Chapter 851 - 399: The Real Rumormonger Revealed, Advanced Cardiac Medication (2)

Chapter 851: Chapter 399: The Real Rumormonger Revealed, Advanced Cardiac Medication (2)

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In the afternoon, Li Jingsheng and the doctors at Sunshine Clinic were so busy they could barely keep up.

The number of patients coming for consultations was clearly higher than before.

After asking around, they found out that some patients had been influenced by the reversal of public opinion online. They felt Sunshine Clinic and Li Jingsheng were trustworthy, so they specially took taxis or drove themselves over for treatment.

There were also people who wanted to encourage and comfort him in person, telling him to keep his original intentions, do his job well,

and not worry about anything else.

Never underestimate the power of the internet. Besides keyboard warriors, there are also many people online who truly have real skills.

They might not be high-ranking officials, but they have a certain influence in society, or hold important positions in some institutions.

The power these people have when they come together is extremely formidable.

With their support, Sunshine Clinic was now immune to all attacks, as solid as a rock.

They stayed busy until after seven in the evening before finally finishing with all the patients.

Li Jingsheng stood up and let out a long breath.

When the clinic’s business was poor before, he’d been hoping from the bottom of his heart that more patients would come.

Now that the clinic was booming, they simply couldn’t handle the volume.

On top of that, he was injured.

Seeing these patients was entirely because of the responsibility on his shoulders.

It had purely turned into just a job.

These people came all this way, bringing their illnesses and pain, full of hope for health and for life. He couldn’t possibly let them make the trip for nothing.

"Dear, hurry and wash your hands and eat! Otherwise the food will get cold."

Ou Qinglan had bought food from the hospital and brought it to the clinic.

Having such a considerate girlfriend looking after him made Li Jingsheng feel especially happy.

Sometimes heaven really is quite fair.

When he was down and out, his ex-girlfriend left him, leaving him alone with his sorrow. Now, heaven had sent him an angel.

Not only was she beautiful, a rich and pretty white-collar type, but she also treated him especially well.

After eating, Li Jingsheng still had plenty of things to do.

He had to review the clinic’s accounts and also check over the cases treated that day. If there were any problems, they needed to be corrected and remedied in time.

Just then, his phone rang.

It was a call from Lian Tao.

If that difficult case wasn’t figured out, Lian Tao probably wouldn’t be able to rest easy.

This kind of perseverance was something well worth learning from for Li Jingsheng.

"Jingsheng, this afternoon I had the patient undergo biochemical tests for renal function and liver function. The results show mild nephritis, and ALT is significantly elevated, more than double the normal value. You might have hit the nail on the head again. It’s very likely the patient really does have a liver disease."

Lian Tao was calling specifically to report the test results.

This morning that patient had developed a pulmonary embolism, which made Lian Tao admire Li Jingsheng to no end.

"The mild nephritis might have developed only after the body started to retain fluid. Judging from the test results, the primary lesion in this patient is very likely actually in the liver."

In fact, Li Jingsheng had already had this hunch.

Because through reasoning and differential diagnosis, he felt the likelihood of a primary kidney problem was very small.

If it really had been a kidney problem that led to cardiac changes, which then led to lung lesions and respiratory failure, and this had gone on for seven years, unless the patient’s kidneys were made of iron, how could they still be functioning now?

Just thinking about it made it clear that was impossible.

Without exaggeration, the course of chronic nephritis can indeed last more than ten years in some cases, even longer, before finally progressing to renal failure and uremia.

But nephritis severe enough to cause cardiac changes is never going to be all that "mild."

So back then he had already suspected the lesion might be in the liver.

With the diagnosis of this patient’s illness at this point, the condition was gradually becoming clearer.

What kind of liver disease can drag on for seven years?

The liver is known as the most silent organ, the most tolerant organ, simply because it has no pain sensation.

More precisely, the inside of the liver has no pain sensation.

The normal liver parenchyma has no pain nerves; only the liver capsule has pain nerves.

So when the liver becomes diseased, we often don’t have any obvious symptoms.

But doctors can make some diagnoses by observing the patient’s skin color and sclera.

If there is scleral icterus, then liver-related investigations must be carried out.

