My Medical Skills Give Me Experience Points

"The patient has a nearly fifty-year history of smoking, his father passed away 20 years ago due to 'Typhoid Fever,' and his mother died of a tumorous abdominal mass 10 years ago. Since no pathological examination was performed, the nature of the mass is unknown."

This means it's very possible that the patient's mother died of cancer as well.

The patient himself has been hospitalized and undergone routine examinations such as X-ray barium meal tests, gastroscopy, blood, and stool tests.

In addition, he also had a B-ultrasound examination of the liver area.

"The upper margin of the liver is at the 6th intercostal space, with the right lobe measuring 13.5cm in oblique diameter, 2cm thick below the midclavicular line and extending 1.5cm, the left lobe 7cm thick and 8cm long, 4cm thick and 3cm long below the xiphoid process, with coarse and enhanced intrahepatic speckles, and the echo distribution is still even, but the vascular course is not clear..."

The B-ultrasound is mainly an examination of the liver.

At present, the possibility of liver cancer cannot be ruled out.

Because the liver does not have pain receptors, it is known as the most silent organ.

Many liver cancer patients are already in the advanced stages by the time they are confirmed.

Before that, there are almost no obvious symptoms.

Zhou Can squints his eyes, carefully examining the B-ultrasound film.

It is undeniable that the basis for diagnosis in the Western medical system is primarily based on various test results taken together.

In this regard, one must praise Traditional Chinese Medicine.

Experienced Traditional Chinese Medicine practitioners, with just a press on the patient's pulse points on the wrist can quickly attain a clear understanding of the patient's condition. It's comparable to a complete physical examination in Western medicine.

Nowadays, why are ordinary people reluctant to go to the hospital? Once you go in, regardless of whether you have an illness or not, a wave of routine checks is mandatory.

If you need to stay in the hospital, even more tests are conducted.

Hundreds, even thousands of yuan are spent just like that.

After waiting in line all day, you're lucky if you can get your test results before the consulting doctor goes off duty.

Although Chinese medicine also charged a consultation fee, it was often very cheap.

Many Chinese medicine practitioners are also of high moral standing, in cases of treating poor people, they would even pay for the medicine themselves.

In contrast, in the current Western medical system, if you don't have money, you essentially can only wait for death.

Don't naively think that public hospitals will accept patients for treatment first and allow payment later.

Those are emergency patients.

And not all emergency patients are afforded the chance to defer payment.

Because if a patient or their family reneges on the payment, it is the relevant medical department that suffers.

From this B-ultrasound film alone, it's hard to tell whether the patient has liver cancer.

At least at Zhou Can's current level, after looking at it, he feels that the possibility of the patient having liver cancer is very small.

If it's not liver cancer, then what cancer could it be?

There are too many types of cancer.

Excluding liver cancer, if there is a neoplastic tumor in other parts of the body, the patient is likely to feel pain or discomfort.

Zhou Can reviewed the patient's symptoms again.

He then asked the patient some simple questions about pain in other parts of the body.

The patient responded that during the onset of the illness, there would sometimes be back pain, which should be classified as referred pain.

At this point, after ruling out liver cancer and abnormalities or severe pain in other parts of the body, there's only one possibility left.

The symptoms caused by this type of cancer coincide with those of a Duodenal ulcer.

Gastroscopy has already been performed, and gastric cancer has been largely excluded.

At this time, Zhou Can suddenly realized, could there be a problem with the gallbladder?

There are two reasons for this: the liver and gallbladder are closely related, so when the liver hardens, the gallbladder is somewhat affected. However, liver hardening is not directly associated with gallbladder cancer.

The Duodenum is very close to the gallbladder, kind of like cousins.

Problems with the gallbladder can cause abdominal pain. Jaundice is also relatively common.

But the patient's liver hardening can also lead to jaundice.

In other words, the symptoms coincidentally overlap to a high degree.

It is this coincidence that even Director Jia, a very experienced diagnostician, missed the mark.

Zhou Can looked at the B-ultrasound film again—no abnormal reflections were seen in the gallbladder, which had good sound transmission.

However, since the gallbladder was not specifically imaged, Zhou Can could not clearly view the condition of the gallbladder wall and common bile duct.

The thought of having the patient undergo another B-ultrasound is tempting, but it would raise doubts among the family members.

Moreover, Zhou Can himself does not have the authority to request the examination.

This matter must be discussed with Director Jia or the attending physician.

"I will take this film to Director Jia for another look, and we will promptly notify you of any issues."

Zhou Can took the patient's B-ultrasound report to Director Jia.

Perhaps Director Jia could notice something abnormal.

At least for now, there seems to be a slight abnormality in the shape of the gallbladder.

Back at the outpatient clinic, Director Jia has already started seeing patients.

His VIP appointments, although limited, are very sought after, with many seeking his consultation.

To avoid patients waiting for a long time or resorting to buying expensive appointments through scalpers, he often tries to add a few more appointment slots.

Moreover, with his schedule often filled with seeing patients in the morning and performing surgeries in the afternoon, his time is incredibly tight.

Zhou Can, holding the film, patiently waited behind Director Jia until his current patient's consultation was finished before presenting the B-ultrasound images.

"Director Jia, I just went to the ward and examined the patient carefully. He has both symptoms of jaundice and abdominal pain, which he has already expressed. There is a significant mass in his abdomen, without any description of it. I suspect the possibility of gallbladder disease or even cancer in the patient. It's just that these symptoms coincidentally overlapped with those of the Duodenal ulcer and liver cirrhosis, reason why the issue wasn't discovered during the examination."

Zhou Can didn't dare to speak too definitively.

Because there's too little evidence for diagnosis.

In medicine, a conclusive diagnosis requires at least one solid piece of diagnostic evidence.