Practicing Medical Skills in a Small Clinic-Chapter 161 - 120: Attending Level Strength and Powerful Diagnostic Abilities (Part 3)

Learning knowledge and applying it are two different things.

As a junior resident, one can only begin to apply medical knowledge to clinical practice. At the senior resident level, knowledge learned can be applied more flexibly in practice.

Now it's even better.

One can start to systematically combine medical knowledge for analysis and diagnosis.

The most common cause of lower limb edema due to malnutrition is hypoproteinemia.

The blood routine results of this infant show anemia, as well as low hemoglobin levels.

In the situation where malnutrition is gradually worsening, the occurrence of lower limb edema is quite normal.

The doctors at the People's Hospital certainly identified the cause of the lower limb edema.

However, to treat the lower limb edema, the causes of anemia and hypoproteinemia must be identified.

Considering the infant's diarrhea has lasted for nearly a month, and occurs multiple times a day, with watery stools that contain mucus, this is one of the main reasons for malnutrition.

Furthermore, the infant's intake has continuously decreased, which is another major reason for malnutrition.

After going in circles, the real cause circles back to diarrhea and reduced intake.

Li Jingsheng finally understands why the attending doctors at the Children's Hospital and the People's Hospital can't escape the cycle of stool examination.

Because the final diagnostic direction points to diarrhea.

Diarrhea in infants under six months isn't a big deal; it's a common phenomenon. But normally, the loose stools of infants shouldn't contain mucus.

Moreover, this infant is over six months old, with diarrhea occurring five to six times per day, watery stools containing mucus, leading to suspicion of intestinal diseases.

Imaging examinations show that the liver, heart, and abdominal cavity are normal.

Then the only suspicions left are intestinal bacterial infection, flora imbalance, enteritis, physiological disorder, or problems with food.

Li Jingsheng forcibly grabs his hair, racking his brains to discern the real cause.

It's as if he's back in the university classroom studying medicine.

Whenever the teacher talked about disease symptoms, he always suspected whether he had that disease too.

At this moment, he feels all the listed causes are possible.

It's really perplexing.

Better start with the simplest elimination.

"May I ask what brand of milk powder you usually give to the child?"

"We're using... brand milk powder, a well-known domestic brand, certainly wouldn't have any problems because my nephew's child also eats this brand of milk powder. We buy it in bulk."

The child's grandmother answered.

Buying in bulk often allows for discounts due to large quantities.

The brand mentioned by the grandmother is indeed a well-known domestic milk powder brand, so the likelihood of problems is very small.

Li Jingsheng excludes food issues and begins checking for the possibility of enteritis.

Causing such prolonged diarrhea in a child, and having almost no effect after medication, makes one primarily suspect fungal enteritis.

For example, the most common Candida albicans.

However, the attending doctor at the People's Hospital has already conducted three stool cultures, all negative.

The possibility of fungal enteritis can basically be ruled out.

Considering the infant's lengthy treatment cycle, long-term use of antibiotics during treatment often leads to oral thrush and perineal and perianal fungal infections.

But previous checks showed smooth oral mucous walls, effectively ruling out oral thrush.

Fungal infection of the perineum and perianal was also checked by Li Jingsheng on-site and ruled out.

Moreover, the stool cultures were negative, which further excludes the possibility of fungal infection.

"Could it be intestinal flora imbalance?"

After consecutively ruling out various possible causes, Li Jingsheng thinks about the infant's long-term high-dose use of broad-spectrum antibiotics, which can easily lead to the suppression of normal intestinal flora and the mass proliferation of drug-resistant bacteria, resulting in severe diarrhea.

Especially staphylococcal enteritis and pseudomembranous enteritis are most likely to occur.

This suspicion is also directly ruled out due to the negative stool culture results.

The attending doctor at the People's Hospital performed three stool cultures on this child, not without reason.

Thus, the only remaining possibility is physiological diarrhea.

Normal physiological diarrhea usually manifests as frequent loose stools. However, appetite and intake, growth, and development are unaffected.

This infant's intake has continuously decreased, and he is over six months old, while also suffering malnutrition. Combining these factors, physiological diarrhea can be completely ruled out.

Having diagnosed to this point, Li Jingsheng is caught in a dilemma.

Limited ability, limited level.

His doctor's rank has reached Attending Level, plus a Master Level in gastrointestinal diagnosis, which has allowed so many diagnostic approaches to emerge and be systematically eliminated.

Otherwise, previously even reaching this point would have been impossible.

At present, his level, even if placed at a tertiary hospital like the Second Hospital, he's already quite competent.

At least he can manage independently in the inpatient department.

As long as he doesn't encounter particularly difficult conditions, he can generally alleviate the chief physician's worries. 𝓯𝓻𝒆𝙚𝒘𝓮𝙗𝓷𝒐𝓿𝙚𝒍.𝙘𝓸𝙢

Compared to a resident doctor, he is undoubtedly much more advanced.

"If I could have 136 more life points, it would be great."

He feels very unwilling.

Diagnosing the cause of this child's illness, clearly there has been significant progress. But once systematically eliminating possibilities, the diagnosis eventually falls into a dilemma.

If he could raise his gastrointestinal diagnosis level by another grade, he believes he could potentially diagnose the real cause.

He seems gentle, but deep down he's quite stubborn.

When he fails to accomplish something, he isn't afraid of setbacks but perseveres, determined to excel at it.

Switching to ordinary people, after managing a clinic for half a year yet failing to even afford employee wages, they would concede to reality, directly sell the clinic, and honestly return to working at a hospital.

If he did that, his girlfriend might not have left.

Because at the time, the two just argued frequently, their emotions gradually estranged, becoming not like before.

Later his girlfriend realized she couldn't sway him, and it's likely she already had a new suitor by then. After all, Li Jingsheng has always been picky in choosing girlfriends; he's uninterested in those with low looks.

Pretty women are never short of suitors.

When his girlfriend became discontent with him, as long as another man was slightly more outstanding than Li Jingsheng, he could easily win her over.

And that's indeed what happened.

Li Jingsheng fretted, wondering where to earn so many life points in such a short time.