The Enhanced Doctor-Chapter 783 Capricious Appendix

"My goodness, I'm the scapegoat, the absolute scapegoat."

After watching the news program, Xu Yino ran straight to Liu Banxia and stared at him intently.

"I can't do anything about it. Even though I anticipated it, I didn't expect it to turn out this way. At least our names are listed in the subtitles, which is pretty good," Liu Banxia said, also feeling helpless.

Although Xu Yino was interviewed, none of her footage or comments were actually used.

The entire news report was narrated by the newscaster, interspersed with a few shots. It was as if Xu Yino had prepared and said a lot, but none of it was used.

In fact, it wasn't just her. Liu Banxia, too, only had a brief shot of himself waving from the car window.

The focus of the news report was still on promoting positive energy, with the car owners who offered help being the protagonists.

However, as Liu Banxia said, having such an introduction was quite good. Perhaps there would be follow-up reports in the future; at least the news would give them more focus.

"This is worrying, Teacher Liu. What are we going to do if we mislead all our interns?" Xu Yino asked.

"If they get misled, it's their own bad luck," Liu Banxia said.

Xu Yino was completely defeated. How can I even have fun anymore? This is so frustrating!

"Teacher Liu, could you come over here for a moment?" Su Wenhao called out.

Liu Banxia glanced over. A patient was lying on the examination bed next to Su Wenhao; he guessed Su Wenhao was having trouble with the diagnosis.

"Acute abdominal pain?" Liu Banxia asked.

Su Wenhao nervously nodded. "The patient is 27 years old, admitted with acute abdominal pain, specifically in the right upper abdomen. The pain started vaguely two days ago and intensified tonight."

"At first, I thought it was cholecystitis. I performed a Murphy's sign test, but the result was negative. Then I suspected appendicitis, but the McBurney's point tenderness test was also negative. The patient's blood pressure and body temperature are normal, and the abdomen is soft."

"What's your preliminary diagnosis?" Liu Banxia asked.

"I don't have a clear diagnosis yet. I want to get the patient an ultrasound. The right upper abdomen is the hepatobiliary region. If it's not cholecystitis, I suspect there might be some minor issue with the liver," Su Wenhao said.

"But I've carefully observed the patient's skin and sclera and haven't found any signs of jaundice related to liver disease. If liver lesions were causing this much pain, the jaundice should be severe."

Liu Banxia nodded and turned to the patient, who was lying curled up on the examination bed. "Any recent changes in your diet? Have you had diarrhea?"

The patient shook his head. "No, it's just that the pain suddenly became severe today. I tried going to the toilet, but I couldn't pass any stool. HISS..."

"When you experience pain in the right upper abdomen, do you also have chest pain or back pain? Have your bowel movements been regular these past two days?" Liu Banxia continued.

The patient shook his head. "No other place hurts, just here. It feels like a stitch. My bowel movements haven't been very regular; sometimes I'm a bit constipated."

"Here, lie flat, please. I'm going to palpate your abdomen. Have you been staying up late recently? Your dark circles are quite noticeable," Liu Banxia said.

"It's abnormal *not* to work overtime these days. I work overtime every day. By the time I get home, wash up, and get to bed, it's already past midnight," the patient complained, as if voicing his grievances eased some of the pain.

Liu Banxia gently pressed his abdomen with his fingers. As Su Wenhao had said, the abdomen was soft.

He then took out his stethoscope and performed an abdominal auscultation on the patient; his bowel sounds were also normal.

"Let's do an abdominal ultrasound. Focus on the liver and gallbladder area, and also check for any signs of intestinal obstruction. The symptoms aren't obvious, but when I pressed, some sections of the bowel felt a bit hard," Liu Banxia said.

"Doctor, is it cholecystitis?" the patient asked.

"We can't completely rule it out yet, but you don't have the typical signs of cholecystitis," Liu Banxia replied.

"We'll do an ultrasound first to assess the situation. If the ultrasound doesn't reveal any abnormalities, we'll need to conduct more detailed examinations."

"But that's for later. We don't want to scare you. Let's do the ultrasound first. Sometimes pain can be referred, and we can't rule out the possibility of some intestinal pain either."

The patient nodded. Once Su Wenhao finished writing the order, the patient went to pay the fee.

"In the future, when you encounter situations like this, you can be more decisive," Liu Banxia said with a smile.

"Actually, I wasn't very confident. The patient only had symptoms of right upper abdominal pain, and his description of the pain level was also vague," Su Wenhao admitted sheepishly.

"Initially, I thought his pain was caused by enteritis, but his later presentation didn't seem to match, and he didn't have diarrhea, so I hesitated."

Liu Banxia remained silent, still looking at him with a smile.

"Actually... I was planning to order a CT scan directly for the patient, as this would give a clearer view of the liver. I suspected there were signs of acute symptoms on his liver, but the blood test results weren't back yet," Su Wenhao confessed.

