CHAPTER 473: PATIENT 473 WHO LOVES TO HICCUP

(Thanks to dear friend Ji Du Fei Xue for his 18,000 rewards, and readers, 160712150011189, tmoo, Wind Rains, Brains, Benbo for their monthly ticket rewards)

"Doctor, doctor, the doctor upstairs said that our child needs surgery immediately."

Before Liu Banxia could leave for his shift break and meal, the mother, who had just taken her child upstairs for a color Doppler ultrasound, rushed back in a panic.

"Please don’t be anxious. Let me look at the ultrasound image first," Liu Banxia said.

The child’s mother hastily handed the ultrasound report to Liu Banxia.

The ultrasound doctor’s description stated that the mass was located in the center of the upper abdomen, surrounded by arterial and venous blood vessels. This description ruled out intussusception, confirming Liu Banxia’s initial diagnosis was accurate.

Intussusception masses usually occur in the right middle and lower abdomen, and blood flow signals in the intestinal wall increase. This is a unique capability of color Doppler ultrasound; a B-scan ultrasound doesn’t have this ability.

DING! Consultation complete.

100 experience points gained, 100 diagnostic skill proficiency points gained.

"Doctor, is this illness very dangerous? Have you eaten? Can you perform the surgery?" the child’s mother asked anxiously again.

"Please don’t worry for now. Judging from the child’s symptoms and blood circulation, there are currently no signs of necrosis," Liu Banxia said.

"Let me first explain what this illness is. It’s a type of congenital disease. To put it plainly, it’s a problem present from birth. Internally, it manifests as shown on this report: a part of the intestine has encroached on the space of another."

"However, your child’s condition isn’t very severe, as it’s a problem he was born with. Many children require surgical intervention in the neonatal stage; otherwise, it can become truly dangerous."

"What we need to do is return this somewhat unruly section of the intestine to its original position. We can perform laparoscopic surgery, which is minimally invasive, or we can do an open abdominal surgery."

"Laparoscopic surgery involves making small incisions in the abdomen, through which we insert instruments to gently correct the malrotation and reposition the intestine. Open surgery means making a larger incision in the abdomen to perform the operation."

"However, there’s one more thing: we still need to see the actual situation inside the child’s abdominal cavity. Such prolonged malrotation will definitely have caused some adhesions. If the adhesions are severe, laparoscopy becomes very difficult, and open surgery would be safer."

"If you opt for laparoscopic surgery, and we discover severe adhesions after making the initial incisions and observing, we will switch to a standard open abdominal surgery. This is not only for our convenience as surgeons but also for the child’s well-being."

"Since it is a surgery, we also need to conduct thorough preoperative examinations. Once the test results are out and an operating room is available, we can proceed directly with the surgery."

"Wang Chao, please take her to get the preoperative examinations done. Then, explain the surgical procedure in detail to ease her anxiety. This surgery isn’t an emergency like a perforated appendix; it’s a semi-emergency."

"Don’t worry. If it were truly dangerous, the child wouldn’t just be in this much pain; he’d be writhing in agony. With thorough preoperative checks, the surgery itself will also be safer."

Hearing his explanation, the child’s mother finally seemed less agitated than before.

These were two completely different reactions from a patient’s family.

One type is always suspicious of doctors. If you suggest any examination, the first thing they think is whether you’re ordering it just to make money. They will repeatedly question, verify, and even resist the examination.

The other type is like this mother just now, who suddenly becomes extremely anxious, almost wishing they could push the child into the operating room immediately to get the surgery done.

If they encountered an unethical doctor, this would be the time they could be "guided" to a certain extent regarding medication and surgical methods.

When the child’s mother is panicking, she’ll basically believe whatever you say, allowing an unscrupulous doctor to profit as they please.

This is where medical ethics is tested. Laparoscopic surgery definitely earns more than open surgery. But the patient’s family must be the one to choose; doctors can’t just randomly recommend procedures for extra profit.

Actually, the difficulty of this surgery wasn’t high. The worst-case scenario would be if the intestinal malrotation couldn’t be corrected, which might then require resecting a segment of the intestine.

However, he felt it wasn’t necessary to tell the child’s mother about this. Wang Chao would be responsible for explaining the more detailed steps and procedures. Wang Chao wasn’t just an assistant; he would be the chief surgeon for this operation.

Wang Chao led the child’s mother to the office and wrote out the orders for the relevant preoperative examinations, leaving the nurses to handle them.

As for who Wang Chao would bring into the operating room to assist him, Liu Banxia didn’t need to worry about it. That was Wang Chao’s personal choice, though given the current situation, he’d likely pick someone available at the moment.

The key was that he, as a senior doctor, had a somewhat unorthodox way of doing things; he was always quick to take other people’s interns under his wing. Others had gotten used to this practice, as it saved them some trouble.

Moreover, these interns always performed exceptionally well; otherwise, they wouldn’t get such comprehensive training opportunities. After all, if the interns one mentors perform poorly, it will eventually affect one’s own evaluation.

