Chapter 902 - 443: No Doubt It’s Intestinal Obstruction, Secured Another Channel

Chapter 902: Chapter 443: No Doubt It’s Intestinal Obstruction, Secured Another Channel

No bowel sounds were heard for about three minutes.

Li Jingsheng tapped the patient’s abdomen with his fingers.

Continued auscultation.

In cases where bowel sounds cannot be heard, experienced doctors will flick or pat the patient’s abdomen. This is to stimulate the patient’s intestinal motility.

Listened for another minute, still not hearing any sounds.

This is definitely abnormal.

The patient appeared to be in a normal mental state, with a natural expression, just a significantly distended abdomen.

This is because the patient naturally has a large beer belly.

Pressing the abdomen with a hand, one can feel the thick abdominal fat.

No matter how thick the abdominal fat layer is, it cannot completely block the transmission of bowel sounds.

This indicates the patient has symptoms of absence of bowel sounds.

Additionally, the patient also reports abdominal distension, causing Li Jingsheng to first suspect bowel obstruction.

However, with typical bowel obstruction, bowel sounds become very active, exceeding ten times a minute. Moreover, they are loud, high-pitched, and sometimes even sound metallic.

This is usually a mechanical bowel obstruction.

The patient’s bowel sounds have completely disappeared, and with abdominal distension, just these two points cannot diagnose bowel obstruction.

The patient’s bowel movements are fairly normal, suggesting that the intestines have remained clear.

"When did you last have a bowel movement?"

Li Jingsheng asked the patient.

"This morning! I usually go to the bathroom after getting up every morning."

The patient’s answer seems to remind the doctors again that his intestine is unobstructed, with no bowel obstruction.

So what could the issue be?

There are many reasons that can cause a reduction or absence of bowel sounds.

It is currently impossible to confirm the patient’s bowel sounds have completely disappeared. Perhaps there is merely a reduction and weakening of bowel sounds.

Some similar patients might take several minutes to hear a bowel sound once.

If bowel sounds are reduced, the most common diseases are constipation, peritonitis, hypokalemia, and so on.

Weakening of gastrointestinal motility can also cause reduced bowel sounds.

If bowel sounds have completely disappeared, there are even more possible diseases.

Electrolyte imbalance, acute peritonitis, and paralytic bowel obstruction, etc. If major abdominal surgery has been performed, bowel sounds disappearance may also occur.

No matter which situation, it is not a good thing.

"Is the body temperature normal?"

Li Jingsheng decided to start from the simplest place.

If peritonitis exists, the body temperature will certainly rise.

"The body temperature is normal."

This was answered by one of the young female doctors.

Looking at her youthful face, she likely just started her internship at the hospital not long ago.

"Have there been any symptoms like vomiting?"

This time, Li Jingsheng asked the patient.

Bowel obstruction can occur at any part.

If it occurs at a high level, such as the jejunum or duodenum, then the patient will have a distinct vomiting response.

This is also a form of self-protection by the body.

The vomitus in bowel obstruction can help professional doctors determine the approximate location of the obstruction.

If the vomitus is gastric content, it can be roughly determined as high bowel obstruction, in places like the jejunum and duodenum.

If it’s lower bowel obstruction, the initial vomitus is also gastric content.

Later, the vomitus becomes intestinal content.

Once food enters the intestines, it ferments.

Vomiting ileum content is distinctly different from gastric content. The smell is also very pungent. You can imagine, feces-like, naturally very disgusting.

"No."

The patient and family answered in unison.

This made Li Jingsheng, who was preparing to follow this clue, begin to deny bowel obstruction as the cause.

Li Jingsheng picked up the patient’s abdominal CT scan to review.

This time there was a useful discovery.

The patient’s cecum in the intestines showed intestinal dilation, not very serious.

Additionally, a mural thickening in the ileum segment was detected.

However, no intestinal inflation problems appeared.

After bowel obstruction occurs, because the contents cannot pass, it causes the bowel to stretch, which is the reason for intestinal dilation.

Many people who have abdominal CT seen intestinal dilation do not understand why.

Most intestinal dilations are associated with tumors, bowel obstruction.

This patient simultaneously showed intestinal dilation and mural thickening, and now bowel sounds cannot be heard, Li Jingsheng naturally has the reason to suspect the patient might have bowel obstruction.

There are many causes for mural thickening.

The most common is after bowel obstruction occurs, intraluminal pressure increases, causing edema in the bowel wall.

So during imaging examination, mural thickening is apparent.

After bowel obstruction occurs, because the gases produced by fermentation cannot be expelled, it accumulates inside the bowel, causing inflation. The entire bowel appears particularly full.

Typically, if there is intestinal dilation, intestinal inflation, mural thickening, then it’s basically diagnosable as bowel obstruction.

The specific location can be determined through imaging examination.

Li Jingsheng quickly screened the patient’s causes in his mind.

The causes of disappearance of bowel sounds are too numerous. Bowel perforation, vascular embolism can also lead to disappearance of bowel sounds.

However, the symptoms of these causes are obvious, and the patient does not have these symptoms, so they can be mostly ruled out.

Just as Li Jingsheng was about to discuss with Xiao Linlin, he unexpectedly heard the sound of the patient’s bowel.

It was very weak, but he was sure it was bowel sounds.

It indicated that bowel sounds hadn’t completely disappeared.

Although the patient had a bowel movement in the morning, if the site of intestinal obstruction is relatively high, then feces from the intestines below the obstruction can still be passed out.

"Director Xiao, I suspect there’s a high possibility of intestinal obstruction in the patient."

Li Jingsheng and Xiao Linlin had a good relationship, so he could speak directly.

