bookpower Chapter 381
Chapter 381
"Do another perfect check..."
Lin Feng continued to prescribe liver function, Wilson's disease, immune-related cirrhosis, parasitic liver disease... And so on projects.
Another hour later,
The results came out.
Liver function: albumin level is only 22g/L (normal 35-50),
No viral hepatitis such as hepatitis B and C were found
No Wilson's disease, immune-related cirrhosis, parasitic diseases, etc
Then add the preceding one:
No cirrhosis...
No long-term history of alcoholism...
• But there are esophageal and gastric varicose veins...
Lin Feng revisited the patient Zhang Chen's illness,
That's right!
Patients also:
Mild ascites
The spleen is also somewhat enlarged.
The above two are actually characteristics of cirrhosis.
Principle: The blood of the spleen has to pass through the portal vein of the liver to come back, if the liver is cirrhosis, the portal vein will also be affected, the pressure of the portal vein will become larger, the blood of the spleen will not come back smoothly, and the spleen will also become larger...
And that low protein...
Many patients with long-term bleeding who are very weak do not necessarily have such low albumin levels.
Only those with severe cirrhosis are so low.
Varicose veins, ascites, mild splenomegaly, low protein, all point to cirrhosis.
As a result, the patient turned out not to be cirrhosis!
It's so weird!
Unless, it is a more special disease!
Combined with what the previous patient stated: low back pain, dizziness... There is also anemia.
Lin Feng thought of it,
"Multiple myeloma"!
Concept: A malignant plasma cell disease, malignant proliferation of plasma cells. Plasma cells are specialized in the production and storage of immunoglobulins and are one of the immune cells. Once malignant value-added, a huge number of useless plasma cells will be produced, destroying the surrounding environment, causing osteoporosis and bone destruction, and the patient will have more prominent bone headache manifestations.
Lin Feng looked at the patient Zhang Chen.
"The low back pain you mentioned, in addition to low back pain, is there any pain in other places?"
"This... It seems that there is, and it doesn't seem to be..."
Lin Feng's expression was serious: "To the doctor, don't hide it, what to say!" "
Zhang Chen nodded: "Yes, but only one point, not serious, that is, the back, chest, hands, feet, sometimes it hurts..."
Lin Feng: "Why didn't you say it when you came?" "
Zhang Chen: "I always feel that these things, but I play basketball a lot, it hurts... Dr. Lin, is my illness serious? "
He thought it was just low back pain, how did it become a small pain in other places is also the same disease?
Zhang Chen realized that the problem seemed to be a bit serious.
Lin Feng continued to deduce the condition:
The patient is anemia, and at first thought that it was venous bleeding, resulting in anemia.
But now it seems,
Not necessarily!
If it is "multiple myeloma", the hematopoietic environment will be messed up by a large number of useless plasma cells, and the materials for producing cells are used to produce plasma cells, then there will be fewer normal cells, resulting in hematopoietic dysfunction, fewer red blood cells, and the patient will be anemia.
One more corroborative evidence.
At this point,
The surrounding interns have already begun to talk.
"It seems that Dr. Lin has found the cause..."
"Looks like I found it..."
"Dr. Lin is awesome..."
Lin Feng: ".................."
I glanced at these interns, and the corners of my mouth hooked: or take the opportunity to teach them on the spot.
"Dear students..."
"Doctor Lin..."
"Since they are all here, then I will test everyone..."
When the interns heard this, they were excited.
Intern Heart: Ahem, I'm pretending... The opportunity to perform has arrived!
Lin Feng: "The patient has body pain, dizziness, anemia, varicose veins, ascites, mild splenomegaly and no cirrhosis... What diseases can you associate with? Hint, it's a disease! "
As soon as the interns listened,
Astonished?
Is this caused by a disease?
And then began to rack your brain.
They all wanted to show it in front of Lin Feng.
If he was favored by Lin Feng and became Lin Feng's student, wouldn't he die happily?
Medical record data, all in,
So a group of interns began to look at it one by one.
10 minutes later...
Lin Feng: "Okay, who has an idea?" It's okay to say it boldly, it's okay to be wrong. "
Next
One by one, the interns spoke enthusiastically.
