radiothebook Chapter 385
Chapter 385
Chapter 385
“Make another perfect check…”
Lin Feng continued to prescribe liver function, hepatolenticular degeneration, immune-related liver cirrhosis, parasitic liver disease, etc. to the patients.
After another hour,
The result came out.
·Liver function: albumin level is only 22g/L (normal 35-50),
·No viral hepatitis such as hepatitis B and C
·No hepatolenticular degeneration, immune-related liver cirrhosis, parasitic diseases, etc.
Then add the preceding:
·No cirrhosis…
·No long-term history of alcohol abuse…
·But there are esophageal and gastric varices…
Lin Feng stroked the patient Zhang Chen’s disease again,
correct!
The patient also:
·Mild ascites
·The spleen is also somewhat enlarged.
The above two are actually characteristics of liver cirrhosis.
·Principle: The blood of the spleen must go back through the portal vein of the liver. If the liver is hardened, the portal vein will also be affected. The pressure of the portal vein will increase, the blood from the spleen will not return smoothly, and the spleen will also become larger…
And that low protein…
Many frail patients with long-term bleeding do not necessarily have such low albumin levels.
Only those patients with severe liver cirrhosis are so low.
Varicose veins, ascites, slight splenomegaly, low protein, all point to liver cirrhosis.
The patient turned out to be not cirrhosis of the liver!
It’s weird!
Unless, it is a special disease!
Combine what the patient said before: low back pain, dizziness…and anemia.
Lin Feng thought,
“Multiple myeloma”!
Concept: A malignant plasma cell disease, the malignant proliferation of plasma cells. Plasma cells are specifically responsible for the production and storage of immunoglobulins and are one of the immune cells. Once the malignant increases in value, a huge number of useless plasma cells will proliferate, destroy the surrounding environment, cause osteoporosis and bone destruction, and patients will have more prominent bone headaches.
Lin Feng looked at the patient Zhang Chen.
“The low back pain you mentioned, apart from low back pain, is there any other pain in Yiyi?”
“This…it seems to have, and it doesn’t seem to be…”
Lin Feng’s expression is serious: “Don’t hide from the doctor, what do you say!”
Zhang Chen nodded: “Yes, but only one point, not serious, that is, the back, chest, hands, feet, sometimes pain…”
Lin Feng: “Why didn’t you tell me when you came?”
Zhang Chen: “I have always felt this, but it’s only because I play a lot of basketball that it hurts… Dr. Lin, my illness is very serious?”
He thought it was just low back pain. How could it become the same disease as the small pain in other places?
Zhang Chen realized that the problem seemed a bit serious.
Lin Feng continued to deduce the condition:
The patient has anemia. At first, he thought it was anemia caused by venous bleeding.
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 all the cell-producing materials are used to produce plasma cells, then there will be fewer normal cells, leading to hematopoietic dysfunction. With fewer red blood cells, the patient will become anemia.
One more corroboration.
at this time,
The interns around have already started talking.
“It seems that Dr. Lin found out the cause…¨々…”
“It looks like I found it…”
“Doctor Lin is awesome…”
Lin Feng: “………………”
Looking at these interns, the corner of his mouth twitched: Why not take the opportunity to teach them on-site.
“Fellow students……”
“Doctor Lin…”
“Since all are here, I will test everyone…”
The interns were excited when they heard it.
Inside the intern: Ahem, I pretend to be forced… The opportunity to perform is here!
Lin Feng: “The patient suffers from general pain, dizziness, anemia, simultaneous varicose veins, ascites, mild splenomegaly and no liver cirrhosis… What disease can you think of? Just remind it, it is a disease!”
When the interns listened,
surprise?
Is this caused by a disease?
Then began to rack his brains to think about it.
They all want to show up in front of Lin Feng.
What if you are attracted by Lin Feng and become a student of Lin Feng, wouldn’t you be so happy?
The medical records are all there,
So a group of interns began to watch them one by one.
10 minutes later……
Lin Feng: “Well, anyone has an idea? Say it boldly, it doesn’t matter if it’s wrong.”
Next,
One by one interns spoke enthusiastically.
