bookpower Chapter 710
Chapter 710
The bleeding situation is better.
But the patient developed a new condition.
When the bed doctor went to the ward rounds, the patient mentioned to him that he was in pain.
And it's still a bone ache.
In addition to lumbar pain, the patient felt that the ischial bones here in the buttocks also hurt, the ribs on both sides also hurt, and the feet also hurt.
All in all, it hurts all over my bones.
Initially.
The bed doctor thought that the patient was too anxious, so he comforted him.
But later it was found that the patient may be really in pain.
And it hurts a lot.
I would mention it every time I saw a doctor, which also attracted the attention of the tube bed doctor.
For patients who believe that this is caused by lumbar disc herniation, the tube doctor is not impressed.
Even a herniated lumbar disc does not cause pain in both ribs.
The patient was told not to rush and left the ICU.
Go directly to the emergency department room.
He reported to Lin Feng: "Dr. Lin, there is something wrong with that patient in the ICU! Since the last time he had a gastroscope, he has been saying that his bones hurt and it looks serious. I suspect that it could be a malignant tumor with bone metastases throughout the body? "
Hearsay.
Lin Feng frowned.
What a situation!
At first, it was still a problem of the digestive tract, and now it is beginning to suspect malignant tumors.
The MRI of the lumbar and cervical spine previously done by the patient was immediately brought up.
There is also a CT of his abdomen before admission.
No obvious bone metastases were reported above, but they were said to have osteoporosis.
A middle-aged man in his fifties who insists on exercising every day, how can there be osteoporosis!
This made Lin Feng suspect that there might really be something wrong.
Then there's the patient's anemia!
There were no bleeding diseases such as hemorrhoids and gastric ulcers before, and the amount of vomiting blood was not very much, how could it be so anemia!
Think of these two cases.
Lin Feng immediately turned over the previous patient's examination.
It was found that the patient's liver function test showed that the albumin level was only 22g/L, and the normal was 35-50.
The situation is getting weirder.
Even if it's bleeding, it's not like this.
Even some weak patients with long-term bleeding do not necessarily have such low albumin levels, which is still the manifestation of patients with cirrhosis.
Immediately, Lin Feng took Xiaoru to the ICU to see the patient's condition in person.
Asked briefly.
The situation is basically the same as what the tube bed doctor said.
It's just that the patient's wife thinks that the patient is exercising regularly, and suddenly hospitalized and can't exercise, so there will be this situation, which is caused by the body being unaccustomed.
As for this statement, Lin Feng just smiled.
Then walked out with Xiaoru and Zhang Donglai, and the doctor in charge comforted the patient and walked out.
The three gathered around Lin Feng.
"The patient is a middle-aged man with gastrointestinal bleeding, gastroesophageal varices, anemia, hypoproteinemia, and bone pain all over the body, what diseases do you all associate with this information?" Lin Feng said softly.
Xiao Ru immediately said: "Teacher, will the patient be a tumor bone metastasis?" Anemia and low protein are all signs of consumption. Maybe the patient has occult tumors that have not been found, such as bowel cancer, lung cancer, etc., after all, colonoscopy and chest CT have not been done! "
The tube bed doctor on the side also nodded in agreement.
Lin Feng smiled.
Zhang Donglai on the side asked in a low voice: "Dr. Lin, could it happen that the patient's lumbar disc herniation is serious?" "
For this proposal, Xiaoru and the tube bed doctor obviously did not agree.
However, Lin Feng did not say anything.
Instead, he whispered, "Here's what I think!" The patient has gastrointestinal bleeding on the surface, but whether it is cirrhosis or stomach ulcer, there is no bone pain. So I agree that patients may have occult conditions, including the possibility of malignancy, so it is reasonable to perfect colonoscopy and chest CT. But what I suspect more is that the patient may be a blood disorder! "
Hearing Lin Feng's words.
The three people at the scene were all stunned!
Extremely shocking!
"Blood disease!"
Lin Feng nodded and continued, "Not bad. There is a blood disorder called multiple myeloma. It is mainly an adverse consequence caused by malignant proliferation of plasma cells. Plasma cells, you should all know. In fact, it is the effector B cell, which is specifically responsible for the production and storage of immunoglobulins, which is one of the immune cells. Once some factors cause the wrong cloning of plasma cells to multiply, a huge number of useless plasma cells will be cloned, and these plasma cells will produce a huge amount of useless immunoglobulins that do not have normal immune function, and then the problem comes! "
After a pause, Lin Feng continued: "Myeloma cells proliferate in the bone marrow, and it is overproliferating, which will destroy the surrounding environment, cause osteoporosis and bone destruction, and the patient will have the performance of bone pain. "
Speaking of this, Lin Feng pointed to the patient in the ICU and continued: "The patient's chest and limbs plus the waist will have pain. The most common is the lumbosacral region, then the chest and back, ribs and lower limb bones, and if you are not careful, you can even break it, this is no joke! "
"Then there's anemia. The hematopoietic environment is messed up by tumor cells, and the materials for producing cells are used to produce plasma cells, then normal cells will become less, red blood cells will be less, patients will be anemia, and more than 90% of patients will be anemic. "
"However, the patient's anemia is not necessarily caused by bleeding, it may be caused by the multiple myeloma itself."
"There may also be fewer platelets. Of course, the patient's low platelets may also be related to splenomegaly, anemia may also be related to splenomegaly, and hypersplenism will eat blood cells. However, the patient's spleen is not very significant, so it is a bit far-fetched to explain anemia and low platelets, and it cannot explain bone pain! "
"As for how to explain hypoproteinemia, the malignant proliferation of plasma cells in patients goes to produce useless globulins, and albumin is naturally reduced."
"In addition, the patient's electrolyte has relatively high blood calcium, and the patient has hypercalcemia, which everyone ignores!"
"The patient's hypercalcemia can also be explained by multiple myeloma, because this disease may cause kidney damage, glomerular filtration is reduced, and blood calcium is naturally high."
"Myeloma! Osteoclasts can lead to bone resorption and also lead to hypercalcemia. "
"Combined with the above information, I think the probability of a patient having multiple myeloma is very high."
"Do a bone marrow aspiration, see if there are abnormal proliferation of plasma cells in the bone marrow. Then draw blood to check immunoglobulin-related tests, serum beta2 microglobulin and so on. "
After saying this, Lin Feng saw that the three were all silent, their eyes were full of shock, and then smiled slightly.
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