Chapter 658: The Seemingly Unserious Physical Examination

"I see in the Medical Record that you have an Inguinal Hernia?" Ji Xiang "finally" remembered he was a Doctor and asked a question related to medical care.

But Bai Chuzhang felt very helpless.

Although an Inguinal Hernia is within the scope of medicine, it had absolutely nothing to do with the Patient's post-Internal Hemorrhoid Surgery bleeding.

"Sigh, don't mention it. That's a sports hernia; many people who play basketball have this problem. They say it's an issue with the core muscle group. When I was young, I even considered surgery, but firstly, I was afraid of the pain, and secondly, I was busy with work, so I just forgot about it."

Ji Xiang and the Patient started chatting along the lines of the Inguinal Hernia, and Ji Xiang even performed a physical examination specifically for the hernia.

If it were anyone else, Bai Chuzhang would have gone up and kicked them in the butt, telling them to get lost.

The purpose of the consultation was to resolve the Patient's post-Internal Hemorrhoid Surgery bleeding, not an Inguinal Hernia from sports!

As the name suggests, a sports-related Inguinal Hernia is a condition that only occurs after strenuous exercise, and it can basically be reduced; wearing a hernia belt also works. It is a condition that doesn't really matter.

Ji Xiang...

It was truly miles off-topic.

"Hello, Bai Chuzhang." Lin Jiuze held a notebook and greeted Bai Chuzhang with a harmless expression.

When he spoke, he gave the Family Member a start.

For five or six minutes, they hadn't even noticed there was someone else standing there.

"Professor Lin, what is your take?" Bai Chuzhang looked straight ahead, not looking at Lin Jiuze at all.

As long as he didn't look at him, the dizzy feeling was much lighter; Bai Chuzhang quickly found a way to deal with Lin Jiuze.

"It's very strange; I don't have any opinion for the moment," Lin Jiuze said helplessly. "Doctor Ji Xiang probably doesn't have one either."

Watching Ji Xiang, who was performing a physical exam and explaining the Inguinal Hernia to the Patient, Bai Chuzhang thought the same.

"Are there many similar patients at Massachusetts General Hospital?"

"I don't know; the specialty I practice is unrelated to this type of disease."

Bai Chuzhang didn't say anything; every trade has its master, so it was normal for Lin Jiuze not to understand.

Bai Chuzhang had understood half of what Lin Jiuze had just written in his notebook; it was roughly the same as the guesses made by the various department heads in the office, only Lin Jiuze had also written down the treatment, which was quite detailed.

Plus some very rare diseases.

Bai Chuzhang's judgment of Lin Jiuze was—his professional level was stronger than the department heads at the Second Affiliated Hospital, even if hemorrhoids were not his own specialty.

Especially those Differential Diagnoses for rare diseases; they truly showed his foundation. Lin Jiuze's technical level was beyond reproach.

It looked like he would have to seek a consultation from Peking Union Medical College Hospital; Bai Chuzhang had a bit of a headache.

He generally didn't want to use his connections at Peking Union Medical College Hospital; after all, it was a long way away, and maintaining those relationships was very troublesome.

Ji Xiang was doing useless work, but Bai Chuzhang didn't disturb him, instead patiently standing at the door watching.

"Doctor Ji Xiang's questioning is very strange, don't you think, Bai Chuzhang?" Lin Jiuze suddenly spoke up.

"It's alright."

"Your hospital really values talent," Lin Jiuze said, making an out-of-the-blue remark.

Bai Chuzhang detected a hint of provocation.

But he still didn't say anything, nor did he look at Lin Jiuze, just acting as if he didn't exist.

A few minutes later, Ji Xiang and the Patient said goodbye with smiles. Although the time was short, the two looked to have a very good relationship; they were practically ready to swear brotherhood on the spot.

"I'll go discuss my opinion; don't worry, you'll be better soon." Ji Xiang and the Patient shook hands with both hands, parting reluctantly.

Leaving the ward, Bai Chuzhang looked at Ji Xiang; everything was understood without words.

