After so thought, Liu Banxia decided not to get involved. These were matters he couldn’t handle. He’d rather just focus on seeing patients.
"Teacher Liu, the patient I just admitted with acute abdominal pain has been diagnosed with appendicitis. Please take a look at the test report," Xu Yino said as she walked in.
Liu Banxia took it and glanced over it. The ultrasound and CT scan images showed clear indications. "Follow the procedure, explain it to the patient, then book an operating room. Go straight to surgery; any doctor can supervise," he said.
"Thank you, Teacher Liu," Xu Yino responded gratefully.
"Do a beautiful job. You’re now responsible for the patients you admit. How much experience you can accumulate, and when you get to perform higher-level surgeries, that depends on your luck," Liu Banxia said.
Xu Yino ran out cheerfully. Compared to her classmates, she and her peers might not have been the first among them to perform surgeries, but their group had certainly perford the most as chief surgeons.
She had already been the chief surgeon for six operations: five appendectomies and one cholecystectomy. These were common surgeries for ergency patients. Their upcoming surgical assignnts still depended on Liu Banxia.
"President Liu, could you co for a consultation? I’m a bit stumped by this case," Wei Yuan said as he approached.
"Oh, Brother Wei, what’s the situation? I didn’t hear any major commotion just now," Liu Banxia replied in surprise.
Wei Yuan explained, "The patient is a 33-year-old woman, recently married around October 1st. She had a convulsion while taking a bath at ho. Her husband called 120 directly, and she was brought to our hospital. Wang Huan and I admitted her. Her vital signs are stable; she just has intermittent convulsions, and we’ve given her dication. The rapid blood test showed slightly high blood calcium concentration, low niacin, and slightly prolonged coagulation ti. Then we did a head CT. There were no masses or cysts, just a minor subarachnoid hemorrhage, though not severe. It was likely caused by hitting her head in the bathtub during a convulsion. We also had neurosurgery take a look. Such a small hemorrhage doesn’t require surgery but needs monitoring. The problem now is that we don’t know how to diagnose her, and she also has so psychiatric symptoms. According to her husband, before their marriage and during their honeymoon, his wife was always very pleasant. But recently, her temper has beco very bad. She gets angry at the slightest provocation and could even be described as deliberately provocative."
Liu Banxia nodded. "This situation is indeed quite complex; no wonder you’re all unsure. Has an MRI been done? Could there be a small tumor that the CT scan didn’t pick up?"
"She’s already been sent for one; that’s why I ca to find you. We can also re-evaluate her cerebral hemorrhage. If there’s nothing serious, we’ll proceed like this for now," Wei Yuan said.
"So, what are your thoughts? You can’t have no ideas at all, right?" Liu Banxia inquired.
"Wang Huan suspects it might be because her blood calcium concentration is too high, causing vasoconstriction in the brain, which led to her convulsions," Wei Yuan stated. "If not controlled properly, she might develop further cerebral hemorrhage soon. It could also worsen the current hematoma, endangering her life."
"Oh, right. According to her husband, the patient has also had diarrhea and frequent bowel movents recently. Her diet has beco irregular, and she’s fond of snacks. We also ran a hyperthyroidism test, which was negative."
"Alright, I’ll go wait for the results with you. But don’t really count on ; I have no clue just from your description," Liu Banxia replied.
It was probably thanks to the improvent in his diagnostic skills. He usually participated in consultations and could often offer constructive opinions.
By now, it had beco a habit in the Ergency Center to call him for consultations, regardless of the departnt. Occasionally, even the neurology departnt would seek his advice.
Today’s patient’s condition involved multiple departnts. However, the Ergency Center didn’t have such fine distinctions; everyone just worked together.
The new MRI results were consistent with the previous CT scan: just a very slight hemorrhage that wouldn’t currently affect the patient.
When the patient was wheeled back, Liu Banxia observed her carefully. The patient’s condition was terrible. She looked nothing like a newlywed; rather, she resembled soone who had been bedridden for months.
"Brother Wang, Brother Wei, why don’t we do another blood chemistry panel to see if her blood calcium concentration has dropped?" Liu Banxia said after so observation. "Actually, I initially thought there might be a brain tumor; otherwise, it wouldn’t cause such a drastic emotional change. A slight change might be understandable, but such a severe one is a different matter."
Wang Huan nodded. "We were thinking the sa, but neither the CT nor the MRI has shown any brain lesions so far."
At this point, the patient lying on the bed started moaning again, muttering sothing unintelligible. Liu Banxia leaned in to listen but still couldn’t make out what she was saying.
"Does she exhibit such symptoms at ho?" Liu Banxia asked the patient’s husband.
