I can see the status bar

Chapter 1128 In-Hospital Consultation
Huang Jiaming, who only ate fruit every day, successfully passed out on the fourth day of the third week of starting to eat fruit.

What makes people even more nervous is that he usually lives alone.Thanks to Huang Jiaming's father who wanted to call his son for some help because the computer at home was malfunctioning that day.After calling several times and no one answered, he became alert, and then went downstairs to his son's house to check on the situation.

After knocking on the door for more than ten minutes without answering, Huang Jiaming's father opened the door with a spare key, and then found his son fainted on the ground.Then he quickly dialed the community number and dialed the 120 emergency number.

The whole process of the matter is actually not complicated, it's just that Huang Jiaming's father couldn't come to the hospital together, so there were some twists and turns in communication.

Sun Lien hung up the phone, and then said to Ma Yongfang, "Before the patient became ill, he ate fruit for about [-] days—only fruit and no other food."

"Is he crazy?" Ma Yongfang was taken aback, then shook her head, "No wonder the illness is so serious."

The fructose contained in fruits is a simple sugar and is absorbed quickly.However, the increase in the fructose content in the blood will inhibit the level of leptin (Leptin) - leptin can reduce food intake by acting on melanin-stimulating receptor 4.At the same time, fructose intake does not cause an increase in insulin levels because it does not rely on insulin breakdown to function.

However, the sweet substance contained in the fruit is not just fructose.Glucose and sucrose, which need to be broken down by insulin to become glycogen, are also commonly found in fruits.The content of these sugars in fruits is basically more than fructose.Especially sucrose, which is a disaccharide, is absorbed and utilized more slowly than fructose and glucose, which are monosaccharides.

Occasionally eating fruit meals will not have too much impact on the human body, but long-term intake of large amounts of fructose will cause liver damage and even lead to non-alcoholic fatty liver in the liver.

Fatty liver is an important factor leading to insulin resistance.

In other words, when a large amount of fruit is consumed, a series of changes that are not very friendly to the body will occur in the human body.

First of all, the glucose and fructose in the fruit are quickly absorbed, the glucose causes the human insulin level to rise, and the fructose quickly enters the liver to start supplying energy for the human body.The liver is busy processing the fructose in the fruit, while flawlessly capturing and synthesizing the glucose into glycogen storage.Therefore, after a large intake of fruits, the blood sugar rise rate in the eater's body will be very fast at the beginning.

Subsequently, sucrose, which is a disaccharide, is absorbed by the body and blood sugar levels rise again.When 1 molecule of sucrose is absorbed and digested, it will be decomposed into 1 molecule of glucose and an equal amount of fructose.Then it aggravates the burden on the liver again, weakening the inhibitory effect of liver glycogen synthesis (Glycogenesis) on blood sugar concentration.

Since the liver's ability to suppress blood sugar is weakened after eating fruit, in order to return blood sugar to normal levels, the body must secrete a large amount of insulin.Long-term, high-level insulin secretion can lead to decreased glucose tolerance and insulin resistance in patients.

At the same time, fructose also triggers leptin resistance, making patients more hungry, and they need to eat more fruits every day to satisfy their desire to eat.This further increases insulin levels in the body and increases the risk of insulin resistance.

This process continued for 18 days without interruption, and a healthy adult just ate himself out of diabetic ketoacidosis.

·
·
·
"So..." Ma Yongfang frowned after listening to Sun Lien's report, "Do you think this patient is type [-] diabetes?"

"The possibility of type [-] is high, but the possibility of type [-] cannot be ruled out." Sun Lien nodded and shook his head again, "Type [-] diabetes patients are only resistant to insulin, but this person's response to insulin is not bad, it is not likely Simple type two."

When Huang Jiaming was admitted to the hospital, his blood sugar level was 54.3mmol/L, and after 25 units of insulin injection, his blood sugar had dropped to 15.2mmol/L. According to a rough calculation, every time Huang Jiaming uses a unit of insulin, his blood sugar can be reduced Decreased by 1.56mmol/L.

