This doctor is great

Chapter 234 Dismantling the conditions for the formation of gout

Gout has a name "rich man's disease".

The poor cannot afford this disease. (??)

Why do you say that?

Because the factor of gout is high purine.

"High purine" foods generally appear in seafood such as shrimp and shellfish, as well as animal offal.

Excessive eating, purines will be too high, and then after the body metabolizes, a large amount of uric acid will be produced, and high uric acid levels will appear, which will cause gout.

In addition to these seafood, there is also the most common dish in Guangdong - Lao Huo Liang Soup.

The longer the soup is boiled, the higher the purine.

There is a joke called: "Look, this is a full pot of Laohuoliang (puru) soup (ling)."

Therefore, from the perspective of epidemiological analysis, it can be found that coastal areas, as well as Guangdong, are areas with high incidence of gout.

In addition, drinking alcohol can also increase the risk of gout.

For example, beer has a guanylic acid in its ingredients, which can be metabolized in the body to generate purines.

At the same time, after alcohol is metabolized by the body, it can also produce "lactic acid", which can inhibit the excretion of "uric acid", thereby increasing the risk of gout.

Analyzing gout,

Generally, it is analyzed from two aspects of "high purine" + "excretion".

So beer exists in both aspects, so gout patients should drink as little as possible.

And the patient ate seafood and drank beer yesterday,

So high uric acid - the possibility of gout is very high.

In addition,

Zhou Mo sized up the middle-aged patient Chen Xu in front of him.

is an obese person.

It is estimated to be more than 170 catties.

This body type, climbing knees, will naturally have more serious wear and tear.

in addition,

Obesity also increases the risk of gout.

The specific process is:

——Obesity is prone to insulin resistance, which affects the excretion of uric acid, and at the same time increases the free fatty acids in the body, and affects the activity of xanthine oxidase, resulting in increased uric acid levels...

According to some papers and guidelines seen by Zhou Mo, it is pointed out that the probability of gout in obese patients is 17.8% higher than that of ordinary people.

Therefore,
It can be deduced from this that the patient Chen Xu is obese, and he ate seafood and drank beer last night, so the probability of gout is very high.

In addition to the above two conditions of gout and joint wear and inflammation,
There is another possibility - rheumatism and rheumatoid.

However, these two generally rely on blood tests.

So far,

Zhou Mo's consultation was basically over.

The analysis is very long, but in fact the question is only a few sentences, less than 30 seconds.

Zhou Mo said to Teacher Zhang Mei, "I'm done asking."

"Specifically, my opinion is that there is a possibility of wear and tear arthritis, gout, rheumatism, rheumatoid...even the possibility of all three together."

"It still depends on the results of the blood draw to diagnose the real cause."

After Zhang Mei listened, she nodded, "Okay, if you come here, what kind of inspection do you want to have?"

Zhou Mo: "First of all, the routine blood test must be done, as well as kidney function for uric acid indicators, X-rays, rheumatism immunity items... that's all."

Teacher Zhang Mei nodded: "Okay, that's it."

Zhou Mo's inspection was exactly as she had imagined.

Thinking of this, Teacher Zhang Mei looked at Zhou Mo with admiration.

4 inspections, within 2 hours, all can be completed.

Among them, rheumatism immunity usually takes 3 working days (the inspection process takes 2 hours, but it takes 3 working days to line up, check, and get the results), but the emergency department will be a little different, and the results should be available in 2 hours. .

"Thank you doctor."

The patient's wife thanked him, and then helped the patient Chen Xu out of the consultation room with difficulty.

Teacher Zhang Mei: "Which one do you think it is?"

Zhou Mo shook his head: "The possibilities are quite high, or all three."

Teacher Zhang Mei smiled.

She thinks the same.

……

……

in the afternoon,

Zhou Mo followed Teacher Zhang Mei to the observation ward.

"doctor!"

The wife of the patient Chen Xu waved quickly when she saw Zhou Mo and the two of them.

"Doctor, are the results all out?"

"it is good."

Zhang Mei and Zhou Mo walked over after hearing the words.

Zhang Mei glanced at the patient Chen Xu, his complexion was relatively good, and the pain was not as bad as it was at the beginning.

"Is it better now?"

"Yes, I don't know why, but it didn't hurt so much in the hospital. I obviously didn't take any medicine."

The patient Chen Xu looked puzzled.

"What about the test result?"

"Here... trouble the doctor..."

Teacher Zhang Mei took a few glances, and then handed the result to Zhou Mo.

"Come and analyze..."

Zhou Mo looked at them one by one.

Rheumatic immunity, rheumatoid examination, all negative.

excluded.

Then the blood routine, white blood cells and some items increased, showing inflammation.

The X-ray showed that the joints were damaged to a certain extent, but based on Zhou Mo's experience with X-rays, it was impossible to judge whether it was wear or gout.

In addition,

Zhou Mo's most concerned result:
Kidney function!

The uric acid level is 395umol/L (420umol/L is the cut-off line for gout).

Teacher Zhang Mei: "How is it? What do you think?"

Zhou Mo frowned: "First of all, arthritis can't run anymore. It should be that yesterday's mountain climbing put too much load on the joints, which caused wear and inflammation."

Teacher Zhang Mei: "What about gout?"

Zhou Mo thought for a while and hesitated: "Although the uric acid level has not reached 420, it should be judged that it is not gout, but the standard of 420 is not certain..."

Teacher Zhang Mei was very interested: "Oh? Tell me more about it."

She thought that Zhou Mo would fall into this trap.

result,

Zhou Mo actually understood!
This is awesome!
Are you sure this is a medical student?Not an old demon?

Zhou Mo analyzed it in detail:
"Although the patient's uric acid is only 390umol/L, which is still below the line of 420umol/L, I still think there is a possibility of gout."

beside,

There happened to be an emergency teacher and 3 interns checking on patients on the bed next to them.The so-called interns are the kind of students who have not graduated from school and come to the hospital to see all kinds of things in the hospital, and they will not really work in the hospital.

Then when I heard the conversation between Zhou Mo and Zhang Mei, I couldn't help but look over.

The three interns couldn't help but chuckled when they heard Zhou Mo's words.

joke!

The textbook gout index is 420!

You can’t say 420 now, is it also gout?
Who is this person?

The knowledge is not solid at all!
The three interns looked at Zhou Mo with disdain.

The emergency doctor teacher next to him also felt that Zhou Mo was wrong.

However, all four of them were curious, what happened to Zhou Mo?

Zhou Mo said to Teacher Zhang Mei at this time:

"Gout, according to the guides and papers I saw, can't use the value of 420 rigidly..."

"First of all, let me tell you about the meaning of 420umol/L, which refers to the saturated concentration of uric acid in the body!"

"When the blood uric acid concentration exceeds 420, it is easy to precipitate "uric acid salt".Deposits in the joints then form tophi over the years.Only with the appearance of "uric acid salts" can pain symptoms appear. "

"So, the point is not 420, but the conditions for the formation of urate. "

said here,

The three interns were dumbfounded.

The emergency room teacher was also dumbfounded.

What Zhou Mo said makes sense!
Zhou Mo continued to talk eloquently: "So, what are the conditions for the formation of "uric acid salt"? "

"It's concentration + temperature!"

(End of this chapter)