I can see health

Chapter 242 The End of the Diagnosis (Second Update)
Everyone returned to the doctor's office, first revised the doctor's order ordered by Li Yao, and then began to write the course record.

Lu Chen specifically asked the nurse on duty to pay attention to the doctor's order for the 10-bed patient to draw blood.

Because these correspond to different time periods, it is easier to miss them.

This morning, Lu Chen was quite busy, except for going to the bathroom, he basically had no time to rest.

Of course, the Department of Cardiology itself is one of the busiest departments in the internal medicine system.

As long as Lu Chen is still in the Cardiology Department, this kind of busy clinical life will be commonplace.

In contrast, Zhou Wei lived a life of "raising mice" ahead of time.

Although Zhou Wei is also a master's degree, his supervisor is in the rising stage of his career, and there is a shortage of people in the laboratory. After various coordination, he was temporarily transferred to the laboratory.

Therefore, Zhou Wei stayed in the laboratory every day, basically not in the clinical department.

However, although the clinical work is hard, the scientific research life in the laboratory is not much better!

"I also want to go to the clinic! Raising mice is not only troublesome, but also really smelly!"

During lunch, Zhou Wei couldn't help complaining to Lu Chen.

"Besides, no matter what I say now, I'm a master's degree, and I still have to take the final exam for the regular training in the future. If I fail the exam, then I won't be able to get my graduation certificate!"

"Don't worry, the instructor won't let you stay in the laboratory all the time." Lu Chen comforted, "You are equivalent to double cultivation. In the future, you can not only do clinical research, but also engage in scientific research. It will be beneficial to find a job or study for a Ph.D. of."

Zhou Wei sighed lightly: "I can only think so now. But within half a year, I won't be able to get out of the laboratory."

"Try to get an SCI, if you can, then it's worth it!" Lu Chen smiled.

"Hey, SCI can't just post it if you want to!" Zhou Wei shook his head and said with a wry smile, "What's more, I'm just a handyman, can you bring my name, just say it!"

Lu Chen smiled helplessly.

This is also the embarrassment of most graduate students.

Do nothing, nothing!

If you do, it may be useless.

Before I have really mastered the key technologies, whether I can post articles depends on the character of the instructor.

……

In the afternoon, as soon as Lu Chen came to the department, he received a piece of unexpected and delighted news from Sun Guoguo.

Dong Hao's radiofrequency ablation surgery was scheduled for the day after tomorrow.

At that time, Lu Chen can go to the catheterization room on the fourth floor together to watch the entire operation process up close.

For a graduate student, this opportunity is extremely rare!
According to Sun Guoguo, this opportunity was won by Mr. Li Yao with him.

This can be regarded as a reward for him winning the first place in the case discussion last weekend!

Compared with the 2000 yuan, Lu Chen would rather choose this opportunity to observe the operation.

What's more, electrophysiological surgery is almost free of radiation effects.

Today, Lu Chen spent the whole day busy.

……

the next day.

The test results of 10 patients came out!

The final result confirmed the analysis of Director Li Yao and Lu Chen.

患者凌晨0点的皮质醇（激素）是402μg/L（参考值55-168μg/L），早上8点皮质醇是450（参考值150-552μg/L），下午16点是578（参考值55-248μg/L）。

It can be clearly seen that the cortisol levels at 0 o'clock and in the afternoon are much higher than normal levels.

And adrenocorticotropic hormone (ACTH) was measured <1.0 (reference value 25-100ng/L).

This is also consistent with Cushing's syndrome!
ACTH is secreted by the pituitary gland to control hormone secretion by the adrenal glands.

Theoretically, if ACTH is secreted more, the adrenal gland will secrete more hormones, because the pressure from above is greater.

But now the patient's ACTH is obviously less.

This is easy to understand, which shows that the increase in cortisol secretion in patients has nothing to do with the pituitary gland. It is not the pituitary gland that makes the adrenal gland secrete more hormones, but the adrenal gland secretes so many hormones on its own initiative.