Under normal circumstances, one unit of insulin can lower blood sugar by about 2.7mmol/L.Insulin in Huang Jiaming's body can only exert 58% of the effect of normal people, which really proves that he has the problem of insulin resistance.

Patients with simple type [-] diabetes will not have insulin resistance, and their absolute lack of insulin secretion means that they will basically not face the risk of insulin resistance.

"Maybe it's type [-] diabetes, combined with... type [-]?" Ma Yongfang suddenly realized, and then asked in surprise, "Is this double diabetes?"

Double diabetes is a rare condition.After all, patients with type [-] diabetes also have fulminant type [-] diabetes... such patients are indeed too miserable
At present, there is only one case of type 21 diabetes combined with fulminant type [-] diabetes reported in China, while there was a paper in Japan, which mentioned that a total of [-] such patients were found in Japan.

Absolutely insufficient insulin secretion in patients with fulminant type [-] diabetes, combined with insulin resistance in type [-] diabetes, is exactly the same as Huang Jiaming's situation.And if you want to determine whether Huang Jiaming is double-diabetic, you need at least one week of continuous monitoring in hospital.

Generally speaking, such diabetic patients need to use a large amount of insulin throughout the day, and they must also take insulin sensitizers, so that it is possible to control blood sugar.

"I don't know about that." Facing Dr. Ma Yongfang's confusion, Sun Li'en could only smile wryly, "I'm not professional enough in the Department of Endocrinology, so you have to do it yourself, Dr. Ma."

"However, I have a suggestion." Sun Li'en thought for a while and said, "If it is really a double diabetic patient, then his treatment and diagnosis will be a very long process. I suggest you contact Director Wu as soon as possible. Let him ask if the endocrinology department can come to the doctor for treatment—if Beihu Hospital can’t, then I’ll call Section Chief Wang, they’re the ones looking for this matter, if you have any questions, just go to the Health and Health Commission.”

·
·
·
In the end, Sun Li'en still didn't persuade Ma Yongfang to come back for dinner.After receiving the call from Ma Yongfang, director Wu said that he would immediately ask the director of the endocrinology department to come down to see the patient's condition.If the other party judges that the patient can be accepted, they will accept the patient immediately.

It takes a relatively long process to determine the treatment plan for patients with double diabetes, and at least Beihu Hospital has not treated similar patients.The director of the Endocrinology Department of Beihu Hospital needs to communicate with Ma Yongfang first, and then he can judge whether this patient can be admitted.

Sun Li'en chatted with Ding Huiguo for a few more words.Ding Huiguo is not hungry at all now, he feels very uncomfortable in his stomach.

The pain caused by peptic ulcer is a very troublesome thing, and conventional painkillers are not good for the pain in this part.Sun Li'en thought about it, and decided to let him eat something first - if there is food in the intestine, the pain of the intestinal ulcer may be relieved a little.

Then, Sun Li'en called Director Wu again and described the patient's problems he had encountered.

"The problem now is that I'm not sure whether he has tuberculosis infection." Sun Lien explained the troubles he encountered on the phone, "I'm not even sure whether his diagnosis of Crohn's disease is correct. Crohn's disease, I can't explain why he was still in remission when he received anti-tuberculosis treatment."

"Why does the community send this kind of patients?" Even the well-informed director Wu is a little confused. He is the director of neurology at Beihu Hospital, and he really has no good ideas for such patients.However, when doctors encounter patients they are not sure about, they always have a fixed plan, "This...how about asking for a consultation?"

As a doctor who is often invited for consultation, Sun Lien actually thinks so.As the director of the Comprehensive Diagnostic Department of the Fourth Central Hospital, I can't even tell whether the patient is tuberculosis or Crohn's disease.It's really embarrassing.But there is no way, you can't make fun of the patient's life and health for the sake of your own face.

Whether it is the status bar or the inspection results obtained so far, it is impossible to determine where Ding Huiguo's problem is.Infections are possible, as is Crohn's disease.When it is impossible to determine what the disease is, it seems that the only way to judge is to rely on the experience of the doctor.

