Chapter 364: Chapter 365: Encounter with a Big Shot!
To diagnose a disease, there must be a key point!
Only by discovering this key point can one truly diagnose the disease.
This is what modern medicine refers to as: the gold standard of diagnosis!
For instance, diagnosing tuberculosis might involve finding the tuberculosis bacillus in sputum cultures, or diagnosing cancer involves finding cancer cells in the tissue, and so on and so forthâ¦
But!
Many diseases do not have a gold standard.
This calls for finding a main clue that can help diagnose the disease!
Once this is found, by following clues, one can help diagnose the disease.
Chen Cang took a deep breath and his gaze upon the elder was filled with reverence.
Chen Cang nodded slightly to signal his gratitude.
The elderly man only smiled faintly, nodded, and said nothing.
â¦
â¦
What made the elderly man formidable lay right here.
But the most formidable aspect wasnât just here.
It also lay in his philosophy of interacting with people.
He knew that Wu Yushu had a problem, perhaps a serious one, but he wouldnât say it outright.
He understood this was a hospital, where the doctorâs word prevailed.
Even though the elder was a renowned doctor, no matter how skilled, he would not overstep his bounds or gratuitously instruct Chen Cang on what to do.
However, as a doctor, seeing a patientâs diagnosis running into issues, his conscience wouldnât allow him to stand idly by.
At this moment, suggesting that Chen Cang âtake the blood pressureâ was a move of high emotional intelligence.
If the elder had asked Chen Cang to take a chest X-ray, do an ECG, or even a cardiac ultrasound, that would be one thing, but would the patient be willing?
What would the patient think?
âYour doctor canât make a diagnosis without someone elseâs help?â
Would the patient think the doctor was incompetent?
They might even refuse to follow the recommendation for further testing.
But taking blood pressure is starting from the patientâs perspective. Think about it: taking blood pressure is such a simple thingâit doesnât cost money, just a straightforward checkup.
Firstly, the patient doesnât have any psychological resistance and follows the advice.
Secondly, the doctor can obtain many useful clues from it.
It could be said that the problem was resolved effortlessly, which is quite impressive.
Never underestimate the sphygmomanometer; it may seem simple.
Yet, this blood pressure detection can reveal many things.
This is where the sophistication lies.
Pulsus paradoxus is the phenomenon where the pulse weakens significantly or even disappears during inhalation and reappears or returns to normal during exhalation. Observing this with a sphygmomanometer is more direct and evident than with manual palpation.
An experienced doctor can feel a lot just by a simple touch.
The occurrence of pulsus paradoxus is due to an increase in intrapericardial pressure, which limits ventricular diastolic filling. With inhalation, systemic venous return is restricted, reducing the volume of blood the right ventricle pumps into pulmonary circulation. Pulmonary circulation is influenced by respiratory negative pressure, causing pulmonary vessels to dilate, which decreases the volume of blood flowing from the pulmonary veins into the left heart, reducing left heart output and causing the pulse to weaken or even disappear.
Pulsus paradoxus is commonly seen in right heart failure, pericardial effusion, and constrictive pericarditis, as well as severe asthma and other diseases.
With this diagnosis, what Chen Cang needed to do next became clear and straightforward.
Combining the cardiac auscultation sounds from before with the current pulsus paradoxus, Chen Cang now had a substantial understanding of Wu Yushuâs condition.
It was almost certainly constrictive pericarditis!
However, to confirm the diagnosis, there must be evidence. Thinking this, Chen Cang began to observe carefully. With Wu Yushuâs breathing, the bulging jugular veins in his neck could be faintly seen, but due to being somewhat overweight, they werenât very pronounced.
Chen Cang remembered Wu Yushu saying that he had come with symptoms of abdominal distension, indigestion, and poor appetite.
He said, âLet me feel your abdomen.â
Wu Yushu cooperatively raised his leg.
