bookpower Chapter 402
Chapter 402
Wang Qing: "After eating the roasted goose, I have to say that the roasted goose in the imperial capital is not so delicious... Later, I went to eat a barbecue..."
Lin Feng: "Did you eat seafood?" "
Wang Qing: "I didn't eat..."
Lin Feng: "Did you drink beer?" "
Wang Qing: "Drinking... Because I eat barbecue, I drink a lot of beer, I can drink more, 2 cases (proud ·jpg)..."
Lin Feng: "..........................."
What a fart!!
Lin Feng glanced at the patient Wang Qing.
Height 160+, weight 160+...
Obviously,
It's an obese person...
On the one hand, this weight, a lot of exercise can lead to knee damage ...
On the other hand, it is still related to the problem of gout.
The body of obese people is more likely to develop "insulin resistance", which affects the function of "kidney excretion of uric acid", and also leads to an increase in free fatty acids in the body and affects the activity of xanthine oxidase, resulting in increased uric acid levels and inducing gout.
Obese people have a higher chance of developing gout, statistically 17.8% higher.
So
Conclusion 2: The patient Wang Qing is obese + drinks beer, and the probability of gout is very high.
(PS: Patients with gout for a long time will appear tophi (see the chapter picture), which is very obvious and easy to touch and see.) But if it is a patient who has just developed gout, there is no tophi. ）
Osteoporosis is then excluded.
"Did you think you had osteoporosis before?"
"Osteoporosis? I don't, I've always been in good health, and I play basketball a lot..."
Wang Qing was very emotional and obviously did not want to lose face in front of his girlfriend.
Lin Feng: "Do you have a sore back or sore body, or have difficulty turning over, sit-up and walking?" "
Wang Qing shook his head repeatedly: "No, no..."
Lin Feng nodded.
Conclusion 3: Temporarily rule out osteoporosis!
As for the fourth "rheumatoid arthritis", rheumatic diseases are relatively hidden and require laboratory tests to get results, so Lin Feng didn't ask.
Here it goes,
Lin Feng's consultation session was basically over.
Then the physical examination, pressed the lower knee joint, the patient Wang Qing screamed in pain...
"Okay, go draw blood and do a test..."
Lin Feng's initial consideration is "gout + joint injury".
"Go draw blood, do a blood routine, kidney function (uric acid index) test... Then take an X-ray of your knee to see how the damage is..."
Lin Feng opened 3 orders.
As for rheumatism, I will not check it, because it will take 2 days to get results.
And Lin Feng feels that the probability of "gout" is as high as 99%...
"Go check it out..."
Lin Feng handed the checklist to the patient Wang Qing.
"Thank you Dr. Lin..."
The patient leaves the consultation room with the checklist, goes to pay the bill, check the exam...
......
An hour later,
All the results are out.
Blood count: increased white blood cells (with inflammation)
Kidney function: uric acid 390umol/L (420umol/L is the dividing line that defines gout)
· X-ray: soft tissue swelling, osteoporosis, subchondral osteosclerosis after disease progression, and/or articular surface cystic degeneration, invasive bone destruction.
Lin Feng smiled after reading the report.
First of all, the blood routine goes without saying, indicating inflammation.
Secondly, X-rays also showed joint damage, arthritis...
So
Arthritis can't run!
The key is, is there "gout"!!
Lin Feng glanced at Chen Qingru, a student beside him.
"Xiaoru, test you... After reading these three examination reports, can it be ruled out that the patient is gout? "
Chen Qingru glanced at the uric acid indicator and replied.
"Teacher, obviously, the patient's uric acid is only 390umol/L, and it can't reach the dividing line of 420umol/L, which is obviously not hyperuricemia, so obviously, it is not "gout"."
"Are you sure?" Lin Feng said with a smile.
"I'm sure!" Chen Qingru still remembers this very well, after all, it is something in the textbook.
Lin Feng laughed: "Then I'll tell you the answer... You answered wrong... Although the patient's uric acid index is not 420, it is still possible to have gout..."
"Huh?"
Chen Qingru was stunned for a moment.
"Teacher, what's going on?"
Lin Feng smiled: "Some diseases, you can't simply follow the indicators... It is still necessary to analyze specific problems on a case-by-case basis..."
And then
Lin Feng began to teach:
"How did the dividing line of 420umol/L come about?!"
"It is the saturated concentration of uric acid in the body!"
"When the blood uric acid concentration exceeds 420, it is easy to precipitate uric acid crystals and deposit them in the joints, causing pain. (It adds up to tophi for many years)"
Lin Feng first talked about its cause.
Then start the analysis:
"When the body temperature is lower than 37 ° C, the saturation of uric acid in the body will also be reduced accordingly, and even if uric acid
"It's October, the temperature was 5 degrees last night, and the temperature of the human body will definitely decrease, causing a decrease in uric acid saturation and the deposition of uric acid crystals..." (So, gout patients, can not catch a cold)
"In addition, the patient climbed the Great Wall yesterday, exercised a lot, caused joint damage, naturally there was inflammation and infection, infection can lead to tissue cell destruction, PH value drop (severe is metabolic acidosis, written near chapter 219 above), thereby inducing the attack of gout..."
Chen Qingru nodded.
Got it!
It turns out that there is such a saying.
Sure enough, what textbooks teach is still too basic.
Lin Feng called nurse Xiao Ai at this time:
"Xiao Ai, draw blood for him (patient Wang Qing) and do a blood gas analysis..."
In blood gas analysis, there is an indicator that is "blood acidity and alkalinity"
Xiao Ai drew blood...
Put it in the analyzer...
Soon the results came out...
Blood pH: 7.36... (less than 7.4)
It's the same as Lin Feng said!
Comprehensive PH value + low temperature, it is probably deduced that the patient's condition should be "gout + joint damage"!
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PS: In addition to the aforementioned soup + seafood + beer + obesity, high blood pressure is also a factor.
There's another factor: fructose.
Commercially available beverages basically contain a lot of fructose,
Fructose is a carbohydrate that can increase blood uric acid levels, can promote uric acid synthesis, inhibit uric acid excretion (make uric acid + excretion have problems, twice the side effects), so a large amount of fructose drinks can increase blood uric acid levels.
It is also a common cause of gout in many young people.
In the past, gout was a disease of older people.
In recent years, young people have begun to have more problems, apparently with drinks.
(What is fructose?) It is a monosaccharide, an isomer of glucose, with the formula C6H12O6. ）
Therefore, drinking water is healthier than drinking drinks.
ps2: Chapter picture: Tophi photo (choose one less disgusting).
ps3: Update complete...
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