Chapter 263 Director Zheng asks for help. It is not necessary to get to the bottom of the problem when treating a disease.
Although we now live in a society ruled by law, there are too many people who take risks for huge profits.
There have been cases where female stars were kidnapped by criminals and then suffered various injuries.
Su Qianqian is like a mirror, and Zhou Can will never allow her to be broken.
"I know! I'm not a three-year-old child, I will be extra careful. But I'm still very touched and happy that you care about me so much! (Smiley face)"
After chatting with her, Zhou Can waited for Wei Fang to arrive.
Some people may not believe it, but these days, if you have money and show favors, you can really buy the loyalty of your subordinates.
Wei Fang was so poor at the time that he didn't even have money to see a doctor.
If Zhou Can hadn't spent a huge amount of money to help her treat her illness, her fate would be completely different from what it is now.
She is a woman who came from the mountains and knows how to be grateful more than women who grew up in the city.
Now Zhou Can has given her a high-paying and stable job, so that she can honor her grandmother who raised her and let her and her grandmother experience the wonderful life in the big city.
Her gratitude and loyalty to Zhou Can were directly reflected in her actions.
He has been protecting Su Qianqian for Zhou Can diligently and responsibly, and so far, there has not been any mistake.
This time, to deal with Hu Wei, Zhou Can needs Wei Fang to implement the dark link.
…
After dinner, Zhou Can will probably spend the afternoon in the interventional operating room and the inpatient department if nothing unexpected happens.
We were busy until around four in the afternoon, and Director Shang left in a hurry because of something.
Zhou Can came out of the operating room and returned to the ward to take care of the patient in bed 12 that he was in charge of.
I thought taking care of bed 11 was already the limit.
Unexpectedly, Director Shang saw that he was still able to handle so many beds with ease, so he added another bed for him.
Moreover, the patients assigned to him are almost all difficult and complicated patients or high-risk patients admitted by the group.
What else can Zhou Can say when he has a teacher who thinks highly of him?
You have to bear it even if you have to shed tears!
However, for him, even though he was taking care of twelve inpatients at the same time and often had to see patients and perform surgeries, he still didn't find it very stressful.
The most time is spent on writing medical records and medical history, and discharging patients.
As for running errands such as getting test results for patients or delivering materials to the medical department for signature, he had never been assigned any such tasks.
He had just finished examining the twelve patients under his care and had made appropriate adjustments to the medical advice for some of them.
Just as I was sitting in the office and preparing to take a break, someone came to my door.
"Doctor Zhou, are you busy now?"
Huang Liang, who used to look down on Zhou Can, now has a smile on his face when he sees him.
Strength is a good thing. It can make these arrogant opponents convinced and lick him with the most flattering smiles.
"Doctor Huang, what's up?"
Zhou Can knew that this guy would never come to his house for no reason, and now that he came to his house with such a shameless face, he must have something to ask for.
"Well... it's like this. My teacher, Director Zheng, is currently seeing patients at the outpatient clinic. He encountered a difficult case and is a little unsure about how to handle it. Director Shang is not in the hospital right now, so he would like to ask you to come over and help with the consultation."
Director Zheng is also a famous expert in gastroenterology.
However, he is not as famous as Director Shang.
As for the level of diagnosis and treatment, that depends on personal opinion.
The fact that Director Zheng was so embarrassed that he personally sent someone to invite Zhou Can to "consult" was enough to show that Zhou Can's status in the Department of Gastroenterology had really improved.
Director Zheng would only take action if he felt that inviting Zhou Can over might help him solve the problem.
I believe Director Zheng must have considered it many times before sending Huang Liang to invite Zhou Can.
"I'll go right over with you."
Zhou Can drank two sips of water, stood up and left.
Director Zheng personally sent someone to invite us, so we have to give him this honor.
Following Huang Liang, they came directly to the No. 2 special specialist clinic in the outpatient department and walked in directly.