After Chen Cang performed an abdominal percussion, he fell silent for a moment. There might be fluid accumulation in the abdominal cavity, accompanied by an enlarged liver.
At this point, Chen Cang had already made a rough diagnosis.
Thinking this, Chen Cang asked in detail about the patientâs medical history and precipitating factors.
Afterward, Chen Cang looked at Wu Yushu, âBased on your symptoms and my examination just now, I feel youâre more likely suffering from constrictive pericarditis.â
Upon hearing this, Wu Yushuâs eyelid twitched reflexively, startled by the medical term.
He had heard of pneumonia and rhinitis, but this was the first time he had heard of pericarditis!
With this thought, Wu Yushuâs complexion changed, âWhat is pericarditis? What does it mean?â
Chen Cang explained, âConstrictive pericarditis is a disease caused by chronic inflammation of the pericardium. Over the long term, it leads to thickening, adhesion, and even calcification of the pericardium, restricting the expansion and contraction of the heart, resulting in reduced heart function and causing systemic blood circulation disorders.â
âYour difficulty breathing, chest pain, including abdominal distention, are all directly related to this!â
Truth be told, Wu Yushu was quite frightened when he heard this.
He could not afford to be illâ¦
That was crucial.
The heavy burden was on him; how could he dare to fall ill?
He didnât even dare to rest, let alone get sick.
Thinking this, Wu Yushu quickly asked, âDoctor, is my condition serious?â
Whether it was serious or not was hard to say, but seeing Wu Yushuâs condition, Chen Cang had to speak the truth:
âTo be honest, itâs not a simple disease. If it continues to develop over the long term, it will not only affect the cardiovascular system but may also involve the liver, lungs, and other systemic diseases.â
Wu Yushu felt a jolt in his heart, âDoes this require hospitalization? Or can I just take some anti-inflammatory medication?â
In Wu Yushuâs mind, inflammation should be treated with anti-inflammatory medicine, right?
But inflammation of the heart⦠that made him feel unsure.
Having heard Chen Cangâs explanation, which seemed quite serious, Wu Yushu became scared.
Chen Cang couldnât help shaking his head, âWith constrictive pericarditis, the main treatment is surgery, supported by medication. The earlier, the better. And the fluid in your abdominal cavity needs to be drained. My suggestion is to arrange for hospitalization as soon as possible.â
âAfter youâre admitted to the hospital, complete the relevant examinations, and then we can devise a specific treatment.â
Chen Cang had said all that needed to be said.
He could see that Wu Yushu seemed somewhat resistant to the examinations, probably for one of two reasons: either financial pressure or the loss of time.
But when the disease comes, treatment still needs to be carried out.
However, the examinations could be done after hospitalization.
That way, insurance could cover a large part of the costs of the examinations.
This was the best Chen Cang could do.
Therefore, Chen Cang did not insist on Wu Yushu having the examination done in the outpatient clinic immediately; he hoped that Wu Yushu could be admitted to the hospital as soon as possible, for the same reasoning.
Upon hearing Chen Cangâs words, Wu Yushu fell silent, sitting there, saying nothing for a long time.
At this time, Chen Cang saw the next patient, an elderly person.
Seeing the elderly person, Chen Cang didnât know what to say. After thinking, he instead offered, âElderly sir, how may I assist you?â
The old man passed over the emergency room registration, âI need an ECG, Iâm feeling a bit of palpitations.â
Once Chen Cang saw the old manâs name, his eyes narrowed!
That name might not mean much to most people.
But in the medical field of Dongyang Province, or rather, in the field of traditional Chinese medicine, the significance was too different.
Chen Cang had come across this name by chance, and never expected to meet such a luminary!
National Medical Master: Zheng Sanshui!
ps: Hehe, this is the third update for now, actually
The extraordinary vessels, they are truly quite interesting, something I have indeed encountered before.
Lastly⦠shamelessly asking for your votes, cough cough!