"I don’t know; we sleep in separate rooms now. She’s also taken a long leave from her company. She won’t even eat at the sa table as , says seeing annoys her," the patient’s husband replied with a bitter smile. "It wasn’t like this before. She used to say she loved the food I cooked and was worried about gaining weight. We were even planning to have a child, but now I don’t even know if we can continue like this."
"Please don’t worry for now. We will definitely do our best to help find the cause. Such a significant change in personality is certainly related to so illness," Liu Banxia comforted him. "We’ll do an EEG shortly to see its findings. The next ti she has a convulsion, we won’t give dication imdiately; we’ll observe her reaction during the episode. Have you noticed anything else we should be aware of?"
The patient’s husband thought for a mont and shook his head. "No. We were university classmates and dated for a long ti after graduation. We finally saved up enough to buy a big house, and that’s when we got married. She likes living in a big house. Even though the mortgage is heavier, I felt it was worth it. We can pay it off slowly; buying a house is a once-in-a-lifeti thing, isn’t it?"
"Leave her to us. We will do our best to treat her," Liu Banxia reassured him again.
There wasn’t much more he could say. This was a difficult case. Although many illnesses could cause these phenona, there were also many aspects that didn’t align with her current manifestations.
"Huh? Look at this, doesn’t this EEG seem a bit strange? It’s as if her brain activity is too sluggish," Wei Yuan said, observing the EEG monitor.
Liu Banxia quickly leaned over to look. It was true; it was much weaker than a normal person’s. This was also a new phenonon because the patient was currently experiencing mild muscle spasms and had already arched her body. When the body has uncoordinated reactions, the brain should release more signals, so the EEG ought to be active.
"Um... do you think it might be pellagra?" Liu Banxia said after observing for a while. "I initially noticed her skin looked a bit poor and thought it was due to inadequate skincare recently. However, she has two small patches of dermatitis on her elbow. Her niacin levels are also a bit low, right? Could it be caused by the low niacin? One of niacin’s roles in the body is to increase the excitability of the central nervous system and protect the cardiovascular and cerebrovascular systems. This is my current hypothesis. Pellagra can affect both the digestive and nervous systems simultaneously. These two small patches of dermatitis could have been easily overlooked during the initial physical examination. Actually, if she weren’t lying on her side with her body arched, I wouldn’t have noticed them."
Wei Yuan and Wang Huan exchanged a glance and gave a thumbs-up. "That sounds about right. We can try supplenting so niacin first. If it really is pellagra, then after regulating it, she’ll be fine as long as she pays attention to her diet."
"Doctor, is it really true?" the patient’s husband asked, his spirits lifting considerably from his previous dejection.
"It’s very likely. We were too focused on the neurological problems initially, only paying attention to her head," Wei Yuan said. "And we’ll see if it’s effective after supplenting with niacin. We really should have paid more attention to her skin from the beginning, instead of just focusing on the external manifestations of her symptoms."
Pellagra is niacin deficiency. Although her niacin level wasn’t extrely low, it was below the normal range. Considering the patient’s current physical presentation and symptoms, the probability of pellagra was high.
Liu Banxia didn’t say much and walked back to his office. Actually, he could ntally reconstruct the recent situation to understand why the two brothers hadn’t noticed the dermatitis on her elbow. When she was first admitted, they definitely prioritized her convulsions before considering other things. And he had just carefully observed that, apart from so dermatitis, the patient didn’t show signs of angular cheilitis or glossitis. Moreover, this patient’s dermatitis was very mild. Such things can also occur in daily life, for example, from contact with corrosive liquids or gases, or an insect bite.
He also knew that even without him, the two brothers would have eventually thought of this disease through careful study. They were just overly worried about the patient, especially since she still had a cerebral hematoma, no matter how small.
After the niacin supplent was administered, the patient’s condition improved significantly. Her body could finally lie properly flat, the expression on her face softened, and she could also chat normally.
DING! Patient encounter completed.
Acquired 200 Experience Points, 100 Diagnostics Skill Proficiency Points.
Looking at this system reward, Liu Banxia also knew that diagnosing this case of pellagra wasn’t difficult; it was rely a matter of focus.
"How are you feeling? A bit better now? Have there been any other unusual occurrences? For example, visual or auditory hallucinations?" Liu Banxia asked.
"I think I’ve heard voices, and I also frequently have stomachaches," the patient said.
Although still sowhat weak, she could finally express herself clearly.
Liu Banxia nodded. "After you go ho, eat more liver, lean at, eggs, soy products, peanuts, and vegetables. That will help regulate your body."
"Mhm." Just as the patient nodded, she suddenly retched, and traces of blood appeared at the corner of her mouth.
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