Chapter 1458: Xu Yino Offers Advice and Strategies

Chapter 1458: Chapter 1458: Xu Yino Offers Advice and Strategies

(Thanks to Chimei Wangli Di Yu Xing, Shizhong de Shashi, Yao Wenrou Gen Wo Shuo, Chiwen/Chiwei, Shuyou20170818155926615, lu Tiezhu, davy_7191, songying_sy, Lang Ru Tie83, Shuyou20191104170717352, Shuyou75185340 for the monthly ticket support)

"Director Chen, how is the situation, can we keep it under control in our ward?"

Liu Banxia asked.

Chen Hongyang nodded. "For the moment it’s still okay. It’s just showing early signs of organ failure, we don’t need to send him to ICU yet. But we can’t wait anymore. First draw blood, do a blood smear, and while we’re at it check thyroid function."

"Then do a lymphocyte differentiation antigen test, see if there’s anything else we need to add. Director Liu, you give the child a detailed physical exam."

"Okay."

Liu Banxia didn’t hesitate at all and directly started examining the child.

The child’s parents stood to the side at a loss, only knowing that their child’s illness seemed to have worsened again. But what exactly was going on, they had absolutely no idea.

Let alone them—even Liu Banxia and this whole group of professionals were a bit stunned right now.

At the moment, Liu Banxia’s physical exam was mainly to check whether the child’s lymph nodes were enlarged.

From the discussion just now, everyone tended to think the child’s current condition was caused by the endocrine system, with the lymphatic system as the first suspect. If thyroid function was ruled out, they would have to start considering other parts of the endocrine system.

The reason the lymphatic system was the first choice was because the child’s symptoms were progressing too fast. If there was a problem in the lymphatic system, it could destroy the body’s immunity in a very short time.

Even more frightening, it could be a primary disease of the lymphatic system, which could also affect the central nervous system.

On top of that, the lymphatic system and the endocrine system are entangled with each other.

Many endocrine organs don’t have their own ducts; they can only rely on circulation through the lymphatic system and blood circulation to be delivered to target organs or target cells.

So whenever we encounter painless lymph nodes, it always draws extra attention from doctors. It’s simply because that situation is too dangerous and often brings you unwanted "surprises."

Liu Banxia’s tactile sense is more sensitive, so having him examine the child would yield better results.

After carefully checking, Liu Banxia shook his head. He hadn’t found any signs of enlarged lymph nodes in the child.

Ding! Task issued: A young patient with rapidly worsening condition

Open-ended task: The young patient was admitted with abdominal pain and bloody stool. During the etiological workup, he suddenly developed hepatic and renal failure. The host needs to further diagnose and clarify the condition. Task reward: to be granted based on diagnostic result.

"Director Chen, what exactly is going on? Are the liver and kidneys ruined?" the child’s mother asked at this moment.

"We just saw from the child’s morning blood test that the liver and kidneys have been affected to some extent, so we need to intervene early and continue to look for the cause," Chen Hongyang said.

"Judging from the current situation, we’re more inclined to believe it’s some problem in the endocrine system that’s causing these effects. But the endocrine system is relatively complex, and there are many subsystems. For now we can only rule them out one by one."

"Try to think back carefully: before the diarrhea started, did the child say anything about feeling unwell anywhere? And in his walking or movements, were there any difficulties?"

The couple looked at each other and shook their heads.

It wasn’t that they didn’t want to say; they really hadn’t noticed anything, and the teacher hadn’t reported any abnormalities about the child at school either.

"For now we’ll first adjust treatment to protect the liver and kidneys, and then see what the latest test results show," Chen Hongyang said.

"Doctor, is it very dangerous?" the child’s father asked.

"If we still haven’t found the cause, we’ll convene a multidisciplinary case conference," Chen Hongyang said.

There was certainly danger, but right now Chen Hongyang didn’t want to "scare" this pair of parents. Moreover, the child’s hepatic and renal failure were only early manifestations for now; it still depended on what the subsequent test results would show.

"The situation is getting quite serious. What ideas do you all have?" After returning to the small meeting room, Chen Hongyang asked.

"There’s no other way, we can only wait for the diagnostic results. If it really doesn’t work, we can only do a lumbar puncture to look at cerebrospinal fluid, and then a bone marrow aspiration," Peng Bo said.

"But we have to be very cautious with those two tests—he’s still just a little kid. However you look at him, he doesn’t seem like leukemia. Even if it were leukemia, the symptoms wouldn’t present like this. Director Liu, what were the liver and spleen like on palpation?"

"They felt normal in both size and shape. Do we need to add an abdominal CT?" Liu Banxia looked toward Wang Huan.

"Basically, if you felt them as normal, we don’t need it for now," Wang Huan said.

"The child’s condition is rather urgent now, and his parents are getting anxious. We need to make a diagnosis before their patience runs out."

"Do you think the current liver and kidney findings might be related to the medications we used?" Liu Banxia asked.