"Hello, Director Zheng!"
Zhou Can lowered his posture and took the initiative to greet.
It is said that when you give someone a rose, the fragrance lingers on your hands.
Even though he was asked by Director Zheng to help, Zhou Can still fully considered Director Zheng's face.
Taking the initiative to say hello is the best respect.
"Doctor Zhou is here, please come and sit down!"
Director Zheng smiled and waved to Zhou Can to come over and sit down.
In front of the family members and the patient, Zhou Can did not hesitate to sit down next to Director Zheng.
The other two young doctors stood there watching and smiled at Zhou Can in a friendly manner.
His eyes were clearly filled with envy and friendliness towards Zhou Can.
"This patient had frequent abdominal pain a year ago, and the symptoms were relieved after defecation. Until a month ago, the patient suddenly had diarrhea and loose stools were watery. At most, he had diarrhea more than ten times a day, and the average number of diarrhea times was no less than five times a day. In the past week or so, the patient took antidiarrheal drugs, but the symptoms did not alleviate, but worsened. In addition to diarrhea, he also had symptoms of thirst, polydipsia, polyuria, and large urine volume."
Diarrhea is the most likely cause of dehydration.
Especially if the diarrhea lasts for a long time, no one can resist it.
It is a normal reaction for the body to feel thirsty and need to drink a lot of water.
"The patient lost more than 10 kilograms in a very short period of time, and his chest would occasionally become red, which would last for about 10 minutes and then disappear."
According to Zhou Can's diagnosis and treatment experience, if a patient loses more than ten pounds in a short period of time, it is a serious problem.
It is often a sign of a serious illness.
"Is that him?"
Zhou Can looked up at the patient sitting there. The family member should be the patient's mother. She was a woman in her fifties with tanned skin, thick bones in her hands, and the skin on the back of her hands looked very rough.
This is a miserable woman.
"Yes, yes, yes, my son is sick. Please take care of him, doctor." The patient's mother was an honest woman. She did not look down on Zhou Can just because he was young, but showed him the same respect and courtesy.
On the contrary, the young patient himself did not seem to have much hope in Zhou Can.
I understand.
After all, Zhou Can was very young, even younger than this patient.
"Have you checked your physical?"
Zhou Can asked Director Zheng.
The physical examination upon admission actually covers a lot of information, including the patient's condition, whether he was carried or walked, his body shape, and the measurement of basic vital signs.
Judging from the appearance, the patient is thin, but not to the point of being frightening.
Zhou Can has seen some patients in the critical care unit who were so thin that they were just skin and bones. That was really scary.
"I have checked it. The patient's physical examination data, chief complaint, medical history and other information are all recorded here."
Director Zheng showed the medical record to Zhou Can.
The patient was admitted to the hospital for physical examination. He was slightly emaciated, conscious, with normal blood pressure, respiration, and pulse. There were no abnormalities in the heart and lungs. His abdomen was soft when pressed, and no obvious mass was felt. There was shifting dullness in the abdomen , and no edema in the lower limbs.
Some patients with severe diarrhea may experience tight abdominal muscles, abdominal bloating, fluid accumulation, etc.
When pressed, the abdomen of this type of patient is often hard.
This patient's abdomen was soft to the touch, and many causes were immediately ruled out.
Zhou Can continued to review the tests the patient had undergone.
Laboratory tests performed in other hospitals included routine blood tests, urine tests, stool tests, and blood biochemistry tests.
We checked a lot, but no obvious abnormalities were found in the patient's overall data.
The results of urine routine test, including sugar, protein and microscopic examination, were all normal, except for the low specific gravity, which was only about 1.0004.
The patient's stool routine examination, bacterial culture, and Sudan III staining done in another hospital were all negative.
Finally, the big hospital gave a diagnosis of "functional diarrhea".
At the same time, because the patient's clinical manifestations included polydipsia, polyuria, and low specific gravity urine, the patient was suspected to have diabetes insipidus.
