I can see the status bar

Chapter 876 SIADH
Meniere's disease, also known as "Ménière's syndrome".It is a kind of fluid in the inner eardrum of unknown etiology, which may be caused by a variety of factors.

The main symptom of this disease is that the patient's hearing fluctuates, and there will be more distinctive "hearing changes" - for example, when listening to a single tone, the patient will say that he heard two sounds of different scales at the same time, Or listening to other people speak with a strange ending.

In addition to the fluctuating hearing loss, the patient will also show obvious symptoms of dizziness.Patients often feel that their body seems to be spinning in a specific direction, and the dizziness will decrease when the eyes are closed.Any movement of the head can increase the dizziness, but it will not affect the patient's consciousness.At the same time, most of this kind of vertigo is intermittent, generally lasting from 10 minutes to several hours, and the longest will not exceed one day.

If you look at the symptoms alone, Meniere's syndrome is indeed similar to syndrome of abnormal secretion of antidiuretic hormone.But Sun Lien thought about it, but felt that this situation was unlikely.

"Ménière's syndrome is not a rare disease, it should be quite common." Sun Lien put forward a different view to Dr. Ma Yongfang, "Ménière's syndrome itself has some special tests to distinguish it, and The patient's vestibular dysfunction and spontaneous nystagmus are features that are less likely to be misdiagnosed."

In addition, Sun Lien doubted Dr. Ma Yongfang's reason for his judgment was that the effect of diuretic and dehydrating drugs on patients was short-lived, and they might help patients restore normal water metabolism at that time.But it is absolutely impossible to have such a profound and long-lasting effect—most of the diuretic and dehydrating drugs are substances that metabolize extremely quickly, and their effects in the human body usually do not exceed ten hours.The last time Zhang Xiedi used diuretic and dehydrating drugs to treat Meniere's syndrome was a few years ago.Sun Li'en really didn't think that the effect of the medicine at that time could last until now.

"If the diagnosis at that time was correct..." Ma Yongfang said after pondering for a while, "this symptom... feels like ADHD syndrome."

Thank goodness.A thought of "Thank God" suddenly rose in Sun Li'en's heart.Dr. Ma's reaction speed is really not bad, it seems that he doesn't need to induce the other party's thinking anymore.

"However...if it is really SIADH (Syndrome of Abnormal Secretion of Antidiuretic Hormone), this patient will be in trouble." Dr. Ma Yongfang's brows did not relax after making the diagnosis. She frowned and looked at the patient again. After looking at the case, she said, "Nearly [-]% of SIADH patients are lung cancer or small cell lung cancer, and the remaining [-]% ​​are other traumatic and mental diseases..." She looked at Sun Lien and asked, "The current blood oxygen level of the patient is How is it going?"

"It's still normal at the moment." Sun Lien also frowned. This is not good news. "Isn't this an endocrine disease? Why is it so closely related to lung cancer?"

"If I know the answer, I may have a share of next year's Nobel Prize." Dr. Ma Yongfang said after making a joke, "The current most mainstream hypothesis is that the lungs under certain conditions Next, ADH (antidiuretic hormone), or something similar to ADH, is produced. But the details of this process, and the mechanism of this mechanism ... is still a mystery."

Now there is no way to continue asking, Sun Lien thought for a while, and then asked tentatively, "Then is it necessary to take a chest X-ray first?"

"It's very necessary." Dr. Ma Yongfang nodded, "I think what you need to do is not only a chest X-ray, but also related tumor markers and other tests... It would be better to add a PET. There are abundant lymph nodes and sufficient blood supply at the same time. Once the tumor in this position shows symptoms, it will be at an advanced stage. It is better to do a more detailed examination, so that oncologists can make a treatment plan more conveniently.”

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Sun Lien was in a bad mood, strictly speaking, very bad.

Although no biopsy has been performed yet, based on the palpation he performed on Zhang Xiedi half an hour ago, Sun Lien can be sure that the possibility of Zhang Xiedi suffering from a tumor is at least [-]%, and the tumor has already metastasized through lymph nodes .

On Zhang Xiedi's left collarbone, there was a lump about two centimeters by four centimeters.Judging from the touch, the lump is regular in shape, soft and mobile, and the patient does not feel tenderness—this may mean that the lymph itself is not inflamed, and the swelling is caused by tissue hyperplasia in the lymph nodes.

In other words, this enlarged lymph node is likely to be a metastatic tumor.

If this conclusion does not have the theorem that [-]% of SIADH is closely related to lung cancer as a precondition, then all this is just a very funny joke.But in the status column, it can be clearly stated that Zhang Xiedi suffers from syndrome of abnormal secretion of antidiuretic hormone, so the nature of this lump...may be very bad.

"Check a chest CT, and tumor markers..." After closing the door, Sun Lien walked to the nurse's station, and said to the nurse on duty today, "You go to draw blood first, and I will make up the doctor's order when I go back."

"What markers are you looking for?" The nurse is very responsible for her work. Although she sympathizes with the martyr's mother, she still decides to finish her work before asking for details, "Does she have a tumor?"

"Check for a neuron-specific ene-purifying enzyme, and add a gastrin-releasing precursor." Sun Lien searched on his phone for a while before he found out what generally needs to be checked for respiratory tumor markers—he is really very knowledgeable about this kind of knowledge. scarcity. "Oh, by the way, arrange another head MRI for her. The dizziness has lasted for a bit too long. Let's see if there is a problem with the brain."

According to Dr. Ma Yongfang, SIADH does cause dizziness in patients, but it usually occurs after the patient has obvious hyponatremia.But although Zhang Xiedi's blood sodium level is a little low...but it's not too low.This also means that there may be other factors in her previous dizziness-the blood sodium level of SIADH patients should be relatively stable, and there will be no sudden large fluctuations.

"Well... add a 24-hour urine potassium and urine sodium test, and check her ADH activity..." Although the diagnosis of tumor and SIADH has been confirmed, Sun Lien decided to find enough evidence first to confirm it Let's talk about the diagnosis of SIADH.

If the tumor markers and CT do not find the problem, maybe we can think about it from other aspects.Sun Lien sighed, he began to hope that there was something wrong with his diagnosis direction.

Lung small cell tumor is a malignant tumor with a very high mortality rate. According to domestic statistics, the five-year survival rate of patients with lung small cell tumor is only 17%.

(End of this chapter)