Edema is a symptom that can be severe or minor. Some girls often complain that their faces are swollen when they wake up, and call it "edema".
In fact, it's just plain fat...
Edema is divided into two types: local and systemic. Mild edema is only seen in the eyelids, infraorbital soft tissue, subcutaneous tissue in front of the tibia and ankle. A slight depression will appear after finger pressure.
There are generally four reasons for this kind of edema: reduced plasma colloid osmotic pressure; increased hydrostatic pressure in capillaries; increased permeability of capillary walls; obstruction of lymph backflow. Corresponding to protein malabsorption and malnutrition, respectively.
Or kidney disease with proteinuria. Venous obstruction or venous return disorder. Infection or inflammatory reaction. Damage to local lymph circulation, or obstruction by parasites and cancer cells.
Judging from the prompts on the status bar, Wang Lin should be in the first situation, suffering from proteinuria and kidney disease.
Tuberculosis generally does not cause kidney disease, let alone proteinuria. Therefore, Sun Lien confirmed Xu Yourong's diagnosis as soon as he saw the patient's condition. This did not look like tuberculosis. Instead, it seemed to be some kind of development and
The symptoms are very similar to tuberculosis infection.
The preliminary diagnosis led by Zhou Jun also eliminated some suspicions for Sun Lien. The sputum smear test result was negative, indicating that there were no pathogens in the patient's sputum that could be directly observed under the microscope. However, the "golden yellow" prompt in the status bar
Staphylococcus aureus infection" also cannot explain why patients suffer from long-term low-grade fever, fatigue and cough. Pneumonia caused by Staphylococcus aureus infection generally manifests as acute suppurative pneumonia. It has a rapid onset and rapid progression, and patients generally present with high fever.
A state of chills, chest pain and purulent phlegm.
In general, if you don’t look at the patient’s condition in the past month and only look at the recent symptoms, it is reasonable to suspect Staphylococcus aureus pneumonia. However, this state still cannot explain the sudden large amount of hemoptysis in the past two days.
Although it is not certain what disease the patient has, it is definitely not tuberculosis. This is Sun Lien's current diagnosis.
For a middle-aged man in his fifties, the lung and kidney problems currently indicated in the status bar may put his life in danger. But what troubles Sun Lien is that he cannot determine what these two problems are.
Which one is more deadly.
"This patient's problem is not simple." Sun Lien briefly shared his analysis process with Zhou Jun. Of course, he omitted the status bar prompts and simply analyzed the patient's disease manifestations, which did not look like tuberculosis.
The reason. Then he suggested, "I suggest that he be transferred to our treatment group."
There have been no new patients in the treatment group for so long that Sun Lien's hands felt itchy.
"Okay." After pondering for a moment, Zhou Jun agreed to Sun Lien's suggestion. Then he took out the phone from his pants pocket. "Dean Liu, there is a new patient who wants to be transferred to Sun Lien's treatment team."
Sun Lien blinked. He almost forgot that his treatment team now has a vice president as a supervisor.
"Dean Liu said that the patient can be admitted, but you have to explain to him why the patient should be admitted after the patient's condition is stable." Zhou Jun nodded towards Sun Lien, "He is under your control now."
"There must be something wrong with the kidneys. As for whether it is glomerular or tubular, or some kind of mixed overflow tissue, it needs to be judged based on other test results." Zhou Ce received a phone call.
A meeting was called to a small conference room. Among the doctors present, except Dr. Pascal, the oldest one, Zhou Ce, was one year older than Xu Yourong.
When Dr. Pascal was called back from the hotel for consultation, he not only showed no dissatisfaction, but also seemed to be very interested. This was the main reason why he came to Ningyuan from the United States! Who would have thought that after coming to Ningyuan, he would be doing cattle work in the outpatient clinic?
Working as a horse, I almost died suddenly from exhaustion. But finally I have work to do now. Comrade Lao Pa geared up and looked at the inspection report in his hand carefully.
Yuan Pingan was reorganizing the patient's condition. Before coming to the conference room, he first went to the patient's family to re-inquire about the condition. He also re-interrogated the patient himself. After comparing the self-reports of both parties, Yuan Pingan
Summarized a relatively accurate case record. And he was also planning to re-screen the cause based on the case records and progress. The patient had already undergone lung lavage sampling, but the laboratory department said that the culture would take at least three days. If it could be done as soon as possible
By narrowing the scope of suspicion, it may be possible to confirm it through PCR testing, which can save a lot of time for patient treatment.
Xu Yourong was very quiet. Apart from occasionally translating the case contents to Dr. Pascal, she mostly observed Sun Lien's movements. Sun Lien confirmed her diagnosis, which made Deputy Chief Physician Xu feel a little proud. But the more important thing was that she was still very quiet.
Confused. She compared the course and progress of the patient's disease many times before making the judgment that "it may not be tuberculosis." But Sun Lien only took a look at the patient and knew that the patient's legs were covered with edema under the quilt.
