Chapter 669: Must Win!

Ji Xiang changed his clothes and returned to the ward, where he saw Lu Gang sitting in front of the computer, looking at a medical record in a huff.

"Deputy Lu Zhuren, what's wrong?" Ji Xiang asked.

"Acute abdomen. Damn it, those cowards in Gastrointestinal and Hepatobiliary don't want to operate," Lu Gang said irritably. "Although I also feel we can't operate—it doesn't look like an intestinal perforation—the patient's condition isn't right."

It was obvious that Lu Gang was anxious and flustered, so his speech was jumbled, as if he hadn't thought it through, relying entirely on instinct to express his anxiety.

Especially after just cursing the Hepatobiliary and Gastrointestinal departments, then turning around to say he didn't think an operation was possible, it almost made Zhao Zhe laugh out loud.

Ji Xiang leaned over and took a look at the lab reports.

The emergency abdominal ultrasound indicated coarse liver echoes, thickened and rough gallbladder walls, and a small amount of fluid in the abdominal cavity.

Blood gas analysis: partial pressure of oxygen 53.8 mmHg, oxygen saturation 84.6%.

Blood potassium 2.4 mmol/L; renal function: blood urea nitrogen 22.08 mmol/L, creatinine 352 μmol/L, uric acid 428 μmol/L.

Emergency amylase 137 U/L; blood routine: white blood cells 9.3×10^9/L, neutrophils 0.787, hemoglobin 105 g/L.

There was acute renal failure accompanied by hypokalemia, but these were nothing in the face of an acute abdomen; they were conditions that could be treated with medication.

"Deputy Lu Zhuren, how was the physical examination?"

"Blood pressure 210/148 mmHg, respiration 23 breaths/min, oxygen saturation 99%, T 36.8°C, heart rate 105 beats/min. Breath sounds in both lungs are coarse, moist rales heard in the right lung, no wheezing, heart rate 105 beats/min, regular rhythm, no pathological murmurs.

Abdominal muscle tension, tenderness across the entire abdomen, rebound tenderness, board-like abdomen, bowel sounds absent, no swelling in the face or limbs."

"A quite typical acute abdomen. Does the upright abdominal X-ray not support intestinal perforation?" Ji Xiang asked again.

This question hit the point, and Lu Gang nodded, feeling uneasy.

Lin Jiuze suddenly became interested; based on his understanding of Ji Xiang, he knew Ji Xiang would likely follow Deputy Lu Zhuren Gang to attend the consultation.

This time, he absolutely could not lose!

He opened his drawer, took out his small notebook, and gripped it tightly.

His palms were a bit damp; Lin Jiuze didn't notice, and he subconsciously wiped the sweat from his palms onto his white uniform.

He had a basic understanding of the patient's condition; it looked like an acute abdomen without a doubt. In an ordinary hospital, the surgery department would definitely have pushed the patient onto the table to open them up and see where the problem was.

But Deputy Lu Zhuren had been hesitating.

There was a problem, but Lu Gang didn't know where the problem lay.

Some things couldn't be explained clearly; they were a kind of "sixth sense" formed from seeing many patients.

As for the "clinical presentation," it was just like Lu Gang's current state.

Lin Jiuze knew that many times when doctors encountered difficult and complicated cases, they relied on years of clinical experience to make judgments; if they really had to explain it point by point, they couldn't do it.

"When does the hospital-wide consultation start? Have you seen the patient, Deputy Lu Zhuren?" Ji Xiang asked.

"I took a look yesterday; we'll go see them together in a moment," Lu Gang answered naturally.

Ji Xiang re-examined the medical record from the Digestive Medicine Department. "Does the patient have a family history of depression?"

"Hmm, when I saw the patient, I didn't feel like the whole family had depression. The diagnosis of this kind of illness, heh." Lu Gang didn't continue, just let out a 'heh'.

Lin Jiuze caught this detail, and various diagnoses regarding abdominal pain caused by depression popped up in his mind.

