When the Doctor Uses A Hack

The case isn't long.

Just a few sentences.

But they reveal a lot of information.

Doctors, when reviewing a medical case, generally focus on a few aspects.

First, deducing the cause from symptoms; second, predicting symptoms based on the cause.

At this moment, the patient's symptoms don't seem too hard to infer.

Regarding symptoms, the patient experienced sudden dizziness and weakness, likely indicative of hypovolemia, along with acute abdominal pain and bloating, which are suggestive of abdominal cavity bleeding!

Regarding signs: rapid pulse, low blood pressure, and obvious peritoneal irritation. This clearly suggests an intra-abdominal condition.

Routine blood tests indicated progressive decline in hemoglobin during the early onset, with no significant changes in MCV or MCH, but persistent low-level Fib and elevated D-dimer. These seemingly disorganized report results obviously lead to one conclusion: it perfectly aligns with symptoms of acute bleeding!

So Chen Cang directly said, "Consider acute hemorrhagic conditions!"

Chen Cang's diagnosis was delivered almost immediately after hearing the case.

Several department heads glanced over repeatedly, full of admiration.

Although this diagnosis isn't particularly difficult, ... arriving at acute bleeding so quickly requires a certain level of competence.

Chen Cang's almost instinctive response displayed his solid expertise!

Huang Qiuying couldn't help nodding, "That's right. Since it's a hemorrhagic condition, accompanied by lower abdominal pain, physical exam and imaging both revealed solid masses in the pelvic cavity, and the patient also has a gynecological history. Therefore, I primarily consider gynecological-related conditions.

There aren't many gynecological conditions that can lead to hemorrhage!

First, pregnancy-related conditions, such as ectopic pregnancy or trophoblastic tumors;

Second, ruptured ovarian or fallopian tube tumors;

Lastly, ruptured endometriotic ovarian cysts."

Chen Cang nodded, "The patient has been menopausal for many years, so pregnancy-related conditions can be ruled out, and endometriotic ovarian cysts are also unlikely!"

At this point, Chen Cang suddenly asked, "Did the patient fall?"

Cui Jisheng nodded, "Yes, but... it was just a minor slip to the ground."

A minor slip and a heavy fall have vastly different implications.

Huang Qiuying said, "Before establishing a diagnosis for gynecological conditions causing hemorrhage, we still need to rule out other systems and other causes of bleeding."

He Zhiqian, the general surgery department head, spoke up: "We've discussed this earlier. In abdominal hemorrhage cases under general surgery, it's usually related to organ damage."

"But organ damage, whether involving solid organs like the liver, spleen, pancreas, or hollow organs such as the stomach, intestines, gallbladder, and bile ducts, as well as vascular damage like the abdominal aorta or inferior vena cava, typically results from severe blunt or penetrating trauma. Pelvic vascular injury is more often secondary to penetrating trauma, pelvic or lower limb fractures.

Since the patient only experienced a minor activity followed by a slow fall with no apparent fractures, it's unlikely to have caused damage to the aforementioned organs or tissues."

He Zhiqian's remarks outright ruled out the possibility of organ damage in the patient.

Next, the urology, hematology, endocrinology, and interventional departments began another round of discussion.

Perhaps many people don't understand what a consultation is?

This is the essence of consultation: proposing a tentative diagnosis, followed by each department partaking in discussions.

This showcases the benefits of specialization.

Every doctor is an expert in their field!

They are highly adept within their domain of expertise.

This process systematically narrows down the patient's possible conditions.

An acute intra-abdominal hemorrhage may seem ordinary, but at this moment, delivering a clear diagnosis remains elusive.

In reality, this is medicine.

As Sir William Osler, one of the founders of Johns Hopkins Medical School, said: "Medicine is an uncertain science!"

The discussion became increasingly tense.

The urology department ruled out the possibility of bladder-area injuries, temporarily disregarding urological-related conditions.

