Chapter 736: Chapter 300: Twists and Turns, Pathological Diagnosis Promoted to Level Five_2
All the necessary tests have now been conducted, and it’s time to diagnose the specific cause and location of the disease.
Despite the patient currently having numerous ailments, Zhou Can is clear in his mind that there likely is only one cause. Moreover, it is a significant malignant disease among chronic illnesses.
Ureteral dilatation, urinary protein, and reduced heart function accompanied by pulmonary artery hypertension—these newly discovered symptoms, when combined, immediately bring urinary system tuberculosis to his mind.
Additionally, the patient’s persistent urgency and frequency of urination further lead him to suspect in that direction.
He carefully reviews the patient’s urine routine test results from another hospital.
Pro 0.3g/L.
The routine blood test shows a WBC count of only 2.2*10^9/L, which is clearly low. Under normal circumstances, an adult’s white blood cells should be above 4.0*10^9/L.
EOS% 15.1%, with Eosinophil levels significantly higher than normal.
However, the Hb and PLT data appear normal.
Reviewing these test results, Zhou Can’s diagnostic thought process, like that of the expert at the Provincial Children’s Hospital, falls into a pitfall of thinking.
Urinary system tuberculosis?
Parasitic infection?
These two diseases are swirling in his mind.
“Dr. Zhou, what disease does my son have?”
The boy’s father seems to be losing patience.
Numerous tests have been conducted, and Zhou Can, who is so young, has yet to produce a diagnosis.
The family’s trust in Zhou Can is gradually diminishing.
His predicament is eerily similar to the day Du Leng was pointedly scolded by a family.
“Please wait, our Dr. Zhou is currently diagnosing your son! Diagnosing this type of highly complex medical puzzle is very challenging, requiring reasoning, differential diagnosis, consideration of various factors, and medical principles — all of which are extremely intricate. Please be patient and try not to interrupt Dr. Zhou’s diagnostic thought process.”
Ji You, sitting next to Zhou Can, fully plays the role of a ‘wise and supportive wife.’
She speaks up to explain and appease the family members.
Her stepping forward to explain is much more effective than if Zhou Can himself had done it.
If Du Leng had such a considerate nurse to help him, he wouldn’t have been scolded relentlessly by the family.
With the family now pacified and without any further concerns, Zhou Can immerses himself wholeheartedly in his diagnosis.
He is seen with furrowed brows, a deep gaze, and periodically, his eyes move slightly, indicating he is deeply in thought.
Diagnosing diseases can be more taxing than solving application problems.
Especially for such difficult cases, the mental exertion is even more significant.
“Order another urinary Ziehl-Neelsen stain!”
After much contemplation, Zhou Can proposes a new test for the patient.
This time, the family is somewhat emotional.
“Haven’t we done the urine routine several times? Why do we have to test it again?”
The family begins to doubt the tests ordered by the doctor, which is not a good sign.
It means that if Zhou Can does not make significant progress in the diagnosis soon, he will completely lose the family’s trust and cooperation. And if that happens, treating this patient will become virtually impossible.
Because we are still only at the diagnostic stage, the family has already raised doubts.
If prescribing medication or proposing surgical options comes up, the family will likely be even less cooperative.
Doctors earn their wages, and dealing with such families can be quite frustrating. Treating one more or one less patient genuinely doesn’t matter to doctors.
The ultimate outcome would be to dismiss the family and the patient.
“The test I’ve ordered for your son is a urine sediment examination, which is different from a routine urine test! They are different types of tests targeting different causes. The routine urine test is a general test that primarily checks for red blood cells, protein, glucose, nitrites, white blood cells, and other indicators in the urine. Urine sediment examination is a method that involves centrifuging the urine, then examining the sediment under a microscope. It is mainly used for diagnosing diseases of the urinary system.”
“Just now, after careful analysis and further diagnosis, I believe your son’s illness requires a screening for urinary system tuberculosis.”
Zhou Can patiently explains and communicates with the family.
His eye contact is sincere, and his attitude is friendly and earnest.
This undoubtedly increases the family’s favorable impression of him.
“I apologize, we misunderstood you! Please proceed with this test for my son, we’ll go pay for it immediately.”
The patient’s mother quickly steps in to smooth things over.
The boy’s father doesn’t say anything, but his face already shows a contrite expression.
Between people, heartfelt communication is always felt, and sincerity is perceived.
Zhou Can’s sincerity has touched the family, naturally making them feel ashamed and guilty.
Soon, the urine sediment results come back.
WBC 118.1/uL, the number of epithelial cells is 72/uL, bacterial count 8317.6/uL…
Zhou Can, still not giving up, conducts a PPD skin test and blood TB-AB for the patient, both of which come back negative.
At this point, urinary system tuberculosis can be largely ruled out.
So what could the illness be?
He picks up the CT scans of the patient to re-examine them.
A tumor was discovered at the Provincial Children’s Hospital, which was surgically removed.
However, this does not rule out the possibility of other malignant tumors lurking in the patient’s body.
Many cancer tumors are difficult to detect when they first develop if they are smaller than 5 millimeters.
In medical terms, tumors smaller than 1 cm in diameter are referred to as microtumors. Doctors tend to treat microtumors somewhat like ants on the ground—not giving them too much attention.
There are both human nature and a wealth of clinical medical experience at play here.
The harm caused by malignant tumors in their early stages is very slight and controllable. Only when they grow to a certain size do they clearly begin to adversely affect the body.