My medical skills add experience

Chapter 467 Clear the fog to see the essence, check three kinds of antibodies

After finding this step, it can be considered that there has been a relatively large progress, but the cause of the disease has still not been diagnosed.

Celiac disease is also only suspected.

In addition, the disease is closely related to heredity and immunodeficiency.

According to research, gluten enteropathy is closely related to eating wheat flour, and gluten may be the pathogenic factor of this disease.The cause of the disease is the result of the interaction of genetics, immunity and gluten diet.

Wealthy people are very particular about their diets, and sometimes what they think is a healthy diet is not necessarily healthy.

This still refers to some wealthy families with more background, and that kind of nouveau riche is not included.

Three generations of eunuchs know how to dress and eat.

It means that only after being rich for three generations can one know what kind of clothes to wear is good clothes, which foods to eat are really good for the body, and how to eat to enjoy the best delicacy.

Even if this child is really celiac disease, it is definitely not enough to rely on a gastroscopy and duodenal mucosal pathological examination to get a diagnosis.

The child reacted with abdominal distension and lower extremity edema, which was consistent with celiac disease.

Some patients with this disease will have obvious abdominal distension, nausea and vomiting.Weight loss, fatigue, emaciation, fatigue, edema.

Zhou Can had already seriously suspected that the patient might have celiac disease, although the patient did not have diarrhea, only abdominal distension.In the diagnosis of symptoms, we must not be dogmatic and copy the knowledge from textbooks mechanically.

Symptoms of the same disease may vary from person to person.

This is closely related to the individual's immunity, physical fitness, tolerance, disease severity, and lesion location.

The physique is different, and some people may just feel nauseous, and may not even vomit.

And some people may have nausea, vomiting, diarrhea, all come.

The child's family background is very good, and he must have good food and clothing.Judging from his weight and height, his physique should be quite good.

It is also because of my good physique that my lower extremities have been edematous for nearly seven months, so I have symptoms of nausea and vomiting.

Therefore, sometimes people with very good physiques also have some shortcomings.

Minor ailments can't make waves on this kind of people, and it's even hard for them to invade their bodies.When a serious illness comes, it is also possible that the progress will be slow.

If it is cancer, the sooner it is detected, the better.

But because the physique is too good, the symptoms may be mild, and the cancer cells grow slowly.When it is discovered, the most frightening thing is that the cancer cells have already spread.

Of course, in general, the stronger the physique, the better.

Theoretically speaking, the stronger the physique, the harder it is for serious diseases and malignant cancers to occur.

Although Zhou Can had already made a certain diagnosis of the cause of the child, he still remained patient and continued to check.

After the expert made his second major discovery, he performed a full colonoscopy on the child.

You can feel the enthusiasm and urgency of this expert at that time.

He must have wanted to rush to diagnose the cause.

The results of a full colonoscopy were normal.

After checking this, the second expert seems to be a little confused again.The colonoscopy is normal, and the stool is intermittently positive for occult blood, so how to explain it?

Because the patient has already undergone a complete gastrointestinal radiography, a gastroscopy and a colonoscopy, and then there is no need to do other colonoscopy.

It is estimated that the family members also put considerable pressure on the expert.

In the end, the child was prescribed medicine according to enteritis.

This really surprised Zhou Can.I don't know what kind of situation the second expert was in at that time, so he prescribed enteritis treatment medicine for the child.One thing is certain, because severe acute and chronic inflammation was found during the pathology of the duodenal mucosa, which may be the basis for medication.

In addition, Zhou Can keenly suspected celiac disease after viewing the medical record information, but it does not mean that the diagnostic thinking and conclusions of other experts are consistent with him.

Because celiac disease has one of the most typical symptoms, that is diarrhea.

and iron deficiency anemia.

Severe diarrhea can be as many as dozens of times a day.

When watching TV dramas in ancient costumes, you can often see two kinds of quack medicines, one is Mongolian sweat medicine, which will make you unconscious when you take it, and you are at the mercy of the enemy.Stealing wealth and sex, this medicine is most commonly used in black shops.

The second is croton, which is a medicine for diarrhea, which is specially used to punish those who have festivals.

What Jianghu pays attention to is pleasure, kindness and hatred.

The power is not as good as the opponent, or the force is not as good as the opponent. When you are wronged, use croton to grind it into powder and secretly put it in the opponent's food. This is a relatively common way of revenge.

Hacking or poisoning people to death at every turn is very rare.

Even in ancient times, the king's law still had a strong deterrent to the public.

Let the enemy have diarrhea to collapse, and generally will not cause the government to investigate.Few people will report to officials, and the risk is relatively small.

Patients with celiac disease are much more miserable than people who ate crotons in ancient times.