"I’m also a bit suspicious of intestinal obstruction. What’s strange is that he doesn’t have any vomiting symptoms, and he could eat and defecate normally at noon, so we can’t diagnose it."

Xiao Linlin is a very cautious practitioner.

With such cases of uncertainty, she usually chooses to have the patient hospitalized for observation.

This is generally a kind of ’occupational disease’ for internists.

Internists focus more on logic and tend to resolve illnesses gently.

Few qualified internists pursue a single dose to directly solve the illness. Most often, they’ll first try some medication; if it’s effective, they’ll continue using it.

If the effect is poor, they’ll quickly adjust or re-examine the cause for a new diagnosis.

Internists’ work involves constant exploration, seeking the truth of illnesses.

This includes pathological mechanisms, causes, etc.

"How about letting him stay in the hospital for observation again? I estimate he’ll show new symptoms by tonight at most."

Li Jingsheng is almost certain it’s an intestinal obstruction.

It’s just that it happened recently, and the condition is progressing slowly.

If it were an acute intestinal obstruction, the patient would already be in severe pain and vomiting, busy without any respite. Right now, this patient looks calm and relaxed, as if there’s nothing wrong.

In this situation, sending the patient to surgery would likely lead to opposition from the family.

After instructing the attending doctor, Xiao Linlin left the ward with Li Jingsheng.

"You must have something to discuss with me, right? Just go ahead."

Xiao Linlin understood him well.

Almost all the doctors who had a good relationship with Li Jingsheng understood him. If there’s nothing up, they rarely contact him.

At most, they like or comment on his social media posts.

Usually, they only reach out when there’s something going on.

He can’t help it; he’s just too busy for casual chats.

The few breaks he has, he uses to address his personal life, spending time with his girlfriend and nurturing their relationship.

"Let’s talk in your office!"

Once inside the office, Li Jingsheng said, "I’ve assembled a medical team specializing in higher-level colonoscopy services. Patients prioritize safety and precision, and my team can provide this service. We can take on patients whose intestinal condition isn’t ideal, where ordinary doctors consider the risk of colonoscopy too high, or the difficulty too great. If you come across such patients, you can refer them to me."

A successful referral won’t bring huge benefits, but at least a cup of milk tea is guaranteed.

The risk is entirely my own; you won’t bear any risk."

Briefly explaining his intention.

"Oh, not bad! You’ve finally decided to go solo? With your skills, as soon as this path clears, the prospects are limitless."

She smiled as she poured Li Jingsheng a cup of tea.

"I have no issues at all. After all, I’m your sister. Let’s skip the milk tea money; anyway, my department can’t handle those patients either. No good stuff should go to waste; directly recommending them to you is fine."

In this network of relationships, having extensive connections really makes a difference.

Li Jingsheng just gave a simple request, and she agreed without a thought.

Now, imagine anyone else trying to discuss such business!

They probably wouldn’t even get through the door.

Just look at those pharmaceutical reps and salespeople; getting into the department director’s office isn’t commonly easy.

"Sister Xiao is always so good to me! I knew you’d agree to help me! Thanks in advance!"

Li Jingsheng was delighted to have so easily reached an agreement.

"No need for thanks! It’s unnecessary!" She said somewhat reproachfully. "By the way, let me mention, you should discuss this with the dean. After all, you’re a renowned physician at our Second Hospital, and a key development target. Every word and action is closely connected with the Second Hospital."

"I’ve already discussed it with the dean; if the main dean didn’t agree, I wouldn’t dare proceed!"

Li Jingsheng replied with a smile.

"Haha, seems I worried too much. You’re always reliable and mature in your work. If there’s nothing else, go get busy! I’ll recommend any suitable patients to you."

Xiao Linlin was somewhat curious about the medical team Li Jingsheng had formed.

She wasn’t aware that Li Jingsheng’s endoscopy skills had greatly improved.

"Thank you, Sister Xiao! Oh, there’s one more thing. I don’t have the venue to perform colonoscopy right now. When I get business, I usually borrow venues from People’s Hospital. But bringing patients from here to People’s Hospital always feels somewhat disloyal to Second Hospital.

You also mentioned earlier, no good stuff should go to waste.

Could we sign an agreement with your gastroenterology department where each time we borrow your endoscopy room, we pay a fee?

If we find any problems with the patient’s intestines needing surgery, we can directly refer them to the General Surgery or relevant departments at Second Hospital."

Li Jingsheng feels a strong sense of belonging to Second Hospital.

The fact that he has come this far, he is forever grateful to Second Hospital.

Now that he has some capability, naturally, he cannot forget his roots.

"Did you sign a similar agreement with People’s Hospital?"

"Not signed yet, planning to sign one. I won’t hide it from you; People’s Hospital has already agreed." Li Jingsheng replied honestly.

"You really have it; People’s Hospital is a top-tier hospital in Jiangli City! They actually agreed to sign such an agreement with you, showing that you’re extraordinarily capable. I have no issues, but I need to consult with the dean, and then I’ll give you an answer."

When she heard that People’s Hospital’s gastroenterology department actually agreed to sign this service agreement with Li Jingsheng, she was quite shocked.

She was secretly impressed by Li Jingsheng’s abilities.

Though she is the gastroenterology director at Second Hospital, walking into People’s Hospital, she wouldn’t be seen as anything significant.

No one would care about her.

After successfully negotiating, Li Jingsheng walked out from Second Hospital, filled with ambition.

He had secured another advanced business channel.

Director Xiao was going to consult the hospital leadership; there was likely to be no problem.

Dean Fu had already agreed, and Vice Dean Jin’s nephew was Li Jingsheng’s student, making it even less likely for Vice Dean Jin to obstruct Li Jingsheng’s development.