"Bai Chuzhang, the Patient's Inguinal Hernia is very strange," Ji Xiang said as his first sentence after stepping out.

Bai Chuzhang felt a vague sense of something unusual.

He guessed that Ji Xiang already had a clear diagnosis but hadn't made it plain. Could it be that he was letting Lin Jiuze jump out on his own and then hitting him with a heavy blow?

But Lin Jiuze was also a shrewd person and didn't speak at all, acting as if he had truly vanished.

Bai Chuzhang couldn't see through Ji Xiang and didn't know if his guess was true or false. Ji Xiang then said, "I suggest doing an Ultrasound."

"An Ultrasound has already been done; didn't you see the results?" After Bai Chuzhang reminded him, he immediately realized he might have misinterpreted. "Xiao Ji, what location do you want to look at?"

"I am considering that the Patient has chronic Budd-Chiari Syndrome and want to check the location and length of the obstruction of the Hepatic Vein and Inferior Vena Cava at the top of the diaphragmatic surface and the second hepatic hilum to determine if it is the membranous type."

"!!!"

"!!!"

Bai Chuzhang and Lin Jiuze were both stunned for a moment.

This diagnosis,

was wildly imaginative.

Both were extremely intelligent and top-tier figures in medicine. After Ji Xiang stated his diagnosis, both Bai Chuzhang and Lin Jiuze had an epiphany almost simultaneously.

Budd-Chiari Syndrome is a type of post-hepatic portal hypertension characterized by obstructive lesions of the Hepatic Vein and the segment of the Inferior Vena Cava above its opening caused by various reasons, often accompanied by Inferior Vena Cava hypertension.

This disease is divided into acute, subacute, and chronic.

Most patients with chronic Budd-Chiari Syndrome will manifest a state of Cachexia or a "spider-man" state.

But there is a very small portion of patients who have no special surface features to suggest it, except for a small amount of ascites, and they will have a hernia and hemorrhoids.

With one sentence, Ji Xiang connected everything, forming a perfect closed loop.

"Xiao Ji, how did you figure it out?" Bai Chuzhang asked, frowning.

"Everyone overlooked the small amount of ascites because the volume was small, and it's normal to overlook it, but I don't see it that way," Ji Xiang said. "Coupled with the Patient having an Inguinal Hernia and the Clinical symptom of continuous bleeding after Internal Hemorrhoid Surgery, my preliminary diagnosis is Budd-Chiari Syndrome."

"After the physical exam, I found that the veins in the Patient's lower abdomen were slightly distended, and the Patient's jugular vein also had slight distension. Of course, these are all my guesses; let's do the examination first."

Bai Chuzhang nodded, and he turned to go to the office with Ji Xiang.

The moment he turned, Bai Chuzhang felt a bit dizzy, but he immediately overcame the physical discomfort and looked back.

Lin Jiuze did not follow them but stood in the ward writing something in his notebook; as he wrote, he would look up at the Patient.

Bai Chuzhang confirmed his inner suspicion and, while chatting with Ji Xiang, corrected his eye-crossing movement.

"Xiao Ji, how high do you estimate the diagnostic accuracy to be?" Bai Chuzhang asked.

"Eighty percent." Ji Xiang gave a reasonable answer.

"Not bad, the surgery should be very simple, right."

"Very simple. The Vascular Department can do it, and the Interventional Department can do it too; it depends on who has done it before. Such cases are rare; chronic Budd-Chiari Syndrome with normal liver function is very difficult to diagnose," Ji Xiang said.

Bai Chuzhang smiled slightly and turned his head to look at Ji Xiang.

By comparison, Ji Xiang's face was kind, while Lin Jiuze looked like a devil.

"That's not what I meant." Ji Xiang saw what Bai Chuzhang wanted to say in his gaze and hurriedly explained.

"Hahaha, it's fine, I know you want to put in a good word for the directors," Bai Chuzhang said. "Find an Ultrasound consultation. By the way, Xiao Ji, if you have any difficulties with your provincial natural science work, call me directly."

(End of chapter)