Although Sun Lien explained it by saying "the patient had slight edema on the eyelids", Xu Yourong still couldn't figure out how Sun Lien could see the edema that he didn't see and the patient didn't notice at a glance, and based on it, supported
Did you diagnose yourself?
Sun Lien was recording the patient's symptoms on a whiteboard. He wrote with a black pen "Cough, low fever, fatigue, lasted for one month; cough worsened, coughing up 200ml of blood, lasted for two days; difficulty breathing, lasted for one day; slight edema, lasted for one month
"What you are doing now is really a bit like House." Dr. Pascal looked at the writing on the whiteboard and smiled. "It's just that you don't make fun of us little ducks, and you're not as magical as him."
Sun Lien capped his pen and said seriously, "Besides, he is the chief physician, and I am just a junior practitioner." He smiled and pointed to the record sheet on the whiteboard behind him, "Judging from this record, the patient's condition is mainly
It is divided into two stages." He pointed to the first line and said, "First the respiratory symptoms lasted for more than a month, and then the condition suddenly worsened within two days."
"The duration of proteinuria and mild edema has not been determined. It is possible that it has continued for a month or even longer?" Zhou Ce put forward a different opinion, "If his kidney symptoms are not secondary to lung disease, but primary to
The kidneys, and then what about the lungs?”
"Then the diseases we need to consider include lupus erythematosus, renal arteriosclerosis, gout kidney, congestive heart failure, heavy metal poisoning, multiple myeloma..." Dr. Pascal casually listed a long list of disease names.
If we check them one by one, it will probably take close to a month."
Sun Lien didn't take Zhou Ce's suggestion too seriously. After all, there was already a pulmonary infection prompt on the status bar. This proved that Wang Lin's current condition must be related to pulmonary infection. Regardless of whether the infection is spread through blood or lymphatic channels, they
It will only appear in multiple places at the same time, instead of infecting the kidneys first, then giving up its base camp, and moving all to the lungs. If Staphylococcus aureus first causes kidney disease and then moves to the lungs, the kidneys should still be golden.
The focus of infection is Staphylococcus aureus.
"Combined with the blood routine and urine test results, it looks more like glomerulonephritis. And it should be acute." Zhou Ce made his own diagnosis. "Acute glomerulonephritis mostly occurs after streptococcal infection, and pneumonia
Streptococcal infection may explain both the patient's pulmonary symptoms and proteinuria."
"I agree." Xu Yourong and Dr. Pascal both nodded.
Sun Lien pondered for a while. Although Streptococcus pneumoniae and Staphylococcus aureus are not the same thing at all, they are both Gram-positive representative bacteria and have a considerable degree of commonality in treatment. The only thing that needs attention is
Yes, Staphylococcus aureus is highly resistant to penicillin antibiotics, but Streptococcus is not.
"Give him cefuroxime sodium, plus oral roxithromycin, give him protamine, and monitor his coagulation time." Sun Lien gave his initial treatment plan. "Maintain oxygen and perform 24-hour cardiopulmonary therapy.
Monitor. If the treatment is effective, transfer the patient to the respiratory medicine department."
The diagnostic team adjourned, and Xu Yourong and Dr. Pascal went to the emergency room to order prescriptions. Sun Lien sat in the empty conference room and began to meditate.
There was a fatal problem with Zhou Ce's diagnosis. Wang Lin's infection was not streptococcus, but Staphylococcus aureus.
In other words, the treatment plan given by Sun Lien could only suppress his bilateral lung infection and coughing up blood, but it did not help the patient's proteinuria.
He must find out as soon as possible what caused Wang Lin's kidney problems.
Sun Lien thought about it for a long time, but still had no idea. Zhou Ce from the Department of Nephrology gave the diagnosis that it was acute glomerulonephritis, but without streptococcal infection, this judgment was simply untenable.
Suddenly, Sun Lien had an idea. What if Zhou Ce's initial assumption was correct? The kidney problem may last longer, but because the symptoms are not obvious, it is ignored by the family and the patient himself.
He took the patient's medical history compiled by Yuan Pingan and read it again. Soon, he found some suspicious traces in the medical history.
The patient himself has been at the critical level of hypertension for a long time. During the physical examination organized by his unit three months ago, he was officially diagnosed with stage one hypertension.
Chronic glomerulonephritis may be caused by kidney damage caused by high blood pressure, and may in turn aggravate the increase in blood pressure. It also shows symptoms of proteinuria. Especially for latent glomerulonephritis, the amount of protein in the patient's urine may be insufficient in a day.
One gram, and there are no symptoms of edema, hypertension and renal function decline.
After pulmonary infection, the burden on the body increases, and persistent low-grade fever and fatigue cause the patient to reduce the amount of exercise. Coupled with the weather, the amount of water in the body is greater than the amount of water, which increases the burden on the kidneys.