When it comes to diabetes insipidus, it is divided into three types: central diabetes insipidus, renal diabetes insipidus, and psychogenic polydipsia.
The patient's clinical manifestations include hypokalemia, with a blood potassium test between 2.2 and 2.8. So the diagnosis given by this large hospital is nephrogenic diabetes insipidus?
Putting a question mark means that it is suspected that the patient is most likely suffering from nephrogenic diabetes insipidus caused by hypokalemia, but the doctor who receives the patient is afraid of being embarrassd and dare not be 100% sure.
So putting a question mark means waiting for further verification.
This large hospital made a statistics on the patients' 24-hour urine volume, which was as high as 11,000 ml.
This is a rather horrifying amount of urine. A bottle of mineral water contains 550 ml, and the urine excreted by a patient in one day can fill 20 mineral water bottles.
In order to find out the cause of the patient's hypokalemia, the large hospital conducted a potassium balance test on the patient, and asked the patient to fast for three days and receive 3g of potassium chloride intravenously every day.
On the third day, blood potassium, urine potassium and fecal potassium were rechecked, and blood K was 3.3mmol/L, urine K was 14mmol/day, and fecal K was 32mmol/day.
A day is 24 hours.
A normal person consumes 100 mmol of potassium every day, and the gastrointestinal tract can almost completely absorb the ingested potassium.
The kidneys are the main organ for regulating potassium balance in the body, and about 90% of potassium is excreted through the kidneys.
The normal fecal potassium intake of a person is less than 10% of the recommended amount.
This patient's level clearly exceeded the standard by more than three times, which indirectly proves that the patient has renal insufficiency.
There are only a few causes of hypokalemia, such as insufficient potassium intake, excessive loss due to vomiting, or the transfer of potassium ions from outside the cells to inside the cells.
This patient had no vomiting symptoms except diarrhea, so this can be ruled out first.
Then the patient's diet is basically normal, and insufficient potassium intake can also be ruled out.
Finally, there is only the third possibility, that potassium ions are transferred from outside the cell to inside the cell.
There are four most common causes of potassium balance inside and outside cells.
1. Acid-base balance. 2. Insulin. 3. Blood aldosterone. 4. Sympathetic nerve activity.
This disease is simply a big test of human internal medicine. No wonder Director Zheng needs to invite Zhou Can to help.
What he didn't know was that although Zhou Can was good at diagnosing illnesses, his medical knowledge was far from profound.
It was only because I had made up a lot of basic medical knowledge in the past two years that I was able to cope with this case analysis.
In order to find out the reason for the patient's abnormal potassium balance inside and outside cells, Zhou Can reviewed the patient's multiple test data again.
After layers of investigation, he finally diagnosed the patient with the first case, hypokalemia caused by acid-base balance factors.
To be more precise, it should be alkalosis.
【Pathological diagnosis +1. 】
[You have diagnosed a complex pathological mechanism with strong reasoning for the first time, and are rewarded with +100 points for pathological diagnosis. ]
This was the first time that he had obtained pathological diagnosis experience points and a high experience point reward without having diagnosed the final and complete cause of the disease.
Diagnosing this case also brought great benefits to Zhou Can.
He activated all the basic medical knowledge he had learned and applied it in practice.
"Did Doctor Zhou find anything?"
Director Zheng was not trying to urge him, but he was worried that the family members and patients had been left out for too long and were becoming dissatisfied.
At least the family members should be able to see that the doctors are working hard to diagnose and treat the patient.
Rather than sleepwalking.
"At present, we have only diagnosed that the patient's hypokalemia is caused by alkalosis. The cause of the patient's diabetes insipidus and diarrhea needs to be further diagnosed and discussed."
Zhou Can delivered some very solid stuff.
"You are worthy of being the youngest and most promising doctor in our gastroenterology department. Your diagnostic ability is rare. You found out that the patient had hypokalemia caused by alkalosis so quickly. It's amazing. It took me a lot of effort and a long time to get to this point. You young people are really powerful!"
