My Medical Skills Give Me Experience Points Chapter 1248: 492: The Renowned Doctor's Path of Training—What’s Up with Dr. Du?

It is becoming increasingly clear that this patient suffers from more than just upper gastrointestinal bleeding; there is a strong probability that a second site of hemorrhage exists within the lower gastrointestinal tract.

Furthermore, it is highly likely that this lower gastrointestinal region is the primary source of the bleeding.

When Zhou Can initially examined the patient, he utilized both his Hemostasis Skill and his Level 6 Pathological Diagnosis Skill to identify the stomach as the most likely origin. However, deeper analysis now suggests the presence of multiple bleeding points.

This suggests an oversight in his preliminary diagnosis.

Nevertheless, even this error has provided him with vital insights, allowing him to explore the diagnostic methodologies employed by elite physicians.

Ultimately, his proficiency in hemostasis and pathological diagnosis remains at a developmental stage, with a notable distance between his current abilities and those of the industry's top experts.

Such oversights are an inherent risk for a practitioner at his level.

Regardless, the fact that he could narrow down the source of bleeding based solely on physical exams, patient history, and clinical symptoms is already a remarkable feat.

One must remember, he is still merely a Resident Doctor!

Even as a junior resident, his competence is striking. Provided he continues his dedicated study and clinical practice, his ascent to the pinnacle of the medical field remains inevitable.

He is far more fortunate than those practitioners who, after decades of service, have failed to reach the level of a competent director.

“Understood. I will arrange for the gastric fluid extraction and testing immediately. Dr. Zhou, you have put in a great deal of effort; please, go get something to eat! If any further insights occur to you, do not hesitate to reach out. Given the severity of the situation, I will proceed with the standard protocol and request a consultation from the Digestive Internal Medicine department.”

Ali’s respect and genuine concern for Zhou Can are deeply felt.

As a fellow doctor, she is intimately familiar with the grueling nature of the profession.

The fact that Zhou Can has been operating all morning and is now tackling this diagnosis on an empty stomach speaks volumes of his professional commitment.

Ali’s decision to involve the Digestive Internal Medicine specialists is a tactical move to identify the root cause or, at the very least, mitigate the immediate risks. She is deeply anxious that the patient's condition could spiral into a critical state at any moment.

…

As Zhou Can sat in the cafeteria, he could not stop his mind from racing over the potential origins of the patient’s ailment.

Should the gastric fluid analysis return no signs of blood, it would necessitate a thorough investigation of the lower gastrointestinal tract.

Considering the patient’s high fever and the circulatory shock brought on by massive blood loss, acute hemorrhagic necrotic enteritis has emerged as a major suspect.

During his palpation of the abdomen, Zhou Can noted distinct tenderness beneath the xiphoid process and around the umbilical region.

Acute hemorrhagic necrotic enteritis typically manifests with symptoms such as periumbilical colic, watery, bloody stools, and occasionally the passage of necrotic mucosal tissue, which carries a characteristic, pungent foul odor.

While this patient suffers from gastrointestinal bleeding and periumbilical pain, other critical indicators remain absent.

Consequently, the condition can neither be definitively ruled out nor confirmed.

At best, the likelihood of this diagnosis sits at about 50 percent.

This uncertainty demands closer monitoring and stool analysis.

But if this diagnosis proves incorrect, what else could be the culprit?

In this moment, Zhou Can felt a profound sense of frustration regarding the limits of his own knowledge.

He mentally reviewed every case study he had ever analyzed, along with all relevant data concerning digestive tract pathologies.

In truth, his skills far exceed those of the average medical student, many of whom possess theoretical brilliance but find their minds blank when confronted with real clinical scenarios.

Countless doctors excel in academic evaluations, only to stumble the moment they step into a clinical setting.

Every professional must navigate this arduous transition.

Over time, practical experience transforms theoretical knowledge into clinical wisdom.

Following an internship year, three years of standardized training, and nearly two years working as a resident doctor, Zhou Can has built a significant repertoire of practical experience. He is perfectly capable of applying his training to actual cases.

Suddenly, his mind settled on another possibility that mirrored the patient’s symptoms.

Ulcerative colitis.

This is a nonspecific inflammatory condition of the bowel that usually features a slow, progressive onset.

Given that the patient’s symptoms have persisted for over a month, the timeline matches perfectly.

The location of the lesions is also consistent with the patient’s condition.

The lower gastrointestinal tract encompasses the colon, after all.

Moreover, considering the patient’s anemia remained unresponsive to both hemostatic treatments and a 1000 ml blood transfusion, Zhou Can now strongly suspects bleeding within the small intestine or the upper colon.

Ulcerative colitis consistently presents with diarrhea, abdominal pain, and bloody or purulent stools, often accompanied by weight loss and fever.

The patient exhibits almost every one of these markers, reinforcing this theory.

The slow progression of the disease aligns perfectly with the clinical profile.

Therefore, the suspicion of ulcerative colitis is remarkably strong.

Although Zhou Can has narrowed it down to two potential diseases, he feels little satisfaction.

A physician of the highest caliber constantly expands their diagnostic framework, weighing every conceivable cause.

The more comprehensive the assessment, the better the outcome.

Diagnostic medicine rigorously tests both a physician’s breadth of knowledge and their total clinical experience.

This is why experts tend to specialize; an individual’s finite time and energy make it nearly impossible to master every field simultaneously.

Zhou Can has undergone extensive standardized training in both Digestive Internal Medicine and Digestive Surgery, which has served him well for quite some time.

This background provided him with the opportunity to synthesize more experience in managing digestive illnesses and to deepen his understanding of the associated complexities.

Just then, two additional conditions entered his thoughts.

Colonic diverticulosis, which typically affects the sigmoid colon and cecum, is frequently marked by fever, an elevated white blood cell count, and clear manifestations of peritonitis.