The Enhanced Doctor-Chapter 605 Unexplained spleen enlargement

Thanks to Ren Yijie for the generous reward of 10,000 coins, davy_7191 for the encouragement, and to all book friends for their inspiring monthly votes.

"What’s the situation?" Liu Banxia asked, following Wei Yuan.

"I had a patient today, a 32-year-old woman," Wei Yuan said. "Her chief complaint is that she often kicks things when walking and frequently drops items she’s holding."

"This time, she fell and got a laceration on her palm. I performed a preliminary examination, and everything was normal. I even tested the nerves and tendons in her hands and feet; all normal."

"So, I only performed a standard suture. However, she insisted she was ill, suspecting a neurological disease. Therefore, I ordered a routine blood test and a blood chemistry panel for her."

"The results were all normal, except for her hemoglobin, which was 103 g/L, indicating slight anemia."

"I discussed this with the patient, and she confirmed she has had issues with anemia. However, it’s usually manageable as long as she maintains a good diet."

"To reassure her, I conducted another physical examination, more thorough this time. I found her spleen to be slightly enlarged, which was confirmed with an abdominal CT scan."

"Now, I’m starting to think the patient’s suspicions might be correct. However, there are many potential causes for an enlarged spleen, and the current blood test results can rule out many of them. That’s why I thought of you; I wanted you to take a look."

Liu Banxia furrowed his brow. Indeed, there were far too many causes for splenomegaly.

For instance, cellular infiltration from various inflammatory cells, leukemia cells, or tumor cells.

That’s why many leukemia and cancer patients exhibit an enlarged spleen. Didn’t the previous patient with infiltrative pancreatitis also have an enlarged spleen?

Then there were conditions related to the spleen itself, like congestion, histiocytosis, fibrosis, and so on. The list seemed endless.

The patient’s current blood tests and chemistry panel were normal, except for the slight anemia.

According to the patient, as long as she ate well, her blood count would improve.

Anemia itself has many causes: iron deficiency, hematopoietic disorders, severe underlying diseases, and more.

This patient had slight anemia, and being a woman, it could even be related to her menstrual cycle. Although it was a symptom, its relevance was still uncertain.

With so many uncertainties, it was genuinely difficult for him to reach an immediate conclusion.

Arriving at the bedside, Liu Banxia saw the patient lying there, eating fruit. Her spirits seemed quite good. Usually, patients who know something is abnormal with their bodies are very anxious.

"Doctor, I should be replenishing some nutrients, right?" the patient asked when she saw them.

"Indeed, some extra vitamins wouldn’t hurt. This is Dr. Liu, our Chief Resident at the Emergency Center. I’ve invited him for a consultation on your case," Wei Yuan said.

"I told them I was sick and it wasn’t just me being clumsy, but they didn’t believe me," the patient said with a laugh.

"You have a great attitude," Liu Banxia commented. "Besides this, have you noticed any other symptoms? Like trouble sleeping, dizziness, or anything else?"

"No other problems, just occasional minor anemia. If I eat a few pork ribs, it usually resolves," the patient replied.

"This is indeed a bit tricky," Liu Banxia mused. "So, the current findings are a mildly enlarged spleen, slight anemia, and clumsiness, correct?"

The patient nodded. "I wasn’t like this before; it only started recently. I wondered if it was from being too tired during the New Year, but that was a while ago, and I’ve been back at work for some time now."

"Try not to worry for now," Liu Banxia said. "Let us look into this a bit more and decide on the next steps for testing. We’ll try to figure this out today, but you might need to stay overnight for observation. Is that okay?"

"No problem. My husband is already at home preparing food to bring me. Are there any dietary restrictions?" the patient asked.

DING! Task Issued: Splenomegaly of Unknown Origin

Open Task: The patient states she is ill. Examination has revealed slight anemia and a mildly enlarged spleen. The host is required to provide further diagnosis. Task rewards will be issued based on the diagnostic results.

Liu Banxia smiled and nodded. "No dietary restrictions for tonight. If any other tests require fasting, those would be for tomorrow."

After speaking, Liu Banxia and Wei Yuan stepped aside.

"The patient’s positive attitude is actually making me more anxious," Wei Yuan said. "She’s placed all her hope in us. We can’t afford an unclear diagnosis."

"You rarely ask for help, but when you do, it’s always a significant case," Liu Banxia remarked. "Let’s order a tumor marker screening later, and then we should consult Wang Huan. I have a feeling this might be an internal medicine issue."

"The internal medicine department is swamped with patients today, so I didn’t want to bother him. There are still several patients waiting to be seen there. Let’s brainstorm first, just the two of us," Wei Yuan said.