Zheng Hongtao couldn't help but sigh.
"You're too kind! Since both of us have diagnosed that the patient's hypokalemia is caused by alkalosis, it means that the previous diagnosis is basically correct. As long as the cause of alkalosis is found, I believe we can make a breakthrough."
Zhou Can is full of enthusiasm for diagnosing and treating this extremely difficult disease.
It's like conquering a city, taking it down bit by bit.
Now we have basically destroyed one of the enemy's acropolis. The next step is to further find out the cause of the alkali poisoning, which is equivalent to tearing a hole in the main city's defense.
This disease has found a breakthrough in treatment.
Although Huang Liang is a senior resident who is about to be promoted to attending physician, he is unable to perform any function in diagnosis and treatment at this level.
All I can do is listen quietly by the side.
"In alkalosis, hydrogen ions transfer to the extracellular space, causing a potential difference between the inside and outside of the cell, and potassium ions passively transfer to the cell, which leads to hypokalemia. Is there any way to correct alkalosis?"
The first thing Zhou Can thought of was treatment.
It is impossible to find out the root cause of some diseases, so doctors often use the clinical treatment method of treating first and then investigating.
It can also be called symptomatic treatment.
That is, after I discover a problem, I can try to help the patient correct it first, and then see how the body reacts.
Many times, the body may have only a small part of the whole system that is wrong. Using drugs or other means to correct it can restore the body to normal operation, which is also a solution.
Many chronic diseases are treated in much the same way.
Patients need to take medication for life.
The general meaning is that the doctor knows that there is something wrong with a subtle link in the patient's three major systems, but has not found the specific cause of the error. At this time, the doctor uses drugs to intervene forcibly to help the patient correct the error, regardless of the cause of the error.
The human body is so amazing.
With the help of medicine, even if the cause of the error can never be found and cannot be cured, it will not affect the treatment effect.
For example, people with diabetes only need to inject insulin regularly.
The doctor knew that there was a problem with insulin secretion, but the specific reasons were varied and limited by the level of medical and technological knowledge, so there was no way to get to the bottom of it.
Ultimately, chronic diseases such as diabetes and high blood pressure almost invariably require lifelong medication.
"The patient had already received routine intravenous potassium supplementation in other hospitals, but this still failed to correct the patient's hypokalemia."
If you want to correct alkalosis, you have to start with the diarrhea.
Zhou Can began to refocus his attention on the patient's diarrhea problem.
At first, the patient suffered from abdominal distension, which developed into severe diarrhea after more than a month.
"Director Zheng, can you do a small intestinal perfusion test on the patient? It will help to find out the type and deep cause of the diarrhea."
Zhou Can thought for a moment and gave a suggestion.
"Are you still starting your diagnosis from diarrhea?"
Zheng Hongtao's eyes lit up slightly.
When you can't find the answer to alkalosis, changing your thinking and targeting the disease itself is also a good idea.
“The person who tied the bell must be the one to untie it. By investigating the type of diarrhea and the underlying causes, perhaps we can solve this difficult case that is like a mystery.” Zhou Can nodded with a smile.
“That makes sense!”
Zheng Hongtao communicated with the patient and his family on the spot that this disease is difficult to diagnose and recommended that the patient be hospitalized for further observation so that the doctor could find the cause.
The small intestinal perfusion test requires arrangements and a longer time to observe the entire intestinal operation process.
The patient had not received effective treatment in other hospitals, so he naturally understood that this disease was difficult to cure.
Now the two doctors seemed to have made some progress in their discussion. Seeing hope, the family members readily agreed to hospitalization.
The beds in the Department of Gastroenterology are as tight as ever.
The patient was first placed under observation and a small intestinal perfusion test was performed while waiting for a new bed to become vacant, and then hospitalization would be arranged.
