The Enhanced Doctor

Chapter 1077: Chapter 1077: Painless Lymphadenopathy

(Thanks for the monthly ticket encouragement from Yang Zhong)

The lunch was quite good, regardless of the gossip being an event itself. Even if Liu Banxia didn’t see that guy as a rival, he was indeed a rival.

Now it has been taken care of like slicing through vegetables, and all the rumors running wild online have quieted down. Many people, after understanding the situation, proactively issued apology statements.

This is also a primary reason why people dare to talk recklessly online.

Few people take it seriously, and after an apology, it’s over. If you keep pursuing it, netizens will have a new stance, saying you’re not magnanimous enough.

Just as they returned from the cafeteria, Li Hao ran up to Liu Banxia with some scans.

"Not ideal?" Liu Banxia asked.

Li Hao nodded and inserted the scans into the viewing lamp.

The cervical disc is indeed protruding but not very serious. The critical issue is the patient’s head MRI shows multiple lacunar infarctions.

Looking at this scan, Liu Banxia frowned.

"Doctor, is this a stroke? At my age, I have a stroke?" the patient asked.

"Don’t worry yet, although this multiple lacunar infarction is a type of stroke, it’s the mildest of strokes and may not be very serious," Li Hao reassured.

"It’s likely these small, mild infarctions have slowed down blood flow, causing your brain to have insufficient blood supply. Teacher Liu, should we call the colleagues from neurology for a consultation?"

Liu Banxia nodded, "Call both neurology and orthopedics, let orthopedics take a look at the cervical spine to be more assured."

Li Hao nodded and quickly started calling for a consultation.

Now the patient’s condition has moved beyond an emergency reception, whether it’s the cervical issue or the cause of multiple lacunar infarctions, it’s not general surgery’s work anymore.

"I don’t think there’s much problem with the cervical spine, just need to be more careful in daily life, the spinal canal is quite clear," Wu Mingyu said after looking at the scans.

"Let me have a look," Peng Bo said.

"Do you experience tinnitus during dizziness, or any effect on vision or memory? Also, how does your complexion look after an episode?"

"I’ve never had tinnitus, nor have any effect on vision or memory," the patient said.

"Don’t worry for now, from the scans it seems likely that it’s caused by the multiple lacunar infarctions, which is a vascular condition. We can use some medication to unblock the blood vessels and enhance neuro-nutrition, and see how it works," Peng Bo said.

"Let’s do a complete blood count and blood biochemistry later. If the blood test shows no issues, then you’ll need to be admitted. This condition requires careful and gradual work to unblock the blood vessels."

The patient nodded, feeling somewhat reassured.

After all, the general public’s understanding of stroke isn’t good, and now he has this condition. Fortunately, the doctors said it could be unblocked, which is a blessing.

"Director Liu, should we perform a full physical examination?" Peng Bo asked Liu Banxia, pulling him aside.

"Is it necessary?" Liu Banxia asked.

"Well, generally, if the multiple lacunar infarctions affect the body, they are often accompanied by headaches," Peng Bo said.

"It might affect vision, hearing, and sleep to some extent. But since the patient currently only has dizziness without other symptoms, I think it’s better to be cautious."

"Also, in some cases, multiple lacunar infarctions are caused by cardio-embolic issues or atherosclerotic plaque rupture."

"Li Hao did listen to the heart and lungs, and everything seemed normal. However, we being surgeons might not be considering everything as thoroughly as you. Should we wait for the blood test results or proceed directly?" Liu Banxia asked.

Peng Bo laughed, "I won’t really consider you guys as mere cutters, let’s wait for the blood test results. With the recent change in weather, there are indeed quite a few stroke and myocardial infarction patients."

"It gets busy during the change of seasons, and with trauma patients, it’s really tiring. Hang in there, I guess they’ll have to add beds in the corridor this year and increase patient turnover rate as much as possible."

The emergency center today is not like the emergency center of the past. Over the past year and more, both active consultations and matched patients have been steadily increasing every month.

The reason is also because there are relatively many general surgeons here in the emergency center, making initial consultations quite good, which has led to the current outcome.

It’s tiring, but it’s a tangible achievement. Without such results, would so many patients be matched here?

If patients were sent here only to be sent right back, who would dare to send them here anymore?

Since the creation of the emergency center, trauma patients have been highly prioritized. Additionally, with the frequent new updates being communicated externally, many more patients have naturally come for consultation.

But as mentioned earlier, winter will be a difficult hurdle. Even after experiencing major accidents in emergency missions, winter still poses a stress test.

After the season changes, it’s easy for people to catch a cold, and after catching a cold, immunity will decrease. Many patients in poor health conditions will have other symptoms flare up.