"Teacher Liu, can intestinal malrotation really persist for so long without correction?" Liu Yiqing asked after finishing her research.

"It’s very possible. Although it’s a congenital malformation, there are significant differences in severity," Liu Banxia said with a smile.

"Actually, in many normal families, parents are often careless. This child must have shown many symptoms throughout his life, but people usually don’t pay much attention to these things."

Liu Yiqing nodded. That was indeed true.

Many symptoms that would alert a doctor might simply be treated at home by drinking hot water. If taken a bit more seriously, perhaps some antibiotics would be given.

At this moment, a male patient in his forties, wearing a mask and glasses, walked in. Liu Banxia glanced at him and thought, I’ll take this one myself.

He took the registration slip and glanced at the patient’s information: 46 years old, hiccups.

"How long have you been hiccuping? Any changes in your diet?" Liu Banxia asked.

"I’ve been prone to hiccups lately, but it’s gotten quite severe these past few days. HIC... like this," the patient said.

"What about your diet? Have there been any significant changes to your usual eating habits? Do you feel bloated?" Liu Banxia asked.

The patient shook his head. "HIC... Nothing else, just a little bloating. I initially thought it was indigestion, HIC... I took some digestive aid tablets, but it’s still the same. Bowel movements are HIC... normal."

"Do you experience any acid reflux, that sour taste in your throat?" Liu Banxia asked.

The patient shook his head, this time choosing not to speak to avoid hiccuping.

"Considering your situation, it doesn’t really seem like gastroesophageal reflux. Let me give you a physical examination first. Please lie down on the examination bed," Liu Banxia said.

Gastroesophageal reflux is when stomach contents flow back into the esophagus. Some patients experience hiccups as a symptom; in severe cases, the reflux can reach the pharynx, causing that sour taste in the throat.

It’s a common ailment in daily life; even Liu Banxia would occasionally experience a bit of reflux himself.

Many factors can cause this condition, including diet, alcohol, strong tea, stress, and so on; all can easily trigger it.

Occasional episodes are nothing to worry about; even more severe ones can usually be managed with acid inhibitors.

However, if it becomes chronic, a detailed examination is necessary. It could potentially lead to gastrointestinal cancer, especially for those with a family history of such diseases, who need to be extra cautious.

This patient’s situation was somewhat different. He had no abdominal symptoms, just persistent hiccups.

However, when the patient unbuttoned his padded jacket, revealing his abdomen, Liu Banxia frowned. He hadn’t looked thin in the padded jacket, but he’s actually quite slender.

"Are you experiencing any diarrhea currently?" Liu Banxia asked.

"Occasional diarrhea, yes. My gastrointestinal function isn’t great. But it’s not very frequent. As long as I don’t eat spicy or cold food, or hot pot, I’m generally HIC... fine," the patient said.

"I’m going to press on your abdomen now. Tell me if you feel any discomfort," Liu Banxia said, beginning to palpate the patient’s abdomen.

"HIC..."

Just as he pressed on the upper abdomen, the patient hiccuped again.

"Does it feel uncomfortable here?" Liu Banxia asked.

"It’s a negligible sensation, nothing particularly distinct. But when you pressed just now, it made me HIC... a little," the patient said.

"HIC... Sometimes my lower back... HIC... has a slight, pulling pain, like it’s being stretched. But it’s not too severe. I... HIC... I don’t exercise much usually."

"Do you ever experience pain when you urinate?" Liu Banxia asked.

"No," the patient replied.

Liu Banxia pondered for a moment. I was just suspecting kidney stones.

Even if kidney stones aren’t obstructing the ureter and causing severe pain, an accumulation of them in the kidney can sometimes cause these symptoms.

"Doctor, HIC... can you prescribe some medication to stop my hiccups first?" the patient asked after sitting up.

"Let’s not rush that. We need to find the correct approach and determine the cause before we can provide targeted treatment," Liu Banxia said.

I really want to order an ultrasound for him right away, Liu Banxia thought, but the current indications aren’t clear enough.

You can’t just recklessly order tests reliant on instruments as a diagnostic basis; you must have at least one clear indication.

The patient had no symptoms of abdominal pain, only occasional slight lower back pain. The other symptoms were just a bit of bloating and the hiccups.

It’s probably not kidney stones either, Liu Banxia mused. If there were many kidney stones, small particles would often be passed during urination, which would cause pain.

DING! Task Issued: The Hiccuping Patient

Open Task: The patient presents with habitual hiccups, but no clear indications have been found during the current diagnostic process. Further diagnosis is needed to confirm the condition. Task rewards will be issued based on the diagnostic results.

Liu Banxia felt a slight headache but proceeded to listen to the patient’s heart and lung sounds.

I hope I can find a clear indication before ordering an ultrasound, rather than sending the patient for a battery of unnecessary tests, he thought.

Conducting a thorough examination first and only relying on instruments when absolutely necessary gives the patient a much different impression—and reflects a better attitude—than performing a cursory check and immediately ordering machine-based tests.