The Enhanced Doctor-Chapter 792 Booster "Three-Piece Set

Liu Banxia had just sat down to read when his phone rang.

"Brother Liu, what's up?" Liu Banxia asked after answering the call.

"Banxia, a friend of mine has a stomachache. He's sweating from the pain. Are you at the hospital? We're driving your way now," Liu Haibing said.

"I'm at the hospital. How long until you arrive? Any other symptoms? Is the pain in the upper or lower stomach?" Liu Banxia asked.

"Can't say for sure, just that his stomach hurts. He's been in pain for about twenty minutes now, and I have a bad feeling about it," Liu Haibing said.

"Then bring him here, and we'll talk when you get here," Liu Banxia said.

"Alright then." Liu Haibing hung up.

Liu Banxia glanced at Xu Yino and waved her over. "A patient with abdominal pain is coming. I'll attend to him. Any residents who haven't left yet? Have those with emergency treatment experience come to observe."

"Okay, there should still be some people around," Xu Yino said, promptly sending out a group text.

Within five minutes, a crowd had swarmed over. It wasn't just surgeons; even doctors from internal medicine had gathered.

"Good lord, what are you all here for? There's no need for such a large crowd; you might frighten the patient," Liu Banxia said with a laugh.

"Teacher Liu, abdominal pain is a common issue in the emergency department. It's a good chance for them to learn something," Xu Yino said.

"Fine then, I'll let it slide. Just don't interfere with my consultation," Liu Banxia reminded her.

If it were just three or five interns observing, it wouldn't be a big deal. But with this many people rushing in, it would be overwhelming. Most people wouldn't be able to handle such a spectacle.

After waiting for more than ten minutes, Liu Haibing and his group walked in from outside, supporting the patient between them.

"Brother Liu, these are all interns here to observe. Still in a lot of pain?" Liu Banxia asked as he stepped forward.

"It hurts, Dr. Liu, you have to save me. It's unbearably painful," the patient said, gritting his teeth.

Liu Banxia took a closer look. How interesting. It's the guy he met at Jinbao's dinner the other day. What was his last name again? Zhou, was it?

"Brother Liu, go register him first, then get him onto a consultation bed. Has he been drinking? Any medical history?" Liu Banxia asked.

"We were drinking, then went to a bathhouse for a soak. Old Zhou has high blood pressure, no diabetes, and no heart disease," Liu Haibing quickly replied.

"Okay, move him to the consultation bed first, and take his blood pressure," Liu Banxia instructed.

Liu Haibing's friends quickly helped him onto a consultation bed.

"When we admit a patient, the first thing to do is to get their medical history," Liu Banxia said, while palpating Old Zhou's abdomen. "This patient has high blood pressure and recently consumed alcohol and soaked in a hot bath. Any thoughts?"

"The patient has upper abdominal pain and a history of high blood pressure. Aside from considering abnormalities in abdominal organs, we should also consider the possibility of cardiac issues, such as myocardial infarction," Xu Zhenkai quickly chimed in.

"Well said, but it's a bit too generalized," Liu Banxia remarked.

"Dr. Liu, am I having a heart attack?" the patient, lying down, grabbed Liu Banxia's hand in panic.

"Don't worry, it's just one of the possibilities we're investigating. With any abdominal pain admission, we have to consider reasonable suspicions," Liu Banxia reassured, then began palpating the patient's limbs.

"Dr. Liu, I apologize for last time. I was wrong," Old Zhou continued. "Am I suffering from an intestinal or gastric perforation? A gastric hemorrhage? I have a history of gastritis."

"Good grief, your self-diagnosis is more impressive than mine!" Liu Banxia said helplessly. "But I have to scold you, not for what happened last time, but because you're too careless with your own health."

"You have high blood pressure, and you frequently drink large amounts of alcohol. To be blunt, you're drinking yourself to death. Your blood pressure can't be brought down, yet you keep pushing it up."

"Drinking alone would be one thing, but you also went for a hot bath, didn't you? That's a terrible habit. The hot water accelerates your blood circulation, doesn't it? You smoke too, right? That's the trifecta for raising blood pressure."

"Brother Liu, and the rest of you, if you want to soak in a bath, don't drink. Don't take this lightly. High blood pressure is an underlying condition that can easily trigger many other problems."

"Heart attacks, cerebral hemorrhages... He also has gastritis, which could easily lead to gastric bleeding. Drinking so much so often could also induce acute pancreatitis."

"And what else? His liver. Who's going to process all that alcohol? His liver has to do the work. Constantly soaked in alcohol—are you drinking for your own pleasure, or is your liver asking for it?"

Liu Haibing grimaced. He knew Liu Banxia was right, but the usual routine for their gatherings was to eat, drink, and then soak in a bath.

"Teacher Liu, blood pressure is 180/90, heart rate is 110," Xu Yino managed to squeeze in.

"See? It's up to 180. Have you taken any medication? What kind of antihypertensive drug? What's your usual blood pressure?" Liu Banxia continued to ask.

