I can see the status bar

Chapter 783 Triple Syndrome

The second imaging examination outside the liver and gallbladder proved that Director Zhao did not need to resign.The drainage tube drained smoothly and there was no twisting.

Without reversal, it means that in theory, Lu Chunyu's liver should no longer have the problem of cholestasis - even if the biliary tract is obstructed, it is impossible to continue to accumulate in the bile.However, the biochemical indicators clearly indicated that cholestasis still prevailed in her body.

The second cholangiography was not completely fruitless, and the Department of Hepatobiliary Surgery reported a new situation-the patient's common bile duct was not dilated, and the bile duct in the liver was sparse and stiff.Based on the opinions of the imaging department, they reported a "biliary sclerosis" back.

"Biliary sclerosis? What's this?" Yuan Ping'an and Zhou Ce, who saw the test results, got together and pulled their hair.The two of you looked at me and I looked at you, and then showed tangled expressions together.

"The hardening is normal... Either it's an infection or an immune problem." Zhou Ce muttered, "Anyway, I don't think her blood routine indicators seem to be an infection."

"How fresh?" Yuan Pingan finally found a chance to yell at Zhou Ce, "Three weeks ago we said she wasn't infected."

Yuan Ping'an's reply did not allow him to achieve the desired effect, Zhou Ce still lowered his head and pondered, "Then tell me... will Lao Pa resign?"

"What?" Yuan Pingan was stunned, but he didn't remember who the "Old Pa" Zhou Ce was talking about.After finally understanding, he asked back with a wry smile, "Why did he resign? Then the big house was bought not long ago, and the loan has not been repaid yet."

"There is something wrong with his diagnosis." Zhou Ce said confidently, "This immune problem can't be caused by the bile duct drainage we did, can it? It can't be because of the use of polyene phosphatidylcholine, right? There is no difference now, so it must be that Lao Pa missed the diagnosis."

"So he has to resign?" Yuan Pingan still couldn't understand the logic.After several seconds, he slapped his thigh suddenly, "Hey, are you talking about Director Zhao?"

Overall, the atmosphere is warm and pleasant.The two of them had a good discussion in the empty office about how upright Director Zhao is and how old Pa is...it's disturbing.

"Old Pa has been the director for a long time, and he has made so many diagnoses. It is still wrong." After denouncing Dr. Pascal, Yuan Pingan smacked his lips and said, "The problem is... the old Pa was in the outpatient clinic before. Time, isn't it also very good?"

"You can't check the misdiagnosis rate and missed diagnosis rate in the outpatient clinic." Zhou Ce muttered, "Many patients who come to the outpatient clinic come only once, and they won't come if they are asked to follow up for follow-up checkups." He looked at Yuan Ping'an and asked, "When you were in Tongxie, how many misdiagnoses were there on average?"

"I don't know that either." Yuan Ping'an replied, "Patients in the emergency department, especially those sent to the Tongxie, often become unconscious when they come. Patients who cannot be rescued after a set of examinations are not there. A small number. And I have basically never seen a few family members of patients who would request an autopsy... So the specific misdiagnosis rate is really difficult to calculate."

Zhou Ce leaned back on the sofa, "So, this is the result of our existing medical system. The patient will not be re-examined if he feels better. No one can say for sure how accurate the diagnosis is." He was silent. After a while, he suddenly hesitated, "But...do you think Dr. Sun's high diagnosis accuracy rate is a bit scary?"

Yuan Ping'an's expression was quite normal at first, but after following Zhou Ce's words to ponder for a while, his expression turned serious. "It's really...the patients he took over seem to have never failed to diagnose the problem."

"Patients who can't find out what's wrong, it's fine if he can't meet them." Zhou Ce continued, "Patients that other doctors have misdiagnosed are sent to us. Dr. Sun can figure out what's wrong every time... …He can even use the cause of the misdiagnosis as a clue to the diagnosis.”

The two big men gasped together, and then sighed, "It's so terrifying!"

After matching the incisions with common words in online novels, Zhou Ce brought up Sun Lien's solution again. "Since something went wrong with Old Pa, guess... has Dr. Sun found out?"

"When you say that, I really feel something is wrong." Yuan Pingan came over, pointed to the prescription written by Sun Lien, and said, "Look at this medicine, UDCA, 250mg TID. This medicine is related to the phase three to four phases of PBC." Sorry."

"Ursodeoxycholic acid is useless for this stage, right?" Zhou Ce nodded, "Then he still wants to prescribe this medicine, does he already have an idea?"

The two pondered for a while, but they still felt that they couldn't explain Sun Lien's medication.

"Think about it in a different direction." In order to protect his little hair, Zhou Ce decided to discuss Sun Lien's medication from a different angle. "Why didn't you use UDCA before, but now?"

"Dr. Sun has always recognized Lao Pa's diagnosis before, but biliary drainage cannot reverse the liver cirrhosis caused by cholestasis..." Yuan Ping'an was stunned when he said this, "So, he still recognizes the diagnosis of PBC?"

Zhou Ce nodded, "However, since Dr. Sun recognizes this diagnosis, it doesn't make sense to prescribe UDCA?"

"Either it's because of a problem with the staging, or... UDCA is aimed at other problems." Zhou Ce regained his energy as he spoke, "The mechanism of action of this drug is to adjust the composition of bile and at the same time protect liver cells... "

"And hepatobiliary surgery also reported a biliary stricture..." Yuan Ping'an suddenly opened his eyes wide, "Good guy, he already noticed it?"

"What do you see?" Seeing Yuan Ping'an's performance, Zhou Ce knew he had already guessed something.But after asking two consecutive sentences, Yuan Pingan still frowned and continued to ponder the question, and did not directly answer Zhou Ce's question.Tormented by curiosity, Zhou Ce scratched his head and patted Yuan Ping'an's shoulder, "If you want to enter the famous detective mode, at least tell me what Dr. Sun saw?"

"In fact, we have already thought about this problem." Yuan Ping'an came back to his senses, and then said in his chest, "This is an immune disease, which can be improved or even treated by UDCA, and it is related to the sparse and stiff intrahepatic biliary tract. Contact me directly." At this point, Yuan Ping'an sighed, as if he was a little dissatisfied with the fact that he only now understood the condition, "We and Dr. Sun have exactly the same information, so how can he see it?"

"What are these three diseases? The overlap syndrome of AIH+PBC doesn't match." Zhou Ce pondered for a while, then shook his head and gave up, "I don't understand."

"Old Pa's diagnosis can't be regarded as a misdiagnosis, at most he is a missed diagnosis." Yuan Ping'an sighed, "Dr. Sun must have seen it, and he suspected that Lu Chunyu had a triple syndrome—AIH+PBC+PSC (primary Sclerosing cholangitis)! The use of UDCA is not only to use it to protect liver cells, UDCA is the main treatment drug for PSC, it is a diagnostic treatment..."

(End of this chapter)