My Medical Skills Give Me Experience Points Chapter 1251: 493: The Gap Between Director and Deputy Director's Skills, Resolving with Angiographic Intervention (2)

Fortunately, the volume of cases within the Cardiothoracic Surgery department has seen a steady uptick, providing him with frequent chances to accrue substantial Experience Points through complex pathological diagnoses.

Zhou Can harbors a suspicion that the patient is suffering from intestinal malignant histiocytosis, though his grasp on the exact diagnosis remains tenuous at best.

He even contemplated recommending a bone marrow analysis for the patient.

Should the condition be intestinal typhoid fever, a marrow culture would likely uncover the truth.

As for a blood culture, since the illness has crossed the four-week threshold and the window for peak bacteremia has closed, the results are almost guaranteed to be negative.

"Right now, we are merely leaning toward a preliminary diagnosis of intestinal typhoid fever. When dealing with such obscure, protracted illnesses, once you rule out malignant neoplasms, you are left with only a dozen or so rare and stubborn conditions—think Crohn’s Disease or ulcerative colitis. However, those ailments usually progress slowly and present with abdominal masses or bowel obstructions, which doesn't fit our patient's profile at all."

"There are cases of acute ulcerative colitis where the severe variety manifests with high fevers and bloody stools. This aligned better with the patient's presentation. She was admitted only today; even if we intended to perform an urgent colonoscopy, intestinal preparation takes time. Given the significant amount of clotted blood remaining in the intestinal cavity, a colonoscopy would be quite difficult and might compromise the accuracy of our findings."

Director Shang approached the diagnosis with extreme caution.

His demeanor indicated that he had largely settled on intestinal typhoid fever, likely complicated by lower gastrointestinal hemorrhaging.

Zhou Can had witnessed the diagnostic logic of a Director-level veteran before, and he felt a deep sense of admiration for it.

Over the subsequent two days, the medical team conducted a battery of follow-up tests.

This included aspirating and monitoring the patient's gastric fluid.

The patient’s fever persisted, fluctuating stubbornly between 37.7°C and 38.9°C.

On the first day, the aspirated gastric fluid was cloudy and pale yellow, containing faint traces of old blood.

By the second day, the fluid had cleared significantly.

At this juncture, an upper gastrointestinal bleed could mostly be ruled out.

The patient’s stools remained black yesterday, confirming that internal bleeding was ongoing.

With the upper tract cleared of suspicion and black stools persisting, it stood to reason that a significant source of hemorrhaging remained in the lower gastrointestinal tract.

Following the bouts of black stool, the patient passed dark-red blood twice this morning.

This matched the observations Zhou Can made during his initial digital examination.

His own gloves had been stained with that same dark-red blood during that first check-up.

The patient’s blood bacterial culture had, as expected, returned negative.

Having moved past the bacteremia peak, that result was perfectly consistent.

The routine bone marrow report also arrived, showing no signs of abnormal histiocytes or immature cells, though the final confirmation awaited the culture results.

By this morning, the patient’s blood pressure had plummeted to 60/42 mmHg, her pulse was thready, and her heart rate sat at roughly 120 beats per minute.

These were dire indicators.

It suggested that the bleeding remained uncontrolled and life-threatening.

Unless the source of the hemorrhage was identified and suppressed immediately, the patient was unlikely to pull through.

Fate dictated that this was Zhou Can’s shift in the emergency department. When the patient slipped into shock once more, the team in the resuscitation room felt they had no choice but to summon him for help.

Upon arriving, Zhou Can immediately performed muscle vein catheterization, finding the central venous pressure to be a dangerously low 0.78 KPA.

The speed of the patient’s decline had been unforeseen.

Despite two days of intensive care and a transfusion of 1000 milliliters of blood, the patient had collapsed into shock again, with blood pressure hitting an alarmingly low point.

Without a clear source of the bleed or an effective means to arrest it, the administration of hypotensive agents would only accelerate her demise.

Zhou Can promptly directed the nurses and staff to expand blood volume and push through transfusions to mitigate the shock; after three bags were administered, they finally managed to stabilize her blood pressure.

"Dr. Zhou, the patient is clearly suffering from active, continuous bleeding—please, you must find a way! I don't believe standard internal medicine approaches to hemostasis are going to work anymore; we likely need a surgical intervention to stop this."

Dr. Ali looked absolutely exhausted after the last forty-eight hours.

She had been deeply distressed by the patient’s decline.

Every physician dreads facing cases that defy standard treatment; as an attending physician with regular capabilities, she felt truly out of her depth with such a complex gastrointestinal hemorrhage.

Watching the patient succumb to shock again, the fifty-year-old doctor was visibly anxious, pacing and wringing her hands.

"Do not panic. We have successfully localized the issue to the lower gastrointestinal tract. The dark red blood in the stool indicates the bleed is likely originating from the ileum or the colon. Unfortunately, her current state makes a barium swallow impossible, and a colonoscopy is equally unfeasible. Even an exploratory laparotomy requires us to map the bleeding site beforehand to be effective."

Zhou Can possessed the depth of experience required to handle such harrowing clinical scenarios.

"If tests aren't an option and we cannot locate the bleed while it continues to ravage her, what on earth can we do?" Ali’s expression was etched with desperation.

Average doctors often reach their limit when faced with such elusive and critical problems.

"Performing abdominal angiography could be our best avenue. While radiological intervention carries its own risks, it is incredibly effective at pinpointing the source of an obscure digestive hemorrhage. We must weigh the pros and cons; to save her life, I believe the risks associated with an abdominal angiography are unavoidable. However, the timing is everything—the procedure must be captured precisely while the patient is actively bleeding."