Chapter 395 - 248: Department Achievement Review: Key Specialty Approval and the Hospital’s Generous Rewards
Chapter 395: Chapter 248: Department Achievement Review: Key Specialty Approval and the Hospital’s Generous Rewards
After an MRI examination, the ophthalmologists made a preliminary diagnosis of endophthalmitis.
They administered targeted treatment, specifically anti-infective therapy for her eye, but her condition did not improve.
Starting the next day, the patient developed a high fever. She was treated with antibiotics, but they had no effect whatsoever.
Suddenly, Shi Lihong’s treatment reached a stalemate.
They were unable to determine the true cause of her illness.
Because the patient had a long history of diabetes, they also considered the possibility of it being a complication of her diabetes.
The Director of Ophthalmology, Dou Weiwei, called in Director Jiang from Endocrinology for a joint consultation. Recently, the Emergency Department had been enjoying unrivaled prestige at City First Hospital. Furthermore, this patient had first been diagnosed in the Emergency Department.
So, Director Dou also invited Huo Yun and Wu Ting to participate in this multi-departmental consultation.
After Director Dou gathered everyone, she exchanged a few pleasantries before distributing the patient’s case file to all the directors present.
Wu Ting also began to read it carefully. According to today’s latest physical examination:
"Patient Shi Lihong, female, 35 years old. Fever and chills for two days. Two days prior, the patient developed fever and chills without any apparent trigger, with a maximum temperature of 40°C... No improvement after antibiotic treatment..."
"Aching limbs, worsening dizziness, lethargy, significantly decreased appetite, poor sleep..."
"Bilateral conjunctival hyperemia, severe pain and itching... Pharynx not congested, symmetrical respiratory movement in both lungs, clear on percussion, slightly coarse breath sounds in both lungs..."
"White blood cell count 15.19 x 10^9/L, neutrophil percentage 95.3%, lymphocyte percentage 1.8%, eosinophil percentage 0%, absolute neutrophil count 14.5 x 10^9/L, absolute lymphocyte count 0.3 x 10^9/L..."
"Fasting blood glucose 10.47 mmol/L, Glycated Hemoglobin: 6.8%, D-dimer >20 μg/mL, Coagulation Factor V, Prothrombin Time 16.30 s, Activated Partial Thromboplastin Time 49.90 s, Thrombin Time 16.60 s..."
Looking at the patient’s condition, Wu Ting couldn’t immediately pinpoint the key issue, but among the various biochemical indicators, he noticed a problem with the patient’s liver function.
’Could it be a liver infection? A liver abscess?’
’But a liver infection couldn’t possibly cause pain and itching in both eyes!’
Moreover, the patient’s physical examination showed no signs of liver problems.
"No jaundice of the skin or mucous membranes, no visible rashes or petechiae, no liver palms, no spider nevi. No palpable swelling of superficial lymph nodes. Conjunctiva not congested, sclera non-icteric bilaterally, coarse breath sounds in both lungs..."
As Wu Ting was brainstorming, Director Dou suddenly thought of something:
"Fellow directors, I have one more piece of information to add. I’m not sure if it will help with the diagnosis."
"For a period before the onset of her illness, the patient was undergoing colon hydrotherapy at a beauty salon for cosmetic purposes. She had a total of four sessions before she got sick."
"Then, after the four sessions, she experienced hematuria, but it cleared up quickly, so she didn’t pay much mind to it..."
As he listened to Director Dou’s supplement, a flash of inspiration suddenly struck Wu Ting’s mind.
’Her liver indicators show a problem, she has diabetes, she’s had multiple colon hydrotherapy sessions, and she experienced hematuria. It’s highly likely her intestinal mucosa was damaged, allowing pathogenic substances from her intestinal contents to enter her bloodstream...’
’It must be caused by some kind of pathogenic bacteria...’
’Liver abscess... endophthalmitis... high blood sugar... mucosal damage from the hydrotherapy... fever and chills...’
Suddenly, Wu Ting thought of a possibility—an infection that could cause endophthalmitis, fever, chills, and even a liver abscess!
The patient should still be in the early stages. If not treated in time, it would most likely lead to blindness and require enucleation of the eyeball!
And beyond that, it could also lead to multiple organ failure.
The patient’s current symptoms were just atypical. After a moment’s thought, Wu Ting decided he had to test his theory.