Depression itself wouldn't cause abdominal pain, but illnesses like abdominal epilepsy, if they persisted for a long time without a confirmed diagnosis, would cause the patient to enter a state of anxiety, eventually leading to depression over time.

The cause and effect were exactly the opposite, but clinically the two appeared together, so it was also within the scope of consideration.

Abdominal epilepsy was also possible.

Lin Jiuze was going all out this time; he was no longer as lazy as before, his eyes were glowing, his hand was gripping the notebook tightly, and his ballpoint pen was being squeezed until it creaked.

He just didn't realize it himself.

Even his harmless expression had vanished; at this very moment, Lin Jiuze was full of fighting spirit.

Fight!

Fight!!

Must win!!!

Arriving at the Digestive Medicine Department, Lu Gang and Ji Xiang performed a physical examination, while Lin Jiuze stood in the corner observing their every move as well as the patient's facial expressions and body language.

After Lu Gang and Ji Xiang left, Lin Jiuze began to write and draw in his notebook.

He would write something, look up to observe; then look down to write, and look up to observe again.

Soon, Lin Jiuze fell into deep confusion.

He attached great importance to this patient, much more seriously than when he was at Massachusetts General Hospital.

He had already prepared his abdominal case analysis; in a short time, Lin Jiuze had written down at least ten diagnoses, but not a single one of these many diagnoses was correct. He even began to harbor deep doubts about the knowledge he had learned.

Abdominal pain, acute abdomen, not an organ issue, not abdominal epilepsy, and certainly not common conditions like intestinal torsion or intestinal spasms.

Then what else could it be?

Lin Jiuze racked his brains trying to think.

Meanwhile, Ji Xiang was chatting with the patient's family about the condition, while Lu Gang began to preside over the hospital-wide consultation.

"This situation is different from before. The patient's board-like abdomen is particularly obvious, accompanied by tenderness and rebound tenderness. An acute abdomen can be clearly diagnosed; although the upright abdominal X-ray shows no crescent sign, it might be an intestinal perforation where not much gas has leaked out."

The doctor from the Digestive Medicine Department said after briefly introducing the patient's situation.

"I remember this is already the patient's third consultation. The previous two..." the Deputy Director of Gastrointestinal Surgery said, "The most absurd thing was the second time; the order was submitted to prepare for surgery, and the patient suddenly said the pain had eased."

"I have also considered this point. Could it be acute cholecystitis? Although the ultrasound doesn't show severe cholecystitis, it can still cause severe pain and an acute abdomen. Every time they are hospitalized, they receive intravenous antibiotics, and it's normal for the cholecystitis to be suppressed under the effect of antibiotics."

"I don't think it's that simple. Generally speaking, cholecystitis causes upper abdominal pain, and unless there is a gallbladder perforation with bile spilling all over the abdomen, there wouldn't be signs of a board-like abdomen."

Numerous doctors were all saying their own things, with no unified answer.

Lu Gang's hair was drooping down, but he couldn't care less; looking at him, his brain was spinning rapidly, trying to figure out exactly what was going on with the patient.

A knock on the door sounded.

Ji Xiang then pushed the door open and walked in on tiptoe.

"I don't think we can operate," the Surgeon said. "The patient's pain eased before surgery the last two times. If we really open them up this time and can't see the problem, or if we search for a long time and can only barely remove the gallbladder, and they are still in pain after the surgery, what are we going to do?"

"The Acute abdomen is already obvious; these are classic signs for a Laparotomy!" the Digestive Medicine Department Doctor insisted, "If we don't operate now, what else is there to do?"

Both sides held to their own views, and an argument broke out.

The more they talked, the more intense it became, even showing signs of slamming tables and cursing.

"Keep your voices down!" Lu Gang raised his volume to suppress the crowd's arguing, "Can't you speak properly? What are you all bickering about?"

Several Doctors resentfully swallowed their words.

(End of chapter)