"Nifedipine. My usual blood pressure is around 160. Without medication, it goes up," Old Zhou said from the bed.

Liu Banxia nodded. "You're lucky you took some medication. Otherwise, this round of drinks plus that soak might have really done you in."

"I just performed a simple abdominal examination on you; there's no board-like rigidity. Zhang Wenzhen, can you tell us what the absence of board-like rigidity implies? And what examinations should be carried out next?"

Zhang Wenzhen, an intern in internal medicine, was taken aback, a little excited that Liu Banxia had remembered his name.

However, his focus wavered, and when he tried to speak, nervousness made him tongue-tied.

"Look, you're making the mistake I warned you about. Stay calm. Take a deep breath and speak now," Liu Banxia said.

"Teacher Liu, the absence of board-like rigidity means peritonitis hasn't occurred yet. It essentially rules out intestinal perforation, gastric perforation, appendiceal perforation, and gallbladder perforation," Zhang Wenzhen hurriedly responded.

"What kind of tests should be done next, Li Tianyang?" Liu Banxia continued.

"Routine blood tests, blood biochemistry, and an electrocardiogram to check for a heart attack," Li Tianyang replied quickly. "Since the patient is also pressing on his upper right abdomen, we should conduct a Murphy's sign test to check for cholecystitis."

"Considering past cases of ectopic appendicitis, we also need to perform an ultrasound to assess the condition of the abdominal organs. This is because if a perforation in the intestine or stomach is small and has been walled off by the omentum, preventing leakage into the abdominal cavity, there might not be any board-like rigidity."

Liu Banxia nodded in satisfaction. "Well done, that was very comprehensive. Considering this patient's situation, we need to consider everything."

"There's one more thing I didn't mention, but I wonder if any of you noticed: the patient's actual pain is much more intense than we might anticipate."

"He drank alcohol, and although he sweated a lot in the bath, the alcohol still has an anesthetic effect on his central nervous system. Taking this into account, his pain is actually very severe and shouldn't be overlooked; he just isn't perceiving it as clearly."

"And for patients of this age, regardless of whether it's severe abdominal pain, chest pain, or chest tightness, we cannot rule out the possibility of a myocardial infarction."

"However, there's another condition we need to consider. Does anyone know what it is? There's a reward for the correct answer. Be bold, who wants to take a shot?"

Although Liu Banxia posed the question, none of them could figure it out.

"Dr. Liu, what else is there? I'm not dying, am I?" Old Zhou asked anxiously from the bed.

"HAHA, another possibility is an aortic dissection," Liu Banxia said with a smile. "Hypertensive patients often have this complication. The basic method to rule it out is also very simple: measure the blood pressure in all four limbs."

"But I just did some preliminary checks, and when I palpated his limbs, I didn't feel any significant change in blood flow, so we can largely rule that out. If you can't feel a difference and still have doubts, then you'll need to take accurate measurements."

"Here's a follow-up question: why can aortic dissection be detected by such a simple method? Good, so many hands up; it seems you all know."

"The aorta is the main artery responsible for supplying blood. If an aortic dissection occurs, it will affect blood supply to the limbs, causing a pressure difference in the blood flow to them. This difference can be between the upper and lower limbs, or between the left and right arms."

"Unless our friend Old Zhou here is exceptionally unlucky and the dissection occurs in a location that perfectly bypasses the blood supply to both upper and lower limbs, then it wouldn't be detected this way."

"Let's proceed as Li Tianyang suggested: blood tests, EKG to check for myocardial infarction, and then an ultrasound to examine the abdominal organs."

Many looked at Li Tianyang with a touch of envy. In terms of performance just now, Li Tianyang had clearly stood out. This highlighted the real gap—a year's difference in accumulated experience separated them.

"Brother Liu, you all really need to be more careful in the future. There have been quite a few incidents caused by drinking together," Liu Banxia said, approaching Liu Haibing as the interns began their tasks.

"Sigh, we've known each other for over ten years. We've always helped each other out. Whenever we have time, we get together for a meal, chat, and see if there are ways we can collaborate," Liu Haibing said with a wry smile.

"Old Zhou does tend to overdo it with alcohol. He drank too much last time you saw him as well. We try to keep an eye on him and not let him drink excessively. This current issue isn't because of drinking, is it?"

"We'll have to wait for the test results," Liu Banxia said. "With his history of gastritis, it could well be severe pain from a gastric ulcer. We need to check step-by-step for any bleeding or perforation."

"Then there's the pancreas and gallbladder to check. Even if Murphy's sign is negative, we'll need to use imaging to examine them. Appendicitis is less likely. So, those are the main possibilities."

Liu Haibing nodded. "We'll really have to be more careful from now on. Everyone needs to help keep an eye on him."

The others around them also nodded in agreement. Old Zhou's condition today had genuinely scared them. It was the first time they had seen someone's forehead actually break out in a sweat from pain.

Coupled with Liu Banxia's explanation—that this was while he was still somewhat anesthetized by alcohol—they couldn't help but wonder: if not for the alcohol, would the pain have been enough to make him pass out?