The Enhanced Doctor

Chapter 1039: Chapter 1039: Learning from Teacher Liu Is Mentally Exhausting

"Doctor, the doctor over there said it might be an issue with the pancreas. Is it cancer?"

Seeing Liu Banxia and his group coming over, the patient’s wife looked anxious.

"Please don’t worry yet. They are all students currently here to learn. The attending doctor is still Doctor Xu." Liu Banxia said.

"At the moment, we only have the CT results. We can review them on the computer first. For a definitive diagnosis, we still need to look at the blood test results."

Liu Banxia’s words somewhat reassured the patient’s wife. As long as it’s not cancer, it’s good. Cancer means a lot of money, and there’s no guarantee for a cure.

"Does the pain relief injection make you feel a bit better? Any recent changes in your diet?" Liu Banxia asked the patient lying on the bed.

"Not really, and I don’t drink much alcohol," the patient said.

"Have you had similar pain before?" Liu Banxia continued to ask.

The patient shook his head, "No, it never happened before, just these last couple of days. It started a bit painful, and I didn’t pay much attention. But today it’s really unbearable, and I’ve been vomiting, even bile."

Liu Banxia nodded, "Just wait a bit longer. Once the blood test results come out, we’ll have a clearer idea."

"Director Liu, here is this patient’s blood test report." Nurse Zhou Qian approached.

"Give it to Doctor Xu; she’s the attending doctor." Liu Banxia nodded.

After Xu Yino received and carefully reviewed the test report, she slightly frowned, "The blood test results are generally normal; there’s no significant increase in white cell count. The serum amylase and lipase levels are not significantly elevated."

"Doctor, does this mean there’s nothing wrong?" the patient’s wife asked.

"Xu Yino, answer." Liu Banxia said.

"Judging from the CT images, the gallbladder and bile ducts show no significant issues. The pancreas is swollen with surrounding seepage, and there’s severe abdominal pain and vomiting. Based on this, it is diagnosed as severe acute pancreatitis." Xu Yino hastily said.

"Doctor, if it’s just inflammation, it should be manageable, right? Just anti-inflammatory treatment through IV?" the patient asked while lying down.

"Well, we have to take it slow." Liu Banxia said.

"Cui Jia, talk to the patient about the causes of pancreatitis. Maybe the patient can relate to some of them, which might help in future living habits."

"Most are caused by biliary system diseases, cholangitis, or stones. Another situation is heavy drinking or binge eating, leading to increased pancreatic secretion and poor drainage, causing pancreatic acinar rupture and onset." Cui Jia quickly explained.

"There are also cases caused by infections, hyperlipidemia-induced fat embolism, surgical or trauma-related complications causing pancreatitis."

"What do you think? Does anything sound familiar?" Liu Banxia asked the patient.

The patient wryly shook his head, "Not really."

Liu Banxia nodded, "There are many triggers for the condition. Pay attention to the things just mentioned in the future. Now that we’ve confirmed it, let’s start targeted treatment. Xu Yino, write the medical orders."

"No more eating; fasting is required, and a nasogastric tube needs to be placed to relieve gastrointestinal pressure and prevent further vomiting." Xu Yino said.

"Also, a Sandostatin infusion is necessary. This is a somatostatin, suppressing pancreatic exocrine secretion and enzymes. Some hydration and electrolyte adjustment are also necessary."

"Let’s add some antibiotics, too, seeing as there’s inflammation present. That’s about it. He needs to be hospitalized. Once the admission is complete, I’ll prescribe the medication." ƒree𝑤ebnσvel.com

The interns around were puzzled. Severe pancreatitis is a very serious illness. Why didn’t Doctor Xu explain it clearly? Instead, she said it lightly, as if treating a cold.

Moreover, although the patient showed symptoms of acute pancreatitis and had CT indications, the two crucial values, serum amylase and lipase, were not elevated.

"Alright, Doctor, I’ll handle the admission procedures. But I didn’t bring that much money. Can it still be treated?" the patient’s wife asked worriedly.

"Yes, it can be treated. The medication won’t cost too much. Director Liu, maybe you can help with the admission?" Xu Yino said.

Xu Yino’s words startled the interns. Wasn’t this too brazen? How could she make the big boss do the errands? Xu Yino probably needs a CT scan of her boldness to see if it’s coated in oil.

"Alright, come with me. Let’s go over the care instructions too." Liu Banxia glanced at Xu Yino and nodded.

The patient’s wife quickly followed them out.

"His condition is far more severe than what we just described. Although he’s only in the early stages of severe acute pancreatitis, we can only observe temporarily in the ward. If the situation worsens, we’ll have to send him to the ICU," Liu Banxia said.

