I can see the status bar

Chapter 267 Consultation
Edema is a variable symptom.Often some girls will complain that their face is swollen after waking up, and they call it "edema".

In fact, it's just plain fat...

Edema is divided into local and systemic. Mild edema is only seen in the eyelids, infraorbital soft tissue, subcutaneous tissue in front of the tibia and ankle.There will be a slight indentation after finger pressure.

There are generally four reasons for this edema: decreased plasma colloid osmotic pressure; increased hydrostatic pressure in capillaries; increased permeability of capillary walls; and blocked lymphatic return.Corresponding to protein malabsorption, malnutrition, or kidney disease with proteinuria, respectively.Vein obstruction or impaired venous return.Infection or inflammatory response.Disruption of local lymphatic circulation, or blockage by parasites and cancer cells.

Judging from the prompts on the status bar, Wang Lin should belong to the first situation, that is, kidney disease with proteinuria.

Tuberculosis generally does not cause kidney lesions, let alone proteinuria.That's why Sun Li'en affirmed Xu Yourong's diagnosis as soon as he saw the patient's condition, it really didn't look like tuberculosis.Instead it appears to be an infection that develops and behaves very much like tuberculosis.

The preliminary diagnosis led by Zhou Jun also ruled out some doubts for Sun Lien.The result of the sputum smear test was negative, indicating that there were no pathogens in the patient's sputum that could be directly observed by a microscope.However, the "Staphylococcus aureus infection" indicated in the status bar cannot explain why the patient has a long-term low-grade fever, fatigue and cough.Pneumonia caused by Staphylococcus aureus infection generally manifests as acute suppurative pneumonia.The onset is fast and the progress is fast. Patients generally show high fever and chills, chest pain and purulent sputum.

In general, if you don't look at the patient's condition in the past month, but only look at the recent symptoms, it is reasonable to suspect Staphylococcus aureus pneumonia.However, this state still cannot explain the sudden massive coughing up of blood in the past two days.

Although it is not yet certain what disease the patient has, it is certainly not tuberculosis.This is the result of Sun Lien's current diagnosis.

For a middle-aged man in his 50s, the lung and kidney problems indicated by the status bar may cause his life to be in danger.But what gave Sun Lien a headache was that he couldn't judge which of the two problems was more fatal.

"This patient's problem is not very simple." Sun Li'en and Zhou Jun roughly shared their analysis process. Of course, he omitted the prompt in the status bar, and only analyzed the patient's disease manifestations, which did not seem to be tuberculosis. reason.Then he suggested, "I suggest, transfer him to our treatment group."

The treatment group had no new patients for so long that Sun Lien's hands were itchy.

"Yes." After pondering for a moment, Zhou Jun agreed to Sun Li'en's suggestion.Then he took the phone out of his pants pocket. "Dean Liu, there is a new patient who will be transferred to Sun Lien's treatment team."

Sun Li'en blinked, he almost forgot that his own treatment team now has a vice president as a supervisor.

"Dean Liu said that the patient can be accepted, but you have to explain to him why you want to accept this patient after the patient's condition is stable." Zhou Jun nodded to Sun Li'en, "He is under your control now."

·
·
·
"There must be something wrong with the kidneys. As for whether it is glomerular or tubular, or what kind of mixed overflow tissue, it needs to be judged in combination with other test results." Zhou Ce was called by a phone call. He was called to a meeting in the small conference room, and besides Dr. Pascal, among the doctors present, he was the oldest - Zhou Ce was one year older than Xu Yourong.

Dr. Pascal was called back from the hotel for a consultation. Not only was he not dissatisfied, but he seemed very excited.This is the main reason why he came to Ningyuan from the United States!Who would have thought that after coming to Ningyuan, he would work as a cow and a horse in the outpatient clinic, and almost died of sudden death from exhaustion.But finally there is work to do now.Comrade Old Pa was gearing up, carefully looking at the inspection report in his hand.

Yuan Ping'an is starting to reorganize the patient's condition.Before coming to the meeting room, he first went to the patient's family members to re-inquire about the course of the illness.And asked the patient himself again.After comparing the private prosecutions of the two parties, Yuan Pingan concluded a relatively accurate case record.And he is also planning to re-screen the cause based on the case records and progress-the patient has received lung lavage sampling, but the laboratory said that it takes at least three days to culture.If the scope of suspicion can be narrowed as soon as possible, it may be confirmed by PCR testing-this can save a lot of time for patient treatment.

Xu Yourong was very quiet. Apart from occasionally translating the contents of the case to Dr. Pascal, she spent most of her time observing Sun Lien's movements.Sun Li'en affirmed her diagnosis, which made Deputy Chief Physician Xu feel a little proud.But more still confused.She compared the patient's course and progress many times before making the judgment that "it may not be tuberculosis".And Sun Li'en just took a look at the patient, and knew that the patient's legs were edematous under the quilt.Although Sun Lien explained it with "slight edema in the patient's eyelids".But Xu Yourong still couldn't figure it out—how did Sun Lien see the edema that he didn't see, and the patient didn't notice, and how did Sun Lien see it at a glance, and based on this, he supported his own diagnosis?

