Chapter 641: Bleeding of Unknown Origin

"I brought it." Xie Kai answered simply, then looked at Zhao Zhe and said, "Zhao Zhe, what is the actual level of Zou Fuzhuren? Don't find us some low-level, slacking professor to treat the patient."

"I'm telling you, this is my child's teacher, you know." Xie Kai was still worried and added another instruction.

Zhao Zhe naturally knew the importance of a teacher.

"Rest assured, Zou Fuzhuren is an expert from the Affiliated Hospital. We have been in contact with him, and his level is quite high." Zhao Zhe remained indifferent to Xie Kai's sarcasm, as if he hadn't heard it, and replied with a smile, "Massive lower gastrointestinal bleeding, resection after angiography, you know it, right?"

"I know." Hearing Zhao Zhe say this, Xie Kai's expression immediately turned solemn.

This surgical procedure is not very famous because many hospitals dare not perform it; after all, it is a destructive surgery, and there are many complications. One slip, and there will be serious consequences.

"At the Affiliated Hospital, this type of surgery is always performed by Zou Fuzhuren."

Xie Kai nodded and went to give a few instructions to Sun Laoshi.

"Doctor Ji Xiang!"

Just as everyone was about to leave, Lin Jiuze appeared. He waved to greet Ji Xiang.

"Doctor Lin, hello." Ji Xiang smiled, "Haven't returned to the United States yet?"

Lin Jiuze seemed a bit hesitant, but only for a moment, then he walked to Ji Xiang's side, "I want to wait and see. There are still some days left in the vacation, no rush to go back."

"You are here to..."

"There is a patient with hematochezia. I brought her to see Zou Fuzhuren."

Lin Jiuze sized up the patient and began talking to Ji Xiang about the last episode of the program from last night.

He was very easygoing and didn't seem as cold as he was when facing others. Ji Xiang didn't mind either; he just chatted about whatever Lin Jiuze brought up.

Arriving at the Gastrointestinal Surgery department, Zou Fuzhuren took the patient to the dressing room for a physical examination.

First, he inquired about the medical history. The patient was a 31-year-old female, denied a history of hypertension, and had visited the Emergency Department of LY City Hospital due to intermittent abdominal pain for over a month, and poor appetite, vomiting, and diarrhea for more than 10 days.

The gastrointestinal endoscope report was handed to Zou Fuzhuren, and he held the report to examine it carefully.

The patient's condition looked very simple, but Ji Xiang always felt something was wrong. He focused his attention on the patient, pondering the specific situation.

"Doctor Ji Xiang, what do you think the patient's situation is?" Lin Jiuze asked with a smile.

"I don't know. Normally, one would consider intestinal tumors or vascular diseases, but the patient's state is a bit strange. Let me think about it again."

Lin Jiuze smiled slightly. He took a notebook out of his pocket, wrote and drew on it, and after finishing, he looked up at the patient, then lowered his head to continue writing.

Indeed, just as Ji Xiang said, the patient's condition looked very simple and straightforward.

But once one pondered deeply and performed a differential diagnosis, one would find that every diagnosis had absolutely nothing to do with her hematochezia.

In clinical practice, one encounters similar situations. For example, fever; there is something called fever of unknown origin, which is actually a diagnostic name.

It is indeed very tricky.

Just as Lin Jiuze was writing and stopping, Ji Xiang focused his mind and entered the System Operating Room.

At the same time, Lin Jiuze's brows furrowed tighter and tighter.

The diagnosis and treatment he wrote were both wrong; the patient's situation was quite special.

This was something Lin Jiuze had not expected.

Originally wanting to show off to Ji Xiang, Lin Jiuze had complex thoughts, but he had hit a wall.

Zou Fuzhuren slurped his saliva and was also pondering intently.

"Zou Fuzhuren, what do you think the situation is?" Xie Kai asked politely.

Encountering a doctor from a superior hospital, Xie Kai immediately became much more docile, lacking the arrogant and domineering air he had when talking to Zhao Zhe.

"Let me think again."

Zou Fuzhuren was in a difficult position.

The examinations the patient had done at the local hospital were very complete, and all evidence pointed to intestinal polyps.

But if it were polyps causing hematochezia, it seemed like something was wrong.

Generally speaking, polyps will bleed, but the patient had undergone a gastrointestinal endoscopy, and the description of the polyps under the scope was—surface smooth, no ulcers.

The pathological changes of polyps start from ulcers, eroding blood vessels, and bleeding, but the situation seen under the scope was different from the patient's symptoms.

One could rashly diagnose colon polyps, but what about after that?

The patient had a doctor with her; the reason they came to a superior hospital was that they did not believe this diagnosis.

Zou Fuzhuren had encountered a difficult problem.

And Lin Jiuze had also encountered a difficult problem.

The two of them, one slurping saliva and the other frowning while writing and looking up at the patient.

The atmosphere in the dressing room became somewhat strange.

They couldn't just stand face-to-face without speaking. After a deep slurp, Zou Fuzhuren prepared to have the patient undergo more relevant examinations, adopting an elimination method to investigate bit by bit.

He believed that this was the only way now.

"May I ask if your urination has been normal recently?" Ji Xiang's voice suddenly appeared, breaking the silence.

Zou Fuzhuren and Lin Jiuze were both stunned.

The patient had intestinal bleeding, and Ji Xiang was asking about urination...

Although normal medical records should describe similar situations, there were also descriptions of the lower body in the medical record; one couldn't just ask every patient to take off their clothes and pants.

If he did that, he would probably be trending on social media before the next day.

It is said that the first department Xiao Ji was in for his standardized residency training was the Urology Department. Could it be that he has a physiological reflex? When encountering a patient, the first thing he does is rule out whether it is a disease of the Urology Department?

Although Zou Fuzhuren felt that Ji Xiang's question was groundless, he remained silent and did not stop him.

"Doctor Ji Xiang, it shouldn't be a disease of the urinary system." Lin Jiuze didn't have so many concerns; he had already written 4 pages, and his hair was almost standing on end.

"Problems with urine volume shouldn't all be diseases of the Urology Department or the Department of Nephrology." Ji Xiang said calmly.

"..." Lin Jiuze was taken aback.

What did Ji Xiang mean?

"I had low urine output a while ago, but it has recovered recently..." The Patient hesitated, "but it seems to have recovered a bit too much; I've been drinking a lot of water and urinating a lot lately."

As they spoke, the Patient's face flushed, "Excuse me, I'd like to go to the restroom."

After the Patient left, the gazes of the several Doctors became much more profound; it seemed there were some issues, but urinary frequency and urgency are generally caused by urinary tract infections.

However, the Patient's chief complaint was hematochezia.

Could it be diabetes?

Could it be hyperkalemia?

Could it be hypercalcemia?

Countless possibilities appeared in an instant, and Zou Fuzhuren looked solemn, "Doctor Ji Xiang, what are your thoughts?"

"Let's have the Patient measure their blood pressure after they return." Ji Xiang did not answer Zou Fuzhuren's question directly, but instead suggested the Patient measure their blood pressure.

"Measure blood pressure? The Patient said she has no history of hypertension," Lin Jiuze said.

"It's a standard physical exam, just measure the blood pressure and see."

"Doctor Ji Xiang, are you considering that the Patient's hematochezia is caused by hypertension?"

As soon as Lin Jiuze asked this question, he felt it was absurd himself.

Hypertension does not cause hematochezia.

Then what did Ji Xiang mean?

Lin Jiuze looked at Ji Xiang, full of suspicion.