The more hormones secreted by the adrenal gland, it will naturally feed back to the pituitary gland. The pituitary gland feels that the adrenal gland has already secreted so many hormones, so there is no need to beat it, and there is no need to put pressure on it, so it secretes less ACTH.

This is the classic negative feedback regulation in the human body!

"Junior brother, do you understand?" Lu Chen told Wei Zhongwen all the principles of negative feedback.

Wei Zhongwen shook his head with a confused look in his eyes.

Lu Chen was not impatient and explained patiently.

Junior brother Wei is a potential source of gratitude, so he needs to take care of it carefully!
Lu Chen thought for a while, then continued:

"Junior brother, think about it, the pituitary gland is the boss, and the adrenal gland is the employee. If you want the employee to work more (secrete cortisol), the boss has to keep urging (secreting ACTH, the purpose is to urge the adrenal gland to work). "

"Now we see employees doing a lot of work (secreting a lot of hormones), but the boss didn't urge them (ACTH is very low), instead they don't talk much (ACTH is really too low), why?"

"Because the employees are now working like crazy, working desperately, and secreting a lot of hormones. After seeing this situation, is the boss still ashamed to urge the employees? There is no reason to urge the employees anymore, so ACTH secretion That's less. Negative feedback regulation is justified!"

Wei Zhongwen suddenly realized, "Brother, it seems to be the reason you said."

"Congratulations, I received the thank you value from Wei Zhongwen!"

Sure enough, hard work pays off!
……

The next step is to improve brain MRI and adrenal CT.

A head MRI is done to confirm that the pituitary gland is fine.

Adrenal gland CT is done to confirm that the problem is in the adrenal gland. Whether it is adrenal adenoma or adenocarcinoma, it must be seen clearly.

In the afternoon, the patient's head MRI was done first, and the results came out.

The pituitary gland is really innocent, all right, without any tumors.

The patient was a little apprehensive, and immediately went for kidney and adrenal CT.

In the eighth district of the heart, doctors from Li Yao's group gathered around a computer.

Everyone is waiting for the results of kidney CT and adrenal CT.

After the patient has completed the CT scan, the images are uploaded to the case system.

Lu Chen immediately clicked on the image map, looking at the shape of the patient's kidneys frame by frame.

"There really is something!"

Lu Chen noticed that there was a small lump in the patient's right adrenal gland, about 3cm in size.

Needless to say, this small lump must be the murderer that caused the abnormal increase in hormone secretion!

About 10 minutes later, the report from the CT room came out.

The diagnosis in the CT report is: right adrenocortical adenoma (high possibility)!
Since then, the truth has finally come out!
When Lu Chen informed the patient and his family of the results, they finally breathed a sigh of relief.

Because judging from the film, it looks more like an adenoma than a cancer.

Adenomas are easier to manage.One cut and done.

……

"Please come to the urology department for consultation!" Li Yao ordered.

Soon the urologist was called to the cardiology office.

The outpatient doctor finally decided to transfer the patient to another department, and the small tumor was excised laparoscopically.

The patient's family naturally agreed immediately!
Lu Chen didn't say anything, and directly helped him go through the transfer procedures, and the patient was transferred to the Department of Urology on the same day.

"Congratulations, the completion of the system upgrade has increased!"

The system beep sounds.

Lu Chen is one step closer to the next upgrade!
……

The eighth district of the heart, the doctor's office.

Although the patient was transferred to another department, all the doctors in Li Yao's group, including Sun Guoguo and Fan Zhiping, were amazed when they recalled the patient's diagnosis process.

From suspected myocardial infarction, aortic dissection, to suspected hypertrophic cardiomyopathy, to Cushing's syndrome and adrenocortical adenoma.

Whenever you think you've reached the diagnostic endpoint, it's often just the beginning!
　It's too late to go home today, just two more.

　　
　
(End of this chapter)