We can only say we’ll deal with it when the time comes.

After chatting a bit with Peng Bo, he returned to the office to study the surgical methods for the two patients scheduled for surgery tomorrow. The focus is mainly on the first patient, as no amount of preparation work is too much.

There is quite some pressure, after all, many people will be observing. Although if TaTME doesn’t work, laparoscopic operations can be used for assistance, it’s somewhat of a fallback.

He is also a person who cares about reputation, understanding the importance of considering the patient’s prognosis as much as possible. Those who don’t know might say he is somewhat presumptuous, trying to grandstand.

While studying, Peng Bo came in with the lab results.

"How is it?" Liu Banxia asked.

"The situation of this patient might be quite severe," Peng Bo said.

"From the blood test?" Liu Banxia asked in surprise.

"It’s somewhat related to the blood test. The other indicators are normal, and there is no anemia. But the chloride and sodium are a bit low, especially sodium, with a value of 118," Peng Bo said.

"In response to this situation, we definitely need to admit the patient, and then we did a physical examination. Auscultation showed normal heart and lung function. However, a lymph node measuring over one centimeter was felt above the clavicle, and it’s painless."

Liu Banxia pinched his brow. A lymph node over one centimeter is not small. Moreover, being painless upon palpation deserves more attention.

This painless lymph node enlargement is troubling, as the lymph nodes are often the body’s first response system to many diseases because they are part of the immune system.

If it’s painful, it indicates lymph node inflammation, which is easy to manage, just treat it with anti-inflammatory measures.

But if it’s painless? Many times it’s caused by tumors, often malignant, where lymph node metastasis has occurred.

The patient was initially to be admitted to neurology, as no tumors were found during the head MRI. So, this patient is very likely to have a thoraco-abdominal tumor, which means they can’t be admitted to neurology.

"Sigh...I was still a bit careless. I didn’t give the patient a detailed physical examination and almost caused a mishap," Liu Banxia sighed.

A physical examination is an important part of the initial consultation, but due to the recent high number of patients, after the patient showed dizziness symptoms, a cardiopulmonary auscultation was performed, but nothing else was considered.

Now applying band-aid solutions, if a physical examination had been conducted during the initial consultation, the patient’s examination would have been more comprehensive.

"Don’t think too much about it, it’s not that the previous checks weren’t thorough," Peng Bo said with a smile.

"How much time does a complete physical examination require? With so many patients now, how could we possibly manage all of them. Normally we do a detailed examination after admission."

"If it were a normally-sized patient, perhaps we could have discovered the enlarged lymph node. The patient is on the plump side, with a thicker neck. So, it’s normal that nothing was seen at first glance."

"I’m asking for your advice on what to do next? Should we continue checking on our end, or send them back to you directly? What’s the next step?"

Liu Banxia nodded, "This is indeed a bit of a headache, there’s a higher chance that it’s a malignant tumor. If it really is a malignant tumor that has metastasized to the clavicle lymph node, the likelihood of it being lung cancer is higher."

"Hold on a moment, let me call Old Chen over. He doesn’t have surgery today, let him have a look. If it’s really lung cancer, we can see if there are any surgical opportunities."

"Alright, any which way works for me here," Peng Bo said.

Upon receiving Liu Banxia’s request for a consultation, Chen Xuehai arrived quickly. When they call him for a consultation, it usually means the condition is particularly tricky.

After listening to the description, Chen Xuehai was also a bit troubled, "This is what I think, we should perform a combined chest and abdomen enhanced CT to resolve it in one go."

"After all, once tumors in abdominal organs and thoracic organs metastasize, they can present like this. If we only perform one, and there are no results, then the patient has to endure the examination again."

"Alright, that’s settled. After running around half the day, let the patient rest a bit. Today, let’s first perform a tumor marker screening," Liu Banxia said.

"If we can identify it, we’ll do an enhanced CT of the corresponding organ tomorrow. If not, then we’ll perform a combined chest and abdomen scan, is that okay?"

"You’re also a deputy director; you can just arrange it. Good luck tomorrow, you’ve got two surgeries back-to-back," Chen Xuehai said.

"Actually, I wanted you to inform the patient, but forget it, I’ll do it myself," Liu Banxia said helplessly.

Explaining such a situation to the patient is not so easy.

Even though the time here hasn’t been too long, there has been a small turnaround regarding the possible condition, so this is a responsibility that Liu Banxia must assume.

At the very least, today, the electrolytes should be adjusted, low sodium, low chlorine, these are very important indicators.

Painless lymph node enlargement is really annoying.

The lymphatic system is throughout the body, and if metastasis has occurred, it’s really hard to say.