Sun Lien is more inclined to Crohn's disease than intestinal tuberculosis.But this kind of judgment lacks conclusive evidence - he just thinks that Ding Huiguo's blood picture does not seem to have obvious symptoms of infection, and the course of the disease is not the same as intestinal tuberculosis.

If it is in the comprehensive diagnosis center, Sun Lien can do dozens of tests or even go directly to mNGS to judge whether there are tuberculosis bacteria, or even consider taking multiple samples in one colonoscopy and sending them for culture.But now, at Beihu Hospital, Sun Lien has no equipment and no time, and at the same time, he has to find a way to save the cost of examination for patients.

It's hard for a clever woman to cook without rice, which is the predicament Sun Lien is facing now.

But luckily, there is always a solution.There is no limit to the road, at least Beihu Hospital still has many experts and scholars from relevant departments in the hospital, and it is still possible to let them conduct a quick in-hospital consultation through video.

About half an hour later, the "remote" multidisciplinary consultation of the entire Beihu Hospital began.In addition to doctors from the Department of Radiology, Pathology, Gastroenterology and Gastrointestinal Surgery, Director Wu, Sun Lien and Song Wen from the Oncology Department also participated.

The first to speak were the radiologists, who were the first to get the results of the patient's imaging examination.

"Currently, CTE suggests that the patient's small intestine is not involved, and the colon has continuous thickening with slight layered changes. There are reactive lymph nodes around the intestines, but no necrosis and calcification of lymph nodes were found." On behalf of Beihu Hospital The doctor who spoke in the Radiology Department was a young looking female doctor, and her voice was pleasant, "We found that the patient had lesions in the upper apical segment of the right lobe and the anterior basal segment in the lower lobe of the left lung. Signs, this is the site where tuberculosis is prone to occur. Although according to the comparison of images from other hospitals before, it can be found that the condition has improved... But the patient has necrotic lymph nodes in both hilums and mediastinum. It may be lymph node tuberculosis, of course there is also the possibility of lymphoma."

Radiology voted for tuberculosis.But they considered lymph node tuberculosis or lymphoma, not intestinal tuberculosis.However, since lymph node tuberculosis is considered, it does not seem impossible to have intestinal tuberculosis.

The next speaker was the pathologist.They completed the examination of the patient's colonoscopic biopsy specimen as quickly as possible and overruled the opinion of the radiology department.

"Let's come here now, look. The patient's this, this... this specimen is infiltrated with a large number of acute and chronic inflammatory cells." The doctor in the pathology department seemed to be the kind of inarticulate, even stammering, but concentrated type of research. "The distribution of the inflammatory response is relatively uniform, no epithelioid granuloma is seen, and some crypt branches are deformed. This lesion is consistent with a chronic active inflammatory response. The existing pathological examination results do not support the judgment of lymphoma or tuberculosis."

It was only when the second person spoke, that they already started to deny each other.Sun Li'en raised his eyebrows, it seems that the situation is indeed... very difficult.

The judgment of the Department of Gastroenterology is very straightforward. The director of the Department of Gastroenterology said bluntly, "We still think it is Crohn's disease for four reasons."

After releasing a clear conclusion, the Department of Gastroenterology began to explain its own views one by one, "First, the patient has undergone colonoscopy repeatedly, and the lesions are all segmental changes under the endoscope, and the patient is not sensitive to hormones. Responding well with IFX (infliximab), it's clearly inflammatory bowel disease—and more importantly, it's hallmark of sterile inflammatory bowel disease."

The director of the Department of Gastroenterology paused for a while and then continued, "Second, lymphoma is nonsense. He has undergone PET-CT, and many colonoscopy biopsies have no evidence of tumor. Only one necrotic lymph node and Extraintestinal reactive lymph node enlargement is just lymph nodes—that's ridiculous."

Sun Lien could feel the anger from the director of the Department of Gastroenterology through the screen. He seemed very dissatisfied with the judgment of the Department of Radiology.