Liu Banxia glanced over. It was true. There weren’t many surgical patients today, but the internal medicine department was inundated.

"Do you have any initial thoughts? Could it be a problem with the spleen itself?" Wei Yuan asked.

Liu Banxia frowned. "The current situation is too ambiguous; it’s hard to say. By the way, did you ask her if she’s had any recent abdominal trauma?"

Wei Yuan nodded with a wry smile. "I did. She mentioned she’s quite clumsy and often kicks or bumps into things."

"So, I’m still puzzled whether the slight spleen enlargement is due to trauma or caused by some underlying disease."

Liu Banxia grimaced. His own expertise only went so far, and Wei Yuan had likely considered most of what he could think of.

Therefore, diagnosing this patient at this moment was genuinely challenging. Even if they wanted to proceed with instrumental examinations, they needed to plan carefully and follow protocol, not just order tests impulsively.

Doing so might lead to many redundant tests, which could negatively affect the patient’s morale.

Take tumor marker screening, for example. If there were early suspicions, it could have been ordered. But according to standard diagnostic procedures, you can’t just order such tests without supporting evidence.

It wasn’t standard practice to order a full battery of blood tests for a patient without specific indications. A hospital operating that way would be buried under a flurry of complaints like snowflakes.

"Well? Say something. I need inspiration," Wei Yuan urged, as Liu Banxia was still pondering.

Liu Banxia could only roll his eyes. "Am I an inspiration machine? Our surgical mindset is a bit different from those in internal medicine. Let’s wait for Wang Huan."

"The patient’s condition isn’t critical at the moment, and she has agreed to stay overnight for observation. There’s not much more we can do right now. It’s almost mealtime. Should you eat first, or should I?"

"You go first," Wei Yuan suggested. "Aren’t you supposed to reward Liu Yiqing? It’s a rare chance for everyone to eat together; we shouldn’t waste it."

Liu Banxia nodded. Encouraging the interns was essential.

Their workload at the emergency center was significantly heavier than at other hospitals.

Success isn’t achieved easily, not even with his System. Others might perceive him as relaxed, but in reality, he put in a tremendous amount of effort that most people didn’t see.

The interns were in the same boat. Their working hours were similar to other interns, but their work intensity had ramped up since their second month in the emergency center.

Otherwise, how would he dare to delegate so much responsibility to them? It was precisely because they had put in the effort and achieved results that he had the confidence to do so.

With a call, the small group of interns gathered excitedly and followed Liu Banxia in a lively procession towards the cafeteria.

"Time for a pre-meal quiz," Liu Banxia announced seriously. "A patient constantly feels clumsy. An examination reveals a slightly enlarged spleen and mild anemia. Her routine blood tests and blood chemistry are normal. What do you think her illness is?"

"Teacher Liu, can you please not be so vague?" Huang Bo spoke up. "I was there when Teacher Wei was examining this patient."

"That’s perfect," Liu Banxia said with a grin. "You can explain the situation in detail then. Saves me the effort."

Huang Bo felt a wave of helplessness. He shouldn’t have opened his mouth. Now, he had no choice but to carefully recount the patient’s situation.

The problem that had stumped Liu Banxia and Wei Yuan was naturally also difficult for the interns. The available data was too sparse to support a diagnosis.

"Think about it while you eat," Liu Banxia said. "Let’s welcome Liu Yiqing’s temporary return with a celebratory pig’s trotter as a reward. Keep up the good work; there are only a few days left. You have to push through!"

"Okay," Liu Yiqing nodded.

"Pediatrics is a gamble of luck, while the ICU is a test of endurance," Miao Rui commented. "I saw Su Wenhao yesterday. Man, he’s lost some weight."

"Haha, don’t worry," Liu Banxia laughed. "Once you adapt, you can eat more and build yourself back up."

"The human body is truly amazing. As long as we don’t exceed our physical limits, many things that seem difficult are actually quite manageable, no big deal."

The interns collectively rolled their eyes, Qing Kewa included.

This girl was also a bit of a handful; she hadn’t done anything to earn a reward recently, so she simply requested a pig’s trotter as one. As her unofficial ’host,’ Liu Banxia had to pay up.

Talking, chatting, and eating, they didn’t linger over their meal. After all, they were the first wave to eat and needed to return to relieve their colleagues.

Of course, whenever they gathered, their table was invariably the liveliest in the cafeteria.

This group of theirs could be called a unique sight at the Second Hospital. Every time they were seen, they were always so distinct, so... cheerfully irreverent.