"Fellow directors, I have a theory. It’s possible the patient’s colon hydrotherapy damaged her intestinal mucosa, leading to an infection from some pathogen. I suggest we give the patient an abdominal B-scan and also run a drug sensitivity test..."
Just as Wu Ting was explaining his plan,
his phone rang. Wu Ting glanced at it—it was a call from Fan City University Medical College.
After Wu Ting answered, he checked the time. He had to go to a contract signing and appointment ceremony soon.
In any case, with so many directors here, Wu Ting had nothing to worry about.
Due to the time constraint, Wu Ting didn’t have a chance to explain the specific details of his judgment or his reasoning based on the relevant indicators.
Besides, it would be difficult to explain in just a few words to specialists in ophthalmology and endocrinology how Klebsiella pneumoniae invasive liver abscess syndrome can cause a liver abscess with extrahepatic metastatic infection that manifests as endophthalmitis.
The patient’s poorly controlled blood sugar was a major factor, compounded by the intestinal mucosal damage from the hydrotherapy... If they didn’t start treatment immediately, the patient’s eye would absolutely be lost and would require removal.
The matter was urgent, and Wu Ting didn’t dare to delay. He directly stated the examination plan. There was still enough time; they could administer symptomatic treatment immediately after a confirmed diagnosis.
"Director Dou, I have to make a trip to Fan City University Medical College now. Regarding Shi Lihong, I suggest getting her an abdominal B-scan as soon as possible to see if there’s a liver abscess. If it’s confirmed, immediately perform a blood culture or a pus culture from the liver abscess."
"As for the specifics, let’s talk on the phone after we have a confirmed diagnosis."
In the past, these directors certainly wouldn’t have believed someone as young as Wu Ting, but after everything that had happened, Wu Ting had built a strong reputation for his diagnostic skills at City First Hospital.
Director Dou and the other directors didn’t have many leads to begin with, so upon hearing the plan, they immediately set out to execute it.
Director Dou went to speak with the patient personally.
When Shi Lihong heard she needed an abdominal B-scan, she became somewhat dissatisfied and resistant.
"Director Dou, do you people even know how to treat patients? It’s just a sore eye. Shouldn’t some eye drops and anti-inflammatory pills be enough to fix it? How come it hasn’t gotten any better after all these days?"
"Besides, it’s my eye that hurts. Why do you need to examine my abdomen? You already checked before, and there was no problem when you pressed on my stomach."
Having become wealthy from a property demolition payout, Shi Lihong lived a life of leisure, spending her days at beauty salons, playing cards, and collecting rent.
This made her extremely arrogant and materialistic. After being treated for so long with no improvement and hospitalized for several days, she was convinced the hospital was just trying to rip her off.
In her eyes, a sore eye was a trivial matter that should clear up with some anti-inflammatories. It was only because the pain was so severe this time, coupled with the fever, that she had agreed to be hospitalized.
She had endophthalmitis once before, and a cheap bottle of eye drops that cost just a few yuan had cured it.
Seeing Shi Lihong’s impatience, Director Dou continued to persuade her patiently.
Muttering a stream of curses, Shi Lihong reluctantly went for the examination.
However, when the results came back, they showed no signs of a liver abscess.
This made Shi Lihong even more furious.
With a grim expression, Director Dou called Wu Ting.
Wu Ting had just arrived at Fan City University. ’My judgment should be correct,’ he thought.
"Director Dou, in that case, let’s perform a CT scan on the patient. It’s possible the B-scan wasn’t sensitive enough."
For detecting a liver abscess, a CT scan is more sensitive than an ultrasound. The reason they had started with a B-scan was because it was standard procedure—B-scan is typically the first choice, with CT used to further clarify any abnormalities found.
It was just that the signs weren’t obvious on the B-scan, so the doctor hadn’t spotted anything.
Based on the patient’s relevant biochemical indicators, Wu Ting was one hundred percent certain there was something wrong with her liver.
Hearing the confidence in Wu Ting’s voice, Director Dou chose to trust him.
However, when she went to communicate this to the patient, Shi Lihong flatly refused.
"This is outrageous! What is this hospital even doing? Are you just trying to rob me? I just had a B-scan that found nothing, and now you want to do a CT scan? Are you trying to waste my money?"
"I’m not doing it! I need you to treat my EYES! My eye hurts! My liver is fine!"