"However, we still have to look at the reality." Unexpectedly, on the third point, the Department of Gastroenterology began to make a quick turn, "At the beginning, when the patient underwent chest CT and T cell spot tests in other hospitals, there were no abnormalities. The physical examination also did not support evidence of tuberculosis. The fever and re-examination during the treatment suggested tuberculosis, which should be a new symptom during the treatment—not a new development of the treatment target disease.” Director of the Department of Gastroenterology He coughed and said, "That's why there is the fourth point. Although the patient's symptoms can be maintained in remission during the anti-tuberculosis treatment, we think this may be the after-effect of IFX (Infliximab) treatment. And according to our query information It was found that a small number of patients with Crohn's disease showed sustained remission of symptoms after receiving anti-tuberculosis treatment. Although the specific reason is still unknown, it may be caused by the impact of anti-tuberculosis drugs on the immune system."

"So, our judgment is that there is no problem with the diagnosis of lymph node tuberculosis in other hospitals, but the patient's intestinal lesions are independent Crohn's disease-this is a compound case of lymph node tuberculosis combined with Crohn's disease."

After the three departments had finished expressing their views, it was the turn of the gastrointestinal surgery doctors to speak.

"Um...we don't know what the patient's problem is." The doctor of gastrointestinal surgery was stunned for a while, and then said, "But so far, the patient has no bleeding, intestinal fistula, acute perforation, obstruction and other complications." Therefore, there is no indication for emergency surgery, and we do not recommend immediate surgical intervention." He thought for a while and then added, "If the internal medicine treatment is not effective, then we have no problem with surgery."

It's really a surgery, it's the same as not saying it.Sun Lien shook his head helplessly, and then asked, "So, your consultation opinion is that there is no problem with the diagnosis of Crohn's disease, and the patient still has tuberculosis infection?"

"That's right, our opinion is this." The director of the Department of Gastroenterology nodded and said, "Since the patient has been treated with anti-tuberculosis treatment before, and the symptoms have also been relieved, then we might as well give anti-tuberculosis treatment again according to the previous situation. Even if the patient does not have TB, the 'evidence' we see is nothing more than the situation after TB infection, and he still has a certain chance of remission due to TB treatment."

"At the same time, this plan can also avoid misjudgment and after immunosuppression, the patient's tuberculosis will progress more seriously." Song Wen suddenly spoke, and she seemed to agree with the judgment of the Department of Gastroenterology, "This plan may not be the best. Appropriate, but certainly the one with the least risk."

Sun Li'en thought about it for a while, nodded and said, "Then I will treat you according to this plan first. Department of Gastroenterology, are you going to send the patient to the inpatient department, or just treat it in the observation room?"

"It's impossible in the inpatient department, let's stay in the observation room." The director of the Department of Gastroenterology said with some headaches, "And the patients have to wear masks all the time—does the observation room have to accept other patients?"

In addition to the double diabetic patient in Ma Yongfang's hands, the patients in the observation room must be treated at present, and there are also patients with aortic dissection who are undergoing surgery and need to be admitted to the CCU for monitoring.These three patients needed hospital treatment, and now the only "safe" bed that can treat them is the emergency observation room.

But if Ding Huiguo has tuberculosis... then at least he should be hospitalized separately from other patients.Tuberculosis is contagious, and other patients in the same ward, that is the high risk group of infection.

"There is a treatment room next to the emergency observation room." Director Wu suggested, "Patients can be treated in the treatment room first."

Song Wen nodded, "I think this proposal is okay." She said suddenly, "In that case, what about the patient with the aortic replacement? He needs intensive care in the heart. Beihu Hospital can now draw at least two Nursing team, are you going to take care of aortic replacement patients while you specialize in caring for tuberculosis patients?"

"There is also a patient with double diabetes." Sun Lien added, "The situation of that patient with double diabetes is not easy, and a lot of related examinations have to be done."

"This..." Director Wu was dumbfounded. After muttering for a long time, he said, "I'm not sure about this...I'll ask the dean."

(End of this chapter)