"The child’s body is in poor condition now, so even though we used doses within the safe range, his metabolism has gone wrong, which led to the decline in liver and kidney function indices?"

"That’s a new line of thought, but we can only see what happens after we adjust the treatment," Chen Hongyang said.

"The child is suffering; from here on there’ll be a whole string of tests. Actually I wanted to ask him a few more questions just now, but his general condition was too poor—much worse than when he came in yesterday."

"What about the child’s ESR?" Wang Huan asked.

ESR is also a very important parameter, referring to the erythrocyte sedimentation rate.

Under normal circumstances, red blood cells settle slowly. Under certain pathological conditions, the sedimentation rate can become significantly faster. Of course, this is also the result of multiple factors acting together.

Chen Hongyang shook his head. "Compared with yesterday there have been some changes, but it’s still within the normal range. The increase now may be related to the changes in his liver and kidney function, but it hasn’t exceeded the upper limit."

Everyone nodded. This was probably also the reason why Chen Hongyang insisted on staying in the ward. Otherwise, if the ESR suddenly shot up, they might have to send him to the ICU.

"Sigh..."

Chen Hongyang let out a sigh.

It’s not that there are no other tests available—on the contrary, there are still plenty of examinations they can do.

It’s just that this is a young patient. If they really arranged all those tests, not to mention the child’s parents, even he himself would feel it’s over the top.

Even when you’re ruling things out, the tests have to be targeted, with a purpose. You can’t just fish randomly like searching for a needle in a haystack; that won’t do.

"Let’s do this: we’ll use ultrasound to scan the child’s abdominal cavity again and take a close look at the liver and kidneys," Liu Banxia said.

"Okay. It’ll take a while for the test results to come back. I’ll set it up first, and when the results are out I’ll call you," Chen Hongyang said.

"I think if we still can’t make a clear diagnosis for the child by this morning, then we’ll need to call in the inpatient departments for a multidisciplinary consultation."

"Agreed."

Liu Banxia answered without even thinking.

The child’s current presentation was too tricky; this wasn’t the time to show off. The child’s condition had to come first.

The current liver and kidney dysfunction may be due to the effects of medication, or it may be a manifestation of the progression of the underlying disease. If it’s the latter, then the child’s situation is truly dangerous.

Delaying even three to five hours could end up threatening the child’s life.

"You don’t have any leaning one way or the other in your mind?"

After they walked out of the small meeting room, Wang Huan asked.

"Brother Huan, honestly I don’t," Liu Banxia said with a bitter smile.

"The known information we have in front of us right now is really very limited. The child’s parents don’t know much about his prior condition, and with the child like this it’s also hard to provide any useful information."

"When we’re diagnosing, we actually also need some information from the patient as a basis for judgment. If you ask whether I have a leaning, well, I do."

"I think it might be lymphoma, leading to gastrointestinal bleeding and liver and kidney failure, while also affecting the brain’s base structures and thereby involving the child’s central nervous system."

"I’m guessing what you all have in mind is roughly the same. Let’s still wait and see the test results later. If the upcoming tests are all negative, I’ll be at a total loss too."

Wang Huan nodded. That was also the judgment forming in his mind.

It’s just that his confidence wasn’t that strong, especially after the physical exam Liu Banxia had done.

If it were lymphoma, there would usually be some response somewhere in the body’s lymphatic system. In the areas where lymph nodes aggregate, there are often masses.

With the sort of palpation Banxia had just done, he hadn’t felt anything, which made this possibility much smaller.

Liu Banxia felt a slight headache coming on.

One patient was his own, and the other was a consult. If both of these patients really developed toward the worst-case scenario, it would be a real nightmare.

Especially this little kid—so far all the test results were murky and confusing.

That patient suspected of having cholangiocarcinoma at least had a direction to pursue. With this young patient they didn’t even have a direction, and could only rule things out blindly.

"Teacher Liu, how’s it going?"

When Liu Banxia came back, Xu Yino hurried over.

"You’ve heard too? There’s still no result yet. Let’s wait and see what the latest tests look like," Liu Banxia said.

"We supplemented the blood work, and we’re also doing an abdominal ultrasound. This ultrasound will be very detailed, and it’ll take some time. It’s worrying. Since you know the situation too, do you have any suggestions?"

"Teacher Liu, did the child have any other symptoms before this?" Xu Yino asked.

Liu Banxia shook his head. "My shaking my head doesn’t mean there weren’t any—it means I don’t know. The child can’t express himself, and the parents never noticed."

"What about the teachers and classmates at school? What about the grandparents? Are the child’s parents the ones who always drop off and pick up the child?" Xu Yino continued to ask.

Liu Banxia was taken aback. Right, these days, in many families the ones in charge of dropping off and picking up the kids are the grandparents.

"Good point. I’ll go ask them."

Leaving that line behind, Liu Banxia turned and ran back.