This was exactly what made this patient so strange.

On physical examination, doctors hadn’t found any jaundice of the skin or sclera, nor obvious features like liver palms.

Also, the patient’s chest X-ray and chest CT had not revealed any liver lesions.

At this point they could basically narrow things down to a relatively small diagnostic range.

Liver disease with a course of more than seven years must be chronic.

And it also had to be a liver disease capable of causing heart failure.

The patient’s ALT had doubled on biochemical testing.

It looked very serious, but given the characteristics of the liver, this might only reflect mild liver damage.

The transaminase content in the liver is about 100 times that in the blood.

If all the enzymes released remain active, then just 1% of hepatocytes undergoing necrosis can double the serum enzyme activity.

This is why once doctors see ALT or AST levels rise, they immediately zero in on the liver and conclude that it’s very likely diseased.

"Brother Lian Tao, if this patient does have a liver problem, do you think it could be hepatopulmonary syndrome?"

Usually hepatopulmonary syndrome appears only when liver disease has reached an advanced stage.

Once it develops, there will be problems such as arterial hypoxemia and portal hypertension.

The symptoms of hepatopulmonary syndrome include dyspnea, cyanosis, gastrointestinal bleeding, and so on.

This patient did have dyspnea and cyanotic skin, so some of the symptoms matched.

"I personally examined the patient and didn’t find liver palms, jaundice, or these obvious signs, so it shouldn’t be hepatopulmonary syndrome."

Lian Tao denied it.

"Why don’t you come over, then? I have a gut feeling that once you’re here, we’ll definitely crack this case." Lian Tao invited him.

"I’m just afraid my boss at home won’t agree! Let me report to her first."

Having brought the diagnosis of this case to this point, with just a little left to go, Li Jingsheng also wanted to help find the cause.

As long as a case this extremely difficult was successfully diagnosed, he would definitely be rewarded with a huge amount of Life Points.

At the very least he could get a hundred points.

There were several medical skills he urgently wanted to upgrade. To improve them quickly, earning these big chunks of Life Points was the fastest way.

"Bro, you’ve got ’tracheitis’ already even before getting married? Just bring her along. Later I’ll treat you and your future sister-in-law to a late-night snack. Maybe then she won’t stop you from running over here to help me."

Lian Tao really knew how to make plans.

"She probably won’t come. She’s like me, kind of a homebody. Oh right, is the patient still on diuretics?"

"No, we stopped them. Why? Don’t tell me there’s danger even without them!"

Lian Tao really was a bit scared.

"Heh, not in this case. Given the patient’s current condition, the only concern about stopping diuretics is the heart. Haven’t you already used oxygen therapy and measures to improve alveolar ventilation? How’s that working?"

"So-so! Anyway, the vital signs are still relatively stable for now."

"Are you using vasodilators?"

"Of course, we started those long ago."

"You must also be using drugs to reduce blood viscosity and for anticoagulation, right?"

"Definitely."

Since all these treatments were in use, it meant things weren’t too bad.

"Have you added phentolamine, strophanthin, isosorbide dinitrate and the like?"

Originally, Li Jingsheng hadn’t wanted to show off, but in the end he still decided to ask.

"Your prescribing skills have improved a lot again, huh! These additional medications were all suggested by Director Rong from critical care. I didn’t expect your medication regimen to be almost on par with his."

"You really overestimate me. This regimen was taught to me by the director of cardiothoracic surgery at our Second Hospital. His prescribing skills are brilliant; I don’t think he’s any worse than Director Rong. I mean in terms of cardiac medications!"

Director Zhang’s surgical skills were decent, but not exactly top tier.

But when it came to cardiac medications, he was insanely good.

He had taught all of it to Li Jingsheng.

This was why, when treating patients with the kind of cardiac changes they were dealing with now, his prescribing level was extremely high.

"For oxygen, you’re using low-flow oxygen, right?"

"Not at first. Later, Director Rong corrected us."

Back when the patient developed pulmonary embolism and needed resuscitation, everyone was doing whatever they could to save him. Since they weren’t all cardiac specialists, it was hard to fine-tune some treatment protocols precisely.