An intern: “Could it be tumor bone metastasis? Anemia and low protein are all signs of consumption. 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 is also an intern: “Could it happen that the patient’s intervertebral disc herniation is serious…”
After Lin Feng listened, he didn’t comment, but he shook his head in his heart and didn’t say anything.
Although these interns are from the most powerful medical schools in the country, knowledge is only knowledge. Once it is transformed into practice, it will always be a little difficult…
at this time,
A tall and beautiful female intern who looked about 90 points raised her hand.
“I think the patient has osteoporosis, it may be some kind of tumor…”
After finishing speaking, he fluffed his hair unconfidently.
Lin Feng’s eyes lit up.
Not bad, one thought of it.
Osteoporosis!
On CT, there were signs of osteoporosis, but the CT report was not written.
Lin Feng never talked about it.
The other students were stunned.
Osteoporosis?
When they watched the CT film, they really didn’t find it!
Lin Feng smiled and nodded: “To be specific…”
The female intern nodded and first called up the MRI of the patient’s lumbar and cervical spine, as well as the abdominal CT done before admission.
“My consideration is this. The patient’s CT did not report obvious bone metastasis, nor did all osteoporosis, but this CT imaging, I can see signs of osteoporosis…”
Lin Feng smiled and nodded: “Yes… continue…”
The female intern continued to analyze: “The patient is 23 years old, and he also likes to play basketball and exercises a lot. It should be impossible for osteoporosis, but now there is osteoporosis…”
Lin Feng: “What else…”
The female intern is embarrassed: “No…I just think it should be in this direction…”
Lin Feng nodded,
“What’s your name?”
“Chen Qingru…”
this moment,
Many interns suddenly looked envious.
This is obviously remembered by Lin Feng, the big guy!
What are the benefits of being remembered by the boss?
The benefits are great!
As long as you behave well, you can stay in Harmony Hospital and even be accepted as a student by Lin Feng.
At this time, Lin Feng then scanned many interns.
“｀” What Chen Qingru said just now makes sense, and he is a bit close to the goal… Now, let me give you a reminder… This is a hematology disease…”
Lin Feng gave a hint,
When the students heard it, they immediately began to think hard.
“Hematology?”
“What’s the disease?”
“Osteoporosis?”
“I see!”
“I know too, 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…
“You do it……”
Lin Feng pointed his finger at one of the dark-looking male interns. He was a bit simple and honest. At first glance, he had a rural temperament. It is estimated that he came from the countryside. Lin Feng is willing to give him a chance.
The male intern was very excited: “It’s “multiple myeloma”! ! ”
Lin Feng calmly said, “Start your analysis!”
Male intern: “Squad leader Chen just reminded you of the symptoms of osteoporosis. Think of the blood disease you mentioned by Dr. Lin: Among the causes of osteoporosis, there are only 5 blood diseases, namely: leukemia, lymphoma, and multiple diseases. Myeloma, Gaucher disease, myelodysplastic syndrome…”
Talk freely.
“(Good Wang) So, I think it’s multiple myeloma!”
All the interns listened,
Multiple myeloma?
Some don’t know this,
Some knew it, but they didn’t expect it, full of chagrin.
Some suddenly realized.
Male intern: “The derivation process is as follows: the patient’s hematemesis is not too much this time. According to the patient’s description, it is at most a small bowl. Why is the anemia so severe? It should be caused by multiple myeloma. Too many plasma cells proliferate, leading to hematopoietic dysfunction…”
Because I guessed the result,
Therefore, from the results, the process will be much simpler, and many details will be connected.
It’s like watching an episode of Conan. You know who the murderer is from the beginning. During the watching process, anything that the murderer does will become evidence of deduction.
but,
Obviously, this male intern is obviously not sufficiently knowledgeable.
Or not enough practice.
He couldn’t proceed with the following derivation.
“What’s your name?”
“Shi Yong…”
Shi Yong was agitated in his heart, fucking, he was taken by Lin Feng’s boss, cool!
The other interns showed envious expressions one by one.
Lin Feng did not embarrass these students anymore.
Started my own derivation:
..