Meanwhile, the hematology department's preliminary deduction focused on vascular damage, as chronic diseases like long-term diabetes can often induce vascular conditions leading to hemorrhage.

Another round of discussions concluded.

The room fell silent once more.

Generally speaking, consultations are often stepwise.

If a diagnosis is reached, then everything proceeds seamlessly.

However...

If, like today, the discussion drags on without pinpointing the cause.

Consultations do not go to waste!

They gradually turn into sessions of shifting responsibilities.

After all, with such a complex patient whose diagnosis remains unclear, treatment can't even begin.

Still, the patient's condition is relatively manageable.

If the condition were truly critical, the first step would likely have been exploratory laparotomy.

Sometimes, imaging tests have limitations.

The bleeding is definitely present, but its volume isn't particularly extensive.

At this moment, the office plunged into silence once again.

Huang Qiuying decisively said, "Notify the operating room. Prepare for exploratory laparotomy!"

Delays at this point were meaningless.

Meanwhile, Chen Cang was also frantically pondering various possibilities.

He had methodically revisited the usual diagnostic avenues, but ... none of them aligned with the patient's symptoms.

No wonder the consultation had gone on for an hour without yielding results.

Just then, Chen Cang suddenly said, "May I go take a look at the patient?"

Huang Qiuying turned to look at Chen Cang, realizing for the first time that he hadn't shared his thoughts since arriving.

Everyone also suspected whether Chen Cang was just here for appearances.

Still, no one forced Chen Cang; after all, he was merely a visiting physician.

Whether he contributes or not, he bears no responsibility.

But...

Truthfully, the department heads didn't think Chen Cang had a chance of offering insights.

However, seeing Chen Cang's earnest demeanor, lacking any hint of pretentiousness, Huang Qiuying paused. "Alright!"

Without further ado, Huang Qiuying personally escorted Chen Cang to the patient's ward.

A sixty-something woman lay on the bed, clutching her abdomen and groaning in discomfort.

Seeing Huang Qiuying arrive, she was about to speak, but suddenly noticed Chen Cang!

Instantly, the woman's face turned red. "Professor Chen!"

The woman's husband, Cui Jisheng, couldn't help but exclaim, "Honey, don't worry; Professor Chen will definitely figure it out!"

The woman nodded, suddenly finding her abdominal pain somewhat alleviated. "Yes, yes! I trust Professor Chen!"

Chen Cang sighed deeply, feeling the weight of the responsibility.

Love and trust are the two things you can't let down!

The department heads around them displayed varied expressions.

If Chen Cang could genuinely diagnose the issue, then he'd prove to be quite remarkable.

But... honestly, if this condition were straightforward, it wouldn't have dragged on until now.

This type of bleeding is undoubtedly rare!

As anticipated, even after a round of palpation by Chen Cang, he also hit a dead end, unable to arrive at an accurate diagnosis!

But Chen Cang's eyes weren't X-ray vision.

He couldn't possibly see inside the abdominal cavity.

The patient's pelvic hematoma remained an unsolved mystery.

Minute by minute, time ticked away!

Chen Cang racked his brains, pondering furiously!

What acute abdominal conditions exist?

His mind functioned like a search engine, continually inserting, analyzing, and repeatedly deducing.

Suddenly, an idea struck Chen Cang, and he quickly said, "Order a color Doppler ultrasound of the upper and lower limb veins!"

Huang Qiuying frowned, "Of the upper and lower limbs? What's the relevance?"

However, a physician from the interventional department, upon hearing Chen Cang's suggestion, couldn't help but twitch an eyebrow!

"Yes, get a Doppler ultrasound done!"

With the interventional physician speaking up, Huang Qiuying no longer resisted.

Gynecology already had ultrasound equipment readily available; the results came fast!

The Doppler ultrasound of the upper and lower limb vessels revealed thrombosis in the right femoral and popliteal veins!

The crowd stared at the results in confusion.

Meanwhile, Chen Cang broke into a sweat, terrified!