"Ah, doctor, isn’t it just inflammation?" The patient’s wife’s face changed instantly.

"Yes, it is a problem with inflammation, but inflammation of the pancreas is extremely serious. And now it’s just the initial stage, even with medication control, as the disease progresses, it will still lead to other problems," Liu Banxia said.

"Even with the most comprehensive treatment, there is a certain mortality rate, it’s a very dangerous disease. Later when he’s in the ward, Doctor Xu will also connect him to a heart monitor, and if you hear an alarm, you need to contact our medical staff."

The patient’s wife was already frightened by Liu Banxia; she never thought her husband’s illness could even be life-threatening. She thought it would be just like the doctor just said, direct treatment, and a few days of infusion would be fine.

"Go do the paperwork first, so we can start the medication as soon as possible," Liu Banxia said another sentence.

The patient’s wife nodded, but her mental state was much worse than before.

Now, the interns understood why it wasn’t explained directly at the bedside earlier. It was to avoid scaring the patient too much to handle it.

"See that? Xu Yino is quite cunning," Liu Banxia said.

"She just used me, not wanting to explain the actual situation to the patient’s family, letting me say it. But it said it is said. In the future, when you’re diagnosing patients, pay attention too. Don’t be quick to speak, assess the situation based on the environment."

"How about that? This counts as a complete diagnosis. The future development of the symptoms will depend on the patient’s luck. Is there anything unclear?" frёeweɓηovel.coɱ

"Teacher Liu, why can severe acute pancreatitis still be diagnosed when serum amylase and lipase levels haven’t elevated significantly?" Intern Chen Jun asked the question that was on all their minds.

Liu Banxia nodded, "Serum amylase and lipase are indeed quite important indicators, so let me ask you a question: why are they so important?"

"Because if the pancreas is inflamed, it means pancreatic cells are destroyed, and pancreatic amylase rapidly leaks outside the pancreas and is absorbed into the blood, then excreted by urine, making blood and urine amylase important indicators for diagnosis," Chen Jun said.

"Lipase elevation is similar to amylase due to pancreatic cell destruction. And... Ah, I get it, it’s because of timing."

Liu Banxia laughed, "Not bad, based on your recent answers performance-wise, you seem to be more studious than I am usually."

"But symptoms have a progression. The patient had abdominal pain a couple of days ago, but it hadn’t developed into the current situation."

"The patient’s blood was taken at the time of consultation, and now it’s been more than two hours. Xu Yino is surely arranging another blood draw, and new lab results should soon show the serum amylase index."

"Regarding lipase, it depends on the patient’s condition. If it doesn’t worsen, we’ll delay the blood draw to check the indicator, perhaps tomorrow."

"Therefore, when diagnosing a patient, we must rely on the overall situation, not just a single test, as serum amylase and lipase are important indicators but not the only ones."

"Let’s expand further, what if a patient has bowel obstruction, peptic ulcer perforation, cholecystitis, cholangitis, autoimmune diseases, drug effects, or some organ dysfunction?"

"Thank you, Teacher Liu," Chen Jun hurriedly said.

He realized he had been too rigid, since many conditions can cause those enzymes to rise simultaneously. Diagnosing an illness requires integrating symptoms shown by the patient as a whole.

Teacher Liu didn’t even think carefully just now, yet listed all possible conditions, really impressive.

"So how about this, since you participated in the diagnosis, I’ll give you some rewards," Liu Banxia said again.

"You can organize your time, staggered time slots, to observe the patient’s related indicators in the ward. One more thing, if the patient’s condition is so dangerous, why not send them to the ICU directly?"

"To save money for the patient." This time it was Cui Jia who spoke.

"Hmm, Comrade Cui has some potential, good. Exactly, the ICU is our last resort, we must hold that line," Liu Banxia clenched a fist.

"Knowledge is endlessly increasing, don’t let it become a burden. Use it when needed, keep what isn’t necessary aside."

After speaking, Liu Banxia returned to the service counter, leaving the rest for them to slowly digest and consider.

"Ah... It would be great if every case could have such a vivid diagnostic process with Teacher Liu," Zhang Pengfei said with emotion.

"But it’s also very tiring, you must listen attentively to every word, can’t let your mind wander or you’ll miss something," Cui Jia said with a chuckle.

"Because Teacher Liu isn’t just teaching how to diagnose a single disease, he covers all possible problems during the diagnostic process and horizontally expands on symptoms."

The group nodded in deep agreement, learning with Teacher Liu seems relaxed, but it’s actually quite exhausting and requires a lot of mental effort.