After eating croton, it will be fine for a day or two at most.

People with celiac disease have diarrhea every day without treatment, and it gets worse and worse.Maybe 24 hours a day, at least eight or nine hours in the toilet.

The child's symptoms are more complicated and confusing. The experts are used to being cautious and careful, and their way of thinking is very different from Zhou Can's.

According to the treatment of enteritis, the effect can be imagined.

In the end, the family members of the child found that the treatment was ineffective for many days, and began to doubt the level of treatment of the Provincial Children's Hospital, so they took the child to the Pediatrics Department of Tuya Hospital for medical treatment.

It is estimated that if the cause of the disease cannot be found in Tuya, and no obvious curative effect can be seen, most of them will be transferred to the big hospitals in the imperial capital and magic capital for diagnosis and treatment.

Relatively speaking, the large hospitals in the imperial capital and the magical capital have more advanced medical equipment.

This advantage is not reflected in a certain inspection instrument or surgical equipment, but in all aspects.

In addition to advanced equipment, they also have a more powerful team of experts.It can even realize multi-department joint diagnosis and treatment, and cooperate closely.Many difficult-to-diagnose diseases and difficult-to-treat diseases can be cured in the big hospitals in the imperial capital precisely because there are more top experts in the imperial capital.

In the field of medical subdivision, the division of experts in Imperial Capital is more detailed.

Even if it is just a gastroenterology department, there may be as many as nearly [-] different experts in subdivided medical fields.

For example, digestive enzymes, this is a subtle to extremely inconspicuous subdivision of the digestive department.

There are doctors in the top hospitals in the imperial capital who specialize in digestive enzymes.

Take a look at Tuya Hospital, which is already one of the provincial head hospitals.Whether it is gastroenterology or surgery, gastrointestinal is generally rarely separated.Almost all of the top experts in these two departments are good at the two subdivisions of stomach and intestines.

Just one intestinal field can be subdivided into small intestine, appendix, cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum, pylorus, duodenum and so on.

The so-called chewing too much is not enough, Tuya's experts focus on multiple subdivisions of the gastrointestinal tract.The top experts in the imperial capital only do one thing in their lives. Those who study the cecum specialize in the cecum, and then use the cecum as the core to carry out in-depth research on the organs and tissues related to the cecum, as well as the role of the cecum in the body's operation.

It is conceivable that there must be a big gap between Tuya's experts and the top experts in the imperial capital.

"After the child was referred to our hospital, did he mainly check his protein?"

After Zhou Can read all the information, he still firmly believed that the child was likely to have celiac disease.

This diagnostic ability can be understood as a gift.

It's not that other experts are inferior to him, it's just that they don't have Zhou Can's high sensitivity and comprehensive diagnosis ability when diagnosing this type of disease.

Zhou Can sometimes overturned during the diagnosis.

Whether this child ultimately has celiac disease is difficult to say.

"I checked the protein loss isotope of the child, and the diffuse abnormal increase in intraperitoneal blood perfusion was found, but no obvious signs of protein loss were found. Blood protein ice, M protein can be seen. Blood immune ice, LGCK monoclonal increase, LGM and Lambda decreases..."

LgM refers to a type of immunoglobulin.

After consultation, Tuya's experts found that the child had hypoalbuminemia, and the disease was chronic.

At the same time, there are relatively thin body shape, splenomegaly, lower extremity edema, and intermittent abdominal distension.

So he put the main diagnosis thinking on severe hypoalbuminemia and elevated blood monoclonal immunoglobulin.

The experts' consultation and discussion records mainly focused on the reasons for the decrease in serum albumin.

They held their own opinions and made various conclusions and analysis.

The first is that the patient has malabsorption of serum albumin.The patient had intermittent abdominal distension and vomiting after eating, and experienced weight loss. Combined with the decrease in the D-xylose test, although no positive fat was detected in the stool, it is still considered that the child has small intestinal malabsorption syndrome.

The second, the possibility of insufficient intake, the experts lined up almost unanimously.The children's self-reports, as well as the family members' and nanny's reports, all show that the children's food intake is acceptable.Not to mention nutrition.

Such a family can eat almost whatever they want.

The third type is synthetic disorder.Hepatic liver function tests found no abnormalities, and common liver virus indicators were negative, which can basically rule out synthetic disorders.

The fourth is the loss of protein in the body.The main route of albumin loss in patients is the kidney and gastrointestinal tract.Urine protein has been checked long ago and it is negative, which can rule out the possibility of kidney loss of albumin.

The gastrointestinal loss route can basically be ruled out, because the protein loss isotope imaging examination did not find obvious protein loss.

