My Medical Skills Give Me Experience Points

Chapter 1250: Chapter 493: The Gap Between Director and Deputy Director, Solving It With Interventional Imaging

"Dr. Zhou not only has great skills, but also a sweet tongue! Let’s quickly discuss the patient’s condition before things get out of hand!"

Director Shang is quite an impatient person.

After the pleasantries, he urged Zhou Can to proceed with the consultation.

It seems that even with the addition of Director Shang and his two graduate students, the cause of the patient’s illness has yet to be clearly diagnosed.

In the past, he would address Zhou Can as Xiao Zhou; now, after not seeing each other for a while, his way of addressing him has become more formal.

"Director Shang is right. After medication, the patient’s temperature has decreased somewhat, but he is still feverish. What is more concerning is that there might be a significant source of bleeding inside his body. The most urgent task is to find out the source of the bleeding."

Deputy Director Han is also someone who believes in doing practical work.

The serious attitude of these senior doctors towards patients and diseases is certainly worth learning from.

The term "a doctor with the heart of a parent" can often be seen in the details.

"After the discussion between the two directors, have any conclusions been reached?"

Zhou Can asked modestly.

"The exact illness of the patient has not been determined yet. However, I believe the patient’s symptoms only resemble upper gastrointestinal bleeding. Having Doctor Ai extract gastric fluid from the patient for monitoring was a good approach, and it has already been implemented. Furthermore, it was mentioned that when you performed a rectal examination on the patient, you found dark red blood on the glove. I think if it were truly upper gastrointestinal bleeding, it would be difficult to find dark red blood during a rectal examination."

Director Shang should have already reviewed the patient’s previous diagnostic and treatment plans.

"There is a method abroad specifically used to distinguish between upper gastrointestinal bleeding and lower gastrointestinal bleeding. Clinical comparisons have found that a high plasma urea concentration is a characteristic of gastrointestinal bleeding, where the degree of increase is related to the amount of bleeding. By examining the ratio of plasma urea nitrogen concentration to plasma creatinine concentration, one can infer whether it is upper or lower gastrointestinal bleeding."

The level of expertise of a chief physician is indeed remarkable.

Zhou Can had read about the identification plan proposed by Director Shang in medical journals.

However, he is not familiar with its clinical application.

The main issue is that he can’t remember those specific values.

Moreover, the accuracy of this method is not 100% but around 95%.

"If the ratio is greater than 100, there is a high probability of upper gastrointestinal bleeding. If the ratio is less than 100, there is a high probability of lower gastrointestinal bleeding."

The method proposed by Director Shang is worth trying.

By simply comparing two biochemical indicators to calculate the ratio, one can distinguish between upper and lower gastrointestinal bleeding.

It’s simple, practical, and cost-effective.

"Based on the calculation, there is a high probability of lower gastrointestinal bleeding."

Director Shang is indeed formidable, worthy of being the director of Digestive Internal Medicine. His personal consultation this time is a huge compliment to the Emergency Department.

"For patients with lower gastrointestinal bleeding accompanied by fever, we should consider the possibility of inflammation and tumors. Since the patient’s illness erupted quickly, the possibility of intestinal bleeding due to intestinal tuberculosis is very low. Therefore, inflammation is primarily considered."

The two graduate students had already pulled out their notebooks, quickly taking notes.

In the past, when Zhou Can followed Director Shang for learning, he would also frequently take notes.

"Dr. Zhou has been away from Digestive Internal Medicine for some time now. Do you still remember the knowledge points about intestinal inflammatory lesions?"

Director Shang, for some reason, suddenly wanted to test Zhou Can.

"You calling me Xiao Zhou like before is actually quite affectionate."

Zhou Can knew that Director Shang had never seen him as just a student.

In Digestive Internal Medicine back then, he had received much care and nurturing from Director Shang.

For instance, the consultation at Xinxiang Women and Children’s Hospital was an arrangement for Zhou Can to go with Deputy Director Shi. It was that very opportunity that successfully inducted Zhou Can into Tu Ya’s pool of distinguished reserve doctors.

"Haha, no problem. I just considered that your status is different now, and worried that calling you Xiao Zhou might negatively impact you!" Director Shang explained with a smile.

"In front of you, I will always be that same Xiao Zhou."

This remark from Zhou Can made Director Shang extremely happy.

No doctor dislikes someone who is affectionate and righteous. Director Shang had spent a lot of effort nurturing Zhou Shi and had always taken good care of Zhou Can.

Three years have passed, and Zhou Can remains filled with gratitude and respect for him, bringing great comfort to Director Shang.

"The many things you taught me back then, I still remember quite clearly. Inflammatory lesions can be categorized into specific and non-specific types. Inflammatory bowel disease generally refers to conditions like ulcerative colitis and Crohn’s disease, considered non-specific chronic intestinal inflammatory diseases, often manifested by symptoms such as abdominal pain, diarrhea, and weight loss."

Zhou Can had long mastered these knowledge points.

"Very impressive!"

Director Shang nodded approvingly, continuously.

"Based on the patient’s medical history, symptoms, and biochemical results, bacterial dysentery and amoebic dysentery can basically be ruled out. I recommend checking the patient’s Widal test, as it is about the fifth week since the patient fell ill, which is the right time to test for the Widal reaction."

"Is Director Shang suspecting that the patient has enteric fever?"

Zhou Can’s eyes lit up.

The diagnostic thinking at the director level is indeed formidable.

Compared to Director Shang, he could clearly feel the gap.

Currently, his pathological diagnosis ability is at the deputy chief physician level, and it will take some time to advance to the director level.

Especially recently, in order to prepare for exams, he has cut back on consultation time, which has reduced the number of patients diagnosed, thus slowing the growth of experience points in pathological diagnosis.