An intern: "Will it be tumor bone metastasis, anemia, low protein are all consumption manifestations, maybe there are hidden malignant tumors that have not been found, such as bowel cancer, lung cancer, etc., after all, colonoscopy and chest CT are not done..."
There was also an intern: "Could it happen that the patient has a serious disc herniation..."
After Lin Feng listened, he was noncommittal, but he shook his head in his heart and didn't say anything.
Although these interns are all from the most powerful medical schools in the country, knowledge is just knowledge, and once it is translated into practice, it will always be a little difficult...
At this moment,
A tall and beautiful female intern with a look of about 90 points raised her hand.
"I think the patient has osteoporosis, maybe some kind of tumor..."
After speaking, he ruffled his hair unconfidently.
Lin Feng's eyes lit up.
Yes, there is a thought point.
Osteoporosis!
On CT, there are signs of osteoporosis, but the CT report is not written.
Lin Feng never said it.
The other students were stunned.
Osteoporosis?
When they look at CT films, they really don't find it!
Lin Feng smiled and nodded: "Specifically..."
The female intern nodded and first brought up the MRI of the lumbar and cervical spine that the patient had done before, as well as the abdominal CT done before admission.
"My consideration is this, the patient's CT did not report obvious bone metastases, nor did all osteoporosis, but this CT image, I can see the signs of osteoporosis..."
Lin Feng smiled and nodded: "Not bad... Go on..."
The female intern continued to analyze: "The patient is only 23 years old, and he likes to play basketball and exercise a lot, it should be impossible to have osteoporosis, but now he has osteoporosis..."
Lin Feng: "And what..."
The female intern was embarrassed: "It's gone... I just think it should be this direction..."
Lin Feng nodded,
"What's your name?"
"Chen Qingru..."
At this moment,
Many interns suddenly showed envious eyes.
This was obviously remembered by Lin Feng, the big guy!
What are the benefits of being remembered by the big guys?
The benefits are great!
As long as you perform well, you can stay in Harmony Hospital, or even be accepted as a student by Lin Feng, that is definitely a step to the sky!
At this time, Lin Feng then scanned a circle of many interns.
"What Chen Qingru said just now makes a little sense, and it's a little close to the goal... Now, let me give you one more hint... It's a hematological disease..."
Lin Feng gave a hint,
When the students heard this, they immediately began to ponder.
"Hematology?"
"What is the disease?"
"Osteoporosis?"
"I know!"
"I know it too, I fuck!"
"What is it? I don't know~~"
Several students raised their hands, and the other students were in a daze.
Lin Feng looked at several students who raised their hands, including Chen Qingru.
Lin Feng decided to give the opportunity to other students...
"Come on..."
Lin Feng pointed his finger at one of the dark-looking male interns, a little humble, with a rural temperament at a glance, it is estimated that it is from the countryside, Lin Feng is willing to give him a chance.
The male intern was excited: "It's "multiple myeloma"!! "
Lin Feng remained silent: "Start your analysis!" "
Male intern: "Just now, the squad leader Chen suggested the symptoms of osteoporosis, thinking of the blood diseases you said by Dr. Lin: Among the causes of osteoporosis, there are only 5 blood diseases, namely: leukemia, lymphoma, multiple myeloma, Gao Xue disease, myelodysplastic syndrome..."
Eloquent.
"So, I think it's multiple myeloma!"
The interns listened,
Multiple myeloma?
Some don't know this,
Some knew, but did not expect, full of chagrin.
Some suddenly realized.
Male intern: "The derivation process is as follows: the amount of vomiting blood this time is not very much, according to the patient's description, at most it is a small bowl of the amount, how can it be so anemia, it should be multiple myeloma caused by too much plasma cell proliferation, resulting in hematopoietic dysfunction..."
Because I guessed the result,
So from the result, the process will be much simpler, and many details will be linked.
It's like watching an episode of Conan and knowing who the murderer is at the beginning, and in the process of watching, anything the murderer does will become the corroboration of the derivation.
But
Obviously, this male intern is obviously not solid enough.
Or not enough practice.
The next derivation, he can't continue.
"What's your name?"
"Shi Yong..."
Shi Yong was excited in his heart, lying in the groove, and was favored by Lin Feng's boss, cool!
The other interns showed envious looks one by one.
Lin Feng did not embarrass these students again.
Started my own derivation:
.