Sun Lien is recording the patient's symptoms on a whiteboard.He wrote in black pen, "Cough, low-grade fever, fatigue, lasted for one month; cough worsened, hemoptysis 200ml lasted for two days; dyspnea, lasted for one day; mild edema, duration undetermined; proteinuria, duration undetermined."

"You are acting a bit like House now." Dr. Pascal looked at the writing on the whiteboard and smiled, "It's just that you won't ridicule our ducklings, and you're not as amazing as him."

Sun Li'en put the cap on his pen and said seriously, "Besides, he is the chief physician, and I'm just a small trainee." He smiled, and pointed to the record on the whiteboard behind him, "From this record, the patient's condition is mainly Divided into two stages." He pointed to the first line of words, "First, the respiratory symptoms lasted for more than a month, and then the condition suddenly worsened within two days."

"The duration of proteinuria and mild edema is undetermined, and it is possible that it has lasted for a month or more?" Zhou Ce raised a different opinion, "If his kidney symptoms are not secondary to lung disease, but primary Kidneys, and what about the lungs?"

"Then the diseases we need to consider include lupus erythematosus, renal arteriosclerosis, gouty kidney, congestive heart failure, heavy metal poisoning, multiple myeloma..." Dr. Pascal casually listed a long list of disease names. "If you want to investigate one by one, it will probably take nearly a month."

Sun Li'en was not too impressed with Zhou Ce's suggestion, after all, there was already a reminder of lung infection on the status bar.That proves that Wang Lin's current condition must be related to the lung infection.Regardless of whether the infection is transmitted through blood or lymphatic channels, they will only appear in multiple places at the same time, instead of infecting the kidneys first, then abandoning the base camp, and transferring them all to the lungs—if Staphylococcus aureus causes kidney disease first, If it was later transferred to the lungs, then the kidneys should still have Staphylococcus aureus infection lesions.

"Combined with the blood routine and urine test results, it looks more like glomerulonephritis. And it should be acute." Zhou Ce made his own diagnosis. "Acute glomerulonephritis is more common after streptococcal infection, and Streptococcus pneumoniae infection can explain both the patient's lung symptoms and proteinuria."

"I agree." Both Xu Yourong and Dr. Pascal nodded.

Sun Lien pondered for a while.Although Streptococcus pneumoniae and Staphylococcus aureus are not the same thing at all, both are Gram-positive bacteria, and there is a considerable degree of commonality in treatment.The only caveat is that Staphylococcus aureus is highly resistant to penicillin antibiotics while Streptococcus is not.

"Give him cefuroxime sodium, plus oral roxithromycin, give him protamine, and monitor his blood clotting time." Sun Lien gave his initial treatment plan. "Maintain oxygen, and perform 24-hour cardiopulmonary monitoring. If the treatment is effective, then transfer the patient to the Department of Respiratory Medicine."

The diagnostic team adjourned, and Xu Yourong and Dr. Pascal went to the emergency room to get a prescription.And Sun Lien sat in the empty conference room and began to meditate.

Zhou Ce's diagnosis had a fatal problem - Wang Lin was not infected with streptococcus, but Staphylococcus aureus.

In other words, the treatment plan given by Sun Lien can only suppress his lung infection and hemoptysis, but it does not help the patient's proteinuria.

He must find out as soon as possible what caused Wang Lin's kidney problem.

·
·
·
Sun Lien thought for a long time, but still had no clue.The judgment given by Zhou Ce from the Department of Nephrology was acute glomerulonephritis, but there was no streptococcal infection. This judgment is simply untenable.

Suddenly, Sun Lien had a flash of inspiration.What if Zhou Ce's initial assumption was correct?Kidney problems may last longer, but because the symptoms are not obvious, are they ignored by family members and patients themselves?

He took the patient's medical history compiled by Yuan Pingan and read it again.Soon, he found some suspicious traces in the medical history.

The patient himself has been at the critical value of hypertension for a long time, and was officially diagnosed as stage I hypertension in the physical examination organized by the unit three months ago.

Chronic glomerulonephritis may be triggered by kidney damage from high blood pressure, which may in turn exacerbate elevated blood pressure.Symptoms of proteinuria were also present.Especially for occult glomerulonephritis, the amount of urine protein in patients may be less than one gram a day, and there is no evidence of edema, high blood pressure and renal function decline.

After a lung infection, the burden on the body increases, and the persistent low-grade fever and fatigue lead to a reduction in the amount of exercise for the patient.Coupled with weather reasons, the body's water intake is greater than its output, which increases the burden on the kidneys.

Could this be the real reason for Wang Lin's symptoms?

　Dry and cool server... Illegal access after a little update... It took me a long time to post it
　　
　
(End of this chapter)