’s knowledge in the relevant field and clinical experience are thoroughly tested.

This is also why experts usually have a singular focus, and few excel in multiple fields simultaneously. An individual’s energy and time are just too limited.

Zhou Can has undergone standardized training in both Digestive Internal Medicine and Digestive Surgery, and for a considerable period.

This provided him with the opportunity to accumulate more experience in diagnosing and treating digestive diseases and to learn more related knowledge.

At this moment, two other diseases popped into his mind.

Colonic diverticulosis, which often occurs in the sigmoid colon and cecum, is frequently accompanied by fever, an increase in white blood cell count, and signs of peritonitis.