Liu Banxia nodded. "I figured you had other ideas and were trying to be elusive. Considering this patient's situation, your line of thinking is quite normal, and either approach could work."

"Our diagnostic principle is to proceed from less invasive to more invasive tests, but we also need to make judgments based on the patient's condition. For this patient, we were able to rule out cholecystitis and appendicitis during the initial physical examination. So, the next step is to consider issues with the liver, common bile duct, intestines, or omentum."

"Therefore, whether we do an ultrasound first or a CT scan first, both are acceptable. Besides, I get the feeling that even if this patient undergoes a CT scan directly, he wouldn't raise any objections."

Su Wenhao nodded.

Although he had undergone training for independent consultations before, actually handling patients independently came with pressure.

It was like learning to ride a bicycle as a child. Even if an adult walked behind you, saying, "I'm holding on," when in fact they weren't holding on at all, you could still ride with ease.

But if you looked back and saw them far away, you'd panic and likely fall.

"Don't worry, the training you've received is more than enough to handle these situations. Otherwise, why would we go to all the trouble of teaching you? Isn't it so you can do the work for us?" Liu Banxia joked.

Su Wenhao gave a shy smile. Perhaps I hesitated this time because my judgment was somewhat 'aggressive.' In fact, I had considered bypassing basic tests and directly diagnosing a liver condition.

After a short wait, the patient returned with the ultrasound report.

"Doctor, please take a look. The doctor who did the scan said it might be appendicitis. My gallbladder and liver are fine, and it's not an intestinal obstruction either," the patient said with a troubled expression.

Liu Banxia frowned. "Let me see. If it's appendicitis... but McBurney's point wasn't tender. Hmm..." Looking at the report, he continued, "It might indeed be appendicitis."

As he spoke, Liu Banxia had already seen the image snapshot on the report. It wasn't very clear, but he could make out an organ resembling an appendix.

The crucial point was that the patient's appendix was located slightly higher than usual, toward the right upper abdomen.

This solved the puzzle: why Murphy's sign and McBurney's point tenderness were negative, why the abdomen was still soft, why intestinal obstruction could likely be ruled out, and yet why the patient still experienced pain in the right upper abdomen.

It was because this appendix was quite wayward. Although Liu Banxia had encountered ectopic appendices during consultations before, none were as stubbornly mispositioned as this one.

"Next, we need to do a CT scan to see the exact situation. If it's severe, you'll need to prepare for surgery. We can consider laparoscopic surgery, which is less invasive, but we can't rule out the possibility of converting to open surgery," Liu Banxia said.

"Doctor, open surgery? You're not trying to scare me, are you?" the patient asked anxiously.

"We're not trying to scare you; we're telling you the facts. It mainly depends on the current condition of your appendix and whether its position is suitable for a laparoscopic procedure. That will be determined during the exploratory laparoscopy," Liu Banxia explained patiently.

"Regardless, you should contact your family. You've been symptomatic for a while. Based on my experience, I can't say for sure if it has perforated, but there's likely some purulence. Ultimately, surgery will be necessary."

"It was because your appendix is anomalously positioned that we couldn't diagnose it initially. We still need to assess the actual situation. As for an appendectomy, don't worry, it's a minor surgery."

"So... does that mean I won't be normal?" the patient asked with concern.

"Don't overthink it. An ectopic appendix is quite common; it's a normal variation. However, we still need to use a CT scan to confirm the appendix's location and current state to clearly determine the specifics of your condition," Liu Banxia said.

The patient nodded. Su Wenhao proceeded to fill out the order forms and also drew some more blood for pre-surgery blood tests.

Su Wenhao had almost blind faith in Liu Banxia's judgment. If Liu Banxia said the appendix was likely purulent, then it almost certainly was, and surgery would definitely follow the CT scan.

"Learned something new, huh? Such a wayward appendix fooled us both," Liu Banxia said.

Su Wenhao gave him a wry look. This case was indeed quite interesting. It was the first time he had encountered appendicitis presenting with right upper abdominal pain.

During their earlier discussion, they had suspected the liver, gallbladder, intestines, and even considered the omentum, never imagining it would turn out to be a very common case of appendicitis.

"HAHA, consider this a successful start for you. You should be happy. If the patient's condition isn't too severe, the surgery can be done tomorrow, and it'll be a good learning opportunity for the interns," Liu Banxia continued.

"Teacher Liu, couldn't we call them over now?" Su Wenhao asked.

Liu Banxia paused for a moment, then gave him a thumbs-up. "You have a promising future! With you 'mentoring' them, I'm sure they'll flourish. Keep it up!"

Su Wenhao is an honest guy, but he's also a bit sly in a quiet way, Liu Banxia mused, feeling quite moved.