I can see the status bar

Chapter 785 You are also black-faced

Do not augment entities unless necessary.This is one of the important principles that doctors follow when making a diagnosis.But in Sun Lien's view, the current situation is not "non-essential".

Existing theories cannot explain symptoms, and a radical revision of existing theories would inevitably add more entities.Therefore, Sun Lien determined that the general direction of Dr. Pascal's diagnosis should be correct.It's just that some details may be missing - such as missed diagnosis.

In all fairness, missing a diagnosis is not a common mistake.But in this case, Sun Lien felt that...it would be abnormal if the diagnosis was not missed.

According to the patient's self-report and related examinations, the diagnosis of AIH+PBC overlap syndrome is not only problem-free, but also reveals a sense of simplicity and beauty.There is absolutely no problem with the logic, and the overlap of diagnosis and symptoms is almost perfect.Apart from failing to consider that the patient may have unreported symptoms and poor response to treatment, there is no reason for any physician to suspect that the diagnosis may be faulty.

But the reality is that Dr. Pascal's original perfect diagnosis has a fatal loophole.And this fatal loophole is likely to be the root of the problem.

Since patients respond well to UDCA, increasing the dose of UDCA becomes a matter of course.Sun Lien first prescribed Lu Chunyu UDCA 250mg qid, then picked up his mobile phone and called Dr. Pascal.

"Is there clay-like stool?" After hearing Sun Lien's description, Dr. Pascal frowned. "I'll be right over." After saying that, he hung up the phone.

Sure enough, it was as expected, and Lao Pa didn't know about this situation either.Sun Li'en sighed, and it seemed that there was nothing wrong with his guess - this was a missed diagnosis.

Fortunately, it was discovered in time.Sun Li'en was thinking with emotion while drinking tea.If it takes a few more days, maybe Lu Chunyu's liver disease will develop to the point of hepatic encephalopathy or even kernicterus.

If this is the case, then don't worry about liver transplantation - if she survives, it is considered that Lu Chunyu's ancestors have accumulated great virtue.And it's the kind that smokes from the ancestral graves.

In all fairness, it is not uncommon for the patient himself not to directly name one of the symptoms.And the doctor's job is to find the crux of the problem while the patient is not telling the truth.There are many doctors in the Zhou Xiufang Comprehensive Diagnostic Center, but the doctors still cannot cover all departments and solve problems comprehensively.What if I encounter this kind of patient again in the future?Sun Lien fell into anxiety for this.This time I used UDCA to achieve better results, but this does not mean that I will also encounter dead mice in the future.

After Dr. Pascale arrived at the office, Sun Lien immediately made a suggestion to him, "We have to continue recruiting."

"Ah?" Dr. Pascal himself was preoccupied with how to deal with Lu Chunyu's diagnosis. He never expected that Sun Lien and himself would talk about personnel issues first. "What's the matter, are you going to persuade me to resign?"

Sun Li'en immediately realized that something was wrong with what he said, and he quickly expressed his thoughts, "We still don't have enough doctors in our specialty to cover all the departments. This time we were lucky and found a missed diagnosis, and we may not have this opportunity in the future. "

What Dr. Pascale said was a joke, of course.He also understood that his missed diagnosis this time was a non-war crime.After listening to Sun Lien's idea, Lao Pa nodded, "I have no problem here, but we need to recruit a group of attending and even deputy chief physicians who have work experience and are good at diagnosis for our diagnostic center... This may be in the recruitment process. There are difficulties."

"That's your business. I don't care about the training." Sun Lien pushed all the troubles onto Lao Pa's head without changing his expression, and then changed the subject before the other party objected, "This patient problem... I feel that the general direction of your diagnosis is not wrong."

"Is the general direction correct?" Dr. Pascal frowned when he heard this, "Aside from the clay-like stool, are there other problems?"

"Her response to UDCA is quite good. After two days of medication, the bilirubin dropped." Sun Lien found out today's blood routine and handed it over. "I just adjusted the dosage and increased the dosage of UDCA by three points." One - now it's 250mg qid."

"If it responds better to UDCA, it won't be PBC. At least it's not a PBC-based lesion." Dr. Pascale frowned. "Her interface hepatitis reaction...may be caused by other diseases?"

Sun Li'en nodded, "Even further, maybe her portal hypertension is not caused by PBC, but caused by this disease that responds well to UDCA."

Gastric varices caused by portal hypertension are an important indicator of the three stages of PBC.This inference also means that a series of symptoms that could have been assigned to PBC before have suddenly been isolated.

"So what we need to consider is that a good response to UDCA will lead to an interface hepatitis reaction, and at the same time induce portal hypertension..." Before Dr. Pascal finished speaking, Sun Lien held up the angiographic results given by the hepatobiliary surgery department Said, "Add another biliary sclerosis."

"...and biliary sclerosis." Dr. Pascal was kind and helpful, "Um...does her biliary sclerosis have bead-like lesions or dry-twig-like lesions?"

"I can't see the onion." Sun Li'en pointed to the radiography photo and said, "But the dead tree branch... this one looks a bit like it."

"The biliary tract is sparse and stiff. This should be a dead tree branch." Dr. Pascal scratched his head. "I am not familiar with the imaging of the biliary tract. If I read correctly, this should be a PSC."

"What?" Although he was mentally prepared, Sun Lien was still a little dazed after hearing this acronym that he had never heard of before, "What is that?"

"Primary sclerosing cholangitis, primary sclerosing cholangitis." Dr. Pascale explained, "This is a disease with unknown etiology, but it is generally believed to be related to the immune system. The main feature is that it responds well to UDCA, and there are special Changes in biliary tract lesions."

"So..." Sun Lien swallowed, "This is a case of AIH+PBC+PSC...triple overlap syndrome?"

"Let's just say it's the triple syndrome." Dr. Pascal leaned forward, then hesitated, "The triple syndrome... I've heard of it, but I've never seen an example."

"That is to say, the incidence rate is extremely low?" Sun Lien showed a gloating expression, "Your face is dark enough!"

(End of this chapter)