Consultation discussion to this point can basically lock the problem in the small intestine.

Especially the duodenum.

After going in a big circle, Tuya's experts discussed it, and found that the results of the diagnosis were coincident with those of the experts from the Provincial Children's Hospital.

Experts from the Provincial Children's Hospital have tried both duodenal ulcer treatment and enteritis treatment, but without any effect.

Tuya's experts treat them as these two diseases. Even if the family members don't scold them in person, they will definitely scold them as a group of quack doctors behind their backs.

"The lesion is likely to be in the small intestine!"

Zhou Can spoke very cautiously, and he didn't say what kind of illness it was, but first said what he could be sure of.

"As a result of everyone's discussion, it was basically determined that there was a problem with the small intestine of the child."

Director Tang Fei narrowed her phoenix eyes slightly, just looking at Zhou Can.

Based on her understanding of Zhou Can, Zhou Can must have more to say.

"Is it difficult for the family members of the child to speak?"

Zhou Can's next text is actually this.

She couldn't help rubbing her forehead, and said with a smile, "One of the family members is an official, and the official position is not low. The other is the female president of a large company, with a net worth of more than one billion, and she is a bit strong, that's for sure. It's the kind that makes sense!"

There is a big difference between a net worth of over [-] million and over a billion.

People with a net worth of one billion are basically middle-level bosses in the business world.With a net worth of over tens of billions, he already belongs to the top tycoons in China.

It may feel that the evaluation of the family members is not specific enough, which will cause Zhou Can to have concerns when diagnosing the cause.

"Their child has been taken care of by a nanny. The child's lower extremity edema occurred for more than half a year. It was not until one time that he ate a lot of meatballs that he felt nauseated and vomited. The nanny called them to say that there was something wrong with the child's body. But they didn't Complain about why the nanny didn’t discover the child’s lower extremity edema earlier. In addition, their child has been treated in the Provincial Children’s Hospital for nearly two months, and they have been cooperating with the doctor. Later, they found that the effect was not significant, and they just took the child to another hospital without any attack on the doctor. the behavior of."

"During the conversation with me, they didn't mention the low level of experts in the Provincial Children's Hospital. They even said frankly that the child may have a relatively rare disease, which made our doctors bother. It is best to find out the cause. It doesn’t matter if they don’t come out, they just take their children to the imperial capital to seek medical treatment. After being transferred to our hospital, there are many kinds of examinations, and they are actively cooperating.”

Director Tang Fei's evaluation of the family members is quite good.

Zhou Can's worries were allayed a lot.

"Director Tang, there are no outsiders here, so I'll just say it straight. I highly suspect that this child may have celiac disease. Although the child's symptoms are not typical, according to the comprehensive manifestations of all aspects, the possibility of celiac disease is extremely high. "

After listening to Zhou Can's answer, Director Tang Fei was stunned, with a hint of disappointment deep in her eyes.

She had great hopes for Zhou Can, thinking that inviting Zhou Can over could find out the cause of the child's illness.

The diagnosis given by Zhou Can is celiac disease, which is indeed a bit unexpected.

"When I discussed with other experts, I also suspected this disease. It's just that the symptoms are a bit wrong. The current inspection is mainly based on duodenal inflammation and severe hypoalbuminemia."

During their discussion, the possibility of celiac disease had been ruled out.

There is no need to doubt the level of these experts, especially the cases that have been consulted jointly, and omissions rarely occur.

"That's right, the child does not have the most obvious symptom of diarrhea. But I have read the medical records. The first time the child experienced nausea and vomiting was because he ate a lot of meatballs. It is equivalent to eating a lot of meat. In addition, the child’s diet is more reasonable, and every time he eats meat, he will match it with wheat food. Celiac disease is mainly caused by eating wheat, and it is caused by its own immune deficiency in this area.”

Zhou Can stated the basis of his diagnosis.

"The child also ate wheat food before, so why did he never get sick?"

Director Tang Fei asked sharply.

"I didn't have the disease before, but it doesn't mean I didn't have the disease. It's just that the disease itself is a chronic disease, and the child's physique is very good, so the onset is relatively late. In addition, there is another way to diagnose the disease."

Zhou Can's eyes were clear and firm.

In terms of diagnosis, he does have a talent that other doctors can't match.

This was revealed when he was still an intern.

As for his surgical talent, it was more of a bonus from the medical experience point system.Of course, his own talent is not bad.

"any solution?"

Director Tang Fei asked.

"Do further serological and imaging examinations on the child, and check his anti-gluden antibodies, anti-endomysial antibodies, and screenprinting antibodies."

Zhou Can suggested to check three kinds of antibodies in one breath.

This is the fastest way to diagnose.

(End of this chapter)