Chapter 253 - 201: Are You Trying to Usurp the Throne, Wu Ting?

Chapter 253: Chapter 201: Are You Trying to Usurp the Throne, Wu Ting?

Of course, it wasn’t that Wu Ting looked down on Cai Qi. Director Cai was already considered quite diligent and hardworking at City First Hospital.

He was simply saddened by the imbalance in medical resources and the vast gap between City First Hospital and Jinggang University Affiliated First Hospital.

Under Wu Ting’s gaze, Director Cai’s heart skipped a beat. He grew uneasy. In Wu Ting’s eyes, he thought he saw... disappointment?

This gave Director Cai an inexplicable sense of defeat. He asked softly, "Dr. Wu, was there something wrong with my judgment?"

As they spoke, the group returned to the conference room.

"Director Cai’s judgment is indeed correct for a typical case of hepatic encephalopathy. However, when ruling out certain conditions, your approach lacked a bit of comprehensiveness and a systematic framework."

Having collaborated frequently with the top experts from Haijin Port, Wu Ting had acquired quite a few top-tier "entries," giving him a completely new understanding of the diagnosis and treatment of many diseases.

His diagnostic skills, in particular, were now built on a comprehensive and systematic framework.

He decided to take this opportunity to teach and enlighten Director Cai, Director Qin, and the others.

A single flower in bloom doesn’t make a spring, but a hundred flowers in full bloom fill the garden.

Since Wu Ting had decided to establish himself at City First Hospital, what he needed to do from now on was to subtly and constantly elevate the habits, awareness, and perspectives of the entire medical staff at the hospital.

Wu Ting was genuinely speaking from the heart as he began his explanation, but in the eyes of the other doctors from City First Hospital, it was perceived quite differently!

Lu Xuejun and Yasui stared at Wu Ting, their eyes shining with admiration.

"Director Cai, the reason for my judgment is mainly the patient’s long-term liver cirrhosis, with existing symptoms like electrolyte imbalance and constipation. Of course, these symptoms are very similar to alcohol withdrawal syndrome..."

"But, did you notice the patient’s ascites, and the fact that his spleen felt enlarged on palpation?"

"As for you thinking that normal transaminase levels mean there’s no liver pathology—in the progression of chronic liver disease, liver function indicators don’t always remain elevated. Transaminase levels only rise when factors like viral co-infections or other infections damage hepatocytes, increasing the permeability of their cell membranes and releasing cytoplasmic alanine transaminase and aspartate transaminase into the bloodstream..."

"This patient is clearly in a cyclical phase of slight elevation. Look at this liver function panel, then look at his follow-up results from a month ago, and the results from the month before that..."

Watching Wu Ting make a complex yet sensitive judgment by synthesizing palpation findings, previous biochemical results, ascites, and various imaging data, Director Cai and the other department heads were stunned.

"We don’t have much experience treating hepatic encephalopathy here at City First Hospital, so we have an insufficient understanding of its atypical symptoms. Our diagnostic thinking is limited, and we didn’t analyze the condition comprehensively... Jumping to conclusions makes it easy to overlook pathogenic factors other than cerebrovascular disease. And when performing differential diagnosis, being too narrow-minded can easily lead to a misdiagnosis..."

Under the influence of his "Director Fu’s Hepatic Encephalopathy Diagnosis and Treatment Technique (Purple)" entry, Wu Ting found himself speaking from a place of deep insight.

Listening to Wu Ting’s analysis, Cai Qi and the others were truly speechless, filled with nothing but shame and profound admiration.

"Furthermore, Director Cai, you only ordered a CT and an ultrasound. Given the liver cirrhosis and palpation findings, you should have ordered an MRI. Similarly, for the head diagnosis, if it only shows brain atrophy, which isn’t very specific, you should add an MRI for that as well..."

Following Wu Ting’s guidance, the additional imaging scans that had been ordered were delivered.

Director Cai took them and began to look them over.

"...Symmetrical high signal intensity on T2 and FLAIR images with a short T1 signal, visible in the globus pallidus, substantia nigra, the area around the red nucleus, and the brainstem..."

"Cerebral infarction is ruled out. It really is atypical hepatic encephalopathy..."

Faced with this diagnostic result, Director Cai had to concede.

Moreover, now that they had a definitive conclusion, they could work backward. The patient’s symptoms—low blood volume, constipation, infection, ascites, fetor hepaticus, asterixis, and abnormal behavior—all matched perfectly!

While Director Cai was thoroughly convinced, Lu Xuejun, an attending physician in hepatobiliary surgery, also felt deeply that Wu Ting was the one who truly had the makings of a great director!

With the diagnosis confirmed, the subsequent treatment was straightforward.

Wu Ting didn’t give Director Cai a chance for trial and error, directly issuing orders in an authoritative manner:

"...Cooling cap to lower intracranial temperature, mannitol to prevent cerebral edema, symptomatic treatment to correct water-electrolyte and acid-base imbalances. Also, restrict protein intake, control the infection, and administer oral lactulose and an IV drip of L-ornithine L-aspartate. Give an enema with 200 mL of 10% vinegar once or twice daily to lower blood ammonia levels..."

"Right away, Dr. Wu."

As the doctors responsible for carrying out the orders, Yasui and Lu Xuejun agreed crisply and immediately, completely ignoring Cai Qi, the director of hepatobiliary surgery.

Cai Qi blinked. He saw the eager attitude of his own right-hand man, Lu Xuejun, the worshipful gaze, the swift execution.

’Am I... about to be pushed aside and replaced?’ he thought.

’Are you planning a coup, Wu Ting?’

Cai Qi felt a slight pang of bitterness but quickly consoled himself. ’It’s not that serious, not at all!’

Wu Ting was just a chief resident; he was still a long way from becoming a director.

Then, thinking about Wu Ting’s treatment plan, Cai Qi’s mood brightened.

Getting to learn Wu Ting’s treatment plan wasn’t a loss at all!

The next time he encountered a similar situation, he, the great Director Cai, could also speak with confidence and eloquence.