Chapter 112 Short bowel syndrome, the most terrifying disease is poverty

Li Jingsheng's eyes narrowed slightly and his expression became serious.

Blood in the stool often means gastrointestinal bleeding.

If it is upper gastrointestinal bleeding, black stool is often passed out. Because the blood produced has been absorbed by the lower gastrointestinal tract and has turned black by the time it is discharged, and is mixed in the stool.

Routine stool examination at this time can often reveal a positive result for fecal occult blood.

In fact, you can see it visually.

The uncle is just an ordinary person, not a doctor. He found blood in the stool he pulled out. In all likelihood, it was not black stool, but directly containing blood.

Based on this information, Li Jingsheng’s proficient gastroenterology diagnosis made a preliminary diagnosis that the patient was likely to have lower gastrointestinal bleeding.

As for where the bleeding is, imaging examination is a good choice.

The conditions of small clinics are limited. Plain abdominal X-rays can detect some intestinal bleeding, but its accuracy is far inferior to abdominal CT. If conditions permit, barium angiography or colonoscopy is even required.

Li Jingsheng immediately gave up the idea of ​​doing an abdominal ultrasound or plain X-ray for the patient.

That 'grandpa'-level X-ray detector can also detect bone injuries and other significant lesions.

It is really difficult for it to detect lower gastrointestinal bleeding.

Judging from the way this uncle was fussing over his search, it would be difficult for him to agree to even a hundred yuan imaging examination fee.

The main reason is that it doesn’t mean much to do this test.

Even X-ray detectors in large hospitals can only detect intestinal paralysis or mild or moderate intestinal dilation at most. If you want to confirm the bleeding site and get more detailed information, you have to do CT and barium angiography. .

"How long have you had blood in your stool?"

Although Li Jingsheng had given up the idea of ​​treating this patient, he still took this opportunity to accumulate more practical experience.

The attribute panel can increase proficiency in diagnostic medical skills, but the accumulation of knowledge still requires hard work and study.

Goldfinger cannot create a medical skill out of thin air for him, or give him knowledge.

At most, it can help him better apply the theoretical knowledge he has learned and apply it skillfully in clinical practice.

"I'm afraid it's been more than ten days! It's gotten worse in the past two days, and my stomach pain is severe. There was occasionally blood in the stools I passed out a few days ago, but not much, and my stomach only hurts for a while from time to time."

My uncle had been bleeding for so many days and never went to the hospital for a checkup.

The main reason is the fear of spending money.

People are poor and life is low, it is the same in every era.

If the pain wasn't unbearable now, I probably wouldn't even come to the clinic.

"In this case, you go and lie down on the treatment bed inside, and I will check your abdomen."

Li Jingsheng decided to conduct an abdominal tenderness examination on his uncle first, so that he could at least locate the approximate lesion area.

For example, appendicitis usually causes pain in the right lower abdomen.

Upper abdominal pain may be caused by the jejunum, ileum, or even the liver. The pain in each location, as well as the depth, can directly reflect which organ or tissue the lesion is.

"Does this examination cost money?"

The uncle hesitated and asked.

“No charge.”

Among the patients Li Jingsheng treats, there are many who care about money, but there are still very few who care about money like this uncle.

After all, after getting sick, almost all patients just want to be relieved of their pain as soon as possible.

As long as the treatment fee is not too expensive to bear, it generally doesn't matter much.

He secretly deduced that either the uncle's finances were in trouble, or he was naturally careless and stingy in everything he did.

There are not many such men, but there are.

She is more picky than women when buying clothes, trying every means to bargain and take advantage of them.

After guiding the uncle to the treatment room inside, Li Jingsheng asked the uncle to lie down and lifted up his clothes to examine his abdomen.

I saw a long wound on the uncle's abdomen.

The suture marks are still relatively clear, indicating that the operation time should be within half a year.

"Have you had any recent surgery?"

"Oh, don't mention it. About six or seven months ago, I was working one day when I suddenly had a terrible stomachache. After I fell to the ground, I fainted from the pain. After my coworker sent me to the hospital for examination, he said it was an intestinal tract infection.

...I had internal strangulation, and then I had an operation to cut off part of my intestines. Until now, I can't work."

When the uncle mentioned this matter, he shook his head and sighed, with a sad look on his face.

Emergency surgery is required to remove part of the intestines, which may be due to intestinal hernia and strangulation.

This disease occurs rarely, but is more likely to occur in middle-aged and elderly people.

Especially some middle-aged men who do heavy physical work sometimes do not rest after meals. In order to do more work, they do heavy work right after eating.

There are also cases where you suddenly exert too much force while working, etc., which may easily lead to intestinal hernia or intestinal volvulus.

If not treated promptly, intestinal necrosis can occur and be fatal.

Now I finally understand why this uncle had to ask many times whether there would be a fee for a check-up and how much it would cost.

I haven't worked for more than half a year, and I am just an ordinary casual worker, usually with little savings.

Treatment costs a lot of money, and you should have to have reexaminations in the next seven months. Taking medicines and so on is also a long-term consumption.

Sit back and eat nothing.

The uncle is probably at the end of his rope now.

"I'll check your abdomen, please relax as much as possible."

Li Jingsheng began to press the painful area of ​​the uncle's abdomen and found that there was a certain degree of abdominal ankylosis.

During abdominal palpation examination, the abdominal wall is obviously tense, stiff, and as hard as a wooden board, which is not good.

Abdominal ankylosis only occurs when acute gastrointestinal perforation, organ rupture, acute peritonitis and other diseases occur.

The uncle has blood in his stool and has had blood in his stool for many days.

Now the blood in the stool is getting worse and the abdominal pain is getting worse, which shows that the condition is progressing and is approaching fiercely.

"Does it hurt here?"

"Um."

"Does it hurt just a little or a lot?"

"It hurts more."

As soon as the uncle finished answering, Li Jingsheng increased his strength slightly.

"Ouch...it hurts, it hurts!"

Li Jingsheng immediately stopped his hand. He judged that the uncle's pain should be in the jejunum.

The small intestine is a part of the digestive tract, which is divided into three parts: the duodenum, jejunum, and ileum.

What’s more interesting is that the medical boundary between the upper and lower digestive tracts is the duodenum.

The suspensory ligament of the duodenum is also called Treves' ligament.

It is like a ‘boundary monument’ between the upper and lower digestive tract.

Above Treves' ligament is the upper gastrointestinal tract. Below it is the lower gastrointestinal tract.

The jejunum occupies approximately two-fifths of the length of the small intestine and is slightly shorter than the ileum.

The pain site is now in the ileum, and further diagnosis requires more information.

"Okay, the examination is over. Get up! When you defecate, is the color of the blood bright red or dark red?"

This is very important.

It can help Li Jingsheng roughly determine the intestinal segment where the bleeding point is.

Rectal bleeding is usually bright red, and the color of the bleeding becomes darker as it goes up the rectum.

Because it takes time from bleeding to excretion from the body.

The longer this time is, the darker the blood will be.

"Hmm... It seems to be dark red! When I wiped my butt, I found blood on the paper. The color is darker. But it is definitely blood."

"Is there a lot of bleeding?"

"I feel a little heavy these past two days, and my stools are a bit like jelly, a little white, and very smelly. It's a bit like the smell of rotting meat."

The uncle described the situation of defecation.

"Doctor, is my illness serious? Is there any cure? How much does it cost?"

"Don't worry, let's go out and talk!"
To be continued...