Gou is practicing medicine in the clinic

Chapter 222 Kidney enlargement is not kidney disease, the doctor's parents are worried

Let alone a street, even if it is just a department, the water is very deep.

Where there are people, there are rivers and lakes. This is an eternal truth.

Li Jingsheng's ability to integrate into this interest group and quickly obtain such a high status is both strength and luck.

The drinking party was over, and everyone dispersed.

There is one small detail that is particularly interesting. Boss Zhao has always been drooling over Tang Ping, but he didn't say a word to her at the banquet, and he didn't even dare to look at her more.

I don't know if it was because the proprietress of Fredo's drugstore was present, and she was worried that she would be jealous and capsize the ship.

Still afraid of Li Jingsheng's strength and status.

In short, Boss Zhao is a smart person, and he is always very cautious about risky things.

Li Jingsheng drank a few glasses of wine, a little smoked, but after returning to the clinic, his mind was clearer than ever.

Sitting in the empty reception hall, he was thinking about the difficult case that Director Mu encountered in his mind.

The patient is less than 40 years old, is a female patient, and the occupation in the medical record is described as an agricultural planter.

It can be predicted that the income of this patient should be relatively low, and the level of education should not be high.

Because under normal circumstances, as long as the middle-aged people with a slightly higher level of education, most of them will go to the city to work in order to increase their family income.

One month ago, the patient developed right lower extremity pain, decreased urine output, and obviously gained weight in the lower extremities.

After checking by the doctors of the Second Hospital, it was not fat gain, but edema.

Oliguria, lower extremity edema, and right lower extremity pain, according to normal diagnostic thinking, the first thing to do is to lock in a problem with the kidney.

In fact, the first number the patient registered was indeed the number of the Department of Urology of the Second Hospital.

Maybe because of financial constraints, I was not willing to register as a director, but as an ordinary outpatient.

The doctor who received the consultation was Tan Shuilin, a young and outstanding doctor in the Department of Urology of the Second Hospital.

This person is quite similar to Dr. Qin of the Orthopedic Surgery Department, and they both belong to the excellent category of residents.

Ordinary residents are also not eligible to open outpatient numbers.

For example, Li Jingsheng, when he first joined the Second Hospital, he could only work under Dr. Xu.Until a few days ago, Dr. Xu asked him to 'stand on his own' and receive treatment separately from Dr. Xu.

Only then did the orthopedic surgeon come forward and help him apply for an outpatient physician number.

Although it is just a very inconspicuous matter, for a doctor, it is a big step forward.

Many resident doctors are anxiously waiting, even if they only have one day a week in the outpatient clinic, they are very happy and looking forward to it.

Because the vast majority of doctors need to wait until they are attending the clinic before they have the opportunity to open a clinic number and officially have the qualifications for consultation.

Just like the ancient doctor, at least he had to be a medical doctor to be eligible for consultation.

At least one must reach the official level to be considered a serious doctor.

This qualification requirement also exists in modern times.Under normal circumstances, a doctor needs to go through one year of internship before graduation, and then three years of regular training and obtain a medical license to become an official resident doctor.

If you want to be a doctor, you have to continue to work hard. You need to work for more than two years for a master's degree before you can take the exam.

Only when you are promoted to attending treatment can you be regarded as 'like a doctor'.

After Tan Shuilin received this patient, he naturally prescribed a number of examinations cautiously and asked the doctor carefully.

For fear of being misdiagnosed.

After careful examination, he found that the patient not only had edema in the lower limbs, but also found two masses in the abdomen, located in the left and right waist and abdomen respectively.

Kidney edema is generally impossible to swell that much.

Aware of the seriousness of the problem, Dr. Tan Shuilin became more cautious.

After inquiring about the symptoms of the patient in detail, the patient reported that the pain started from the right waist and buttocks, like a needle prick, and extended to the back of the right thigh until it reached the calf.

At the same time, the patient also experienced a series of symptoms such as decreased urine output, abdominal distension, lower extremity edema, dizziness, fatigue, nausea, and vomiting.

These symptoms vaguely point to serious kidney disease, such as uremia.

According to the actual measurement, the patient's urine output on the day was only about 500ml.

The patient's body temperature was 37.8 degrees, with obvious low fever.

The systolic blood pressure is 190mmhg, and the diastolic blood pressure is 118mmhg.

Adults have normal blood pressure, with systolic blood pressure between 90-139mmHg and diastolic blood pressure between 60-89mmHg.This is the ideal blood pressure range.

This female patient obviously has high blood pressure.

Patients with uremia will have high blood pressure and fever, and Dr. Tan further determined that the patient has renal failure combined with acute nephritis.

After abdominal ultrasonography, the patient's bilateral kidneys were found to be enlarged.

This also confirmed that the lumps felt at the waist and waist of the patient's abdomen belonged to enlarged kidneys.

The kidney is actually a bit like a sponge. Its internal structure is very complicated. It mainly filters fluid through the glomerulus, and excretes toxins and excess water into urine.What is useful returns to the blood circulation.

This is why for some heart diseases, the doctor will ask to check the urine routine and even check the kidney function.

It's really not an over-medication, but the doctor suspected that the kidney disease caused the heart change.

Dr. Tan Shuilin prescribes routine blood and urine tests for the patient.

Hemoglobin 47g/l, white blood cell count 5.7 times ten to the ninth power per liter.

Lymphocytes are around 0.35.

Platelets89.

The urine protein quantification is 0.26g/day, which is the 24-hour measurement.

Urine specific gravity 1.015, blood urea nitrogen 14.7mmol/l.

After checking here, Dr. Tan Shuilin has confidently believed that the patient has rapidly progressive nephritis, renal failure and polycystic kidney disease.

So he was admitted to the hospital, and the patient was treated with various measures such as diuresis, dilation of blood vessels, and infection.

It can be seen from this that Dr. Tan Shuilin is not bad in both diagnosis and prescription.

But after three days of treatment, the patient not only did not improve significantly, but the blood urea nitrogen rose to 22mmol/l.

Dr. Tan Shuilin realized that something was wrong, and hurriedly asked for help from the superior physician.

There are still experts in the Department of Urology. After further diagnosis and examination of the patient, Director Zhang Zhongsheng of the Department of Urology immediately asked for help from the Department of Nephrology.

Let’s talk about the two departments of nephrology and urology. One is in charge of internal medicine and the other is in charge of external diseases. In fact, they both diagnose and treat kidney diseases.

The difference is that the housekeeping skill of urology is to solve problems such as kidney stones and ureteral stenosis through minimally invasive surgery.

Nephrology is good at drug treatment.

In terms of diagnostic level, internal medicine is better, which is natural.

Because when treating with drugs, the cause of the disease must be clearly investigated, and the pathological mechanism must be straightened out.

Urology is more brutal.

In most cases, it is found that the patient has stones or tumors, etc., which can be solved directly by surgery.

The chief physician of the Department of Nephrology came to the clinic and thought that the patient's kidney edema and other lesions were probably just symptoms.

What does this mean?

That is to say, the cause of kidney enlargement is not the kidney itself, but another lesion that has not been identified.

This is what doctors fear most.

The symptoms were obvious, and the lesions were also extremely obvious. After treatment, it was found to be useless.

The real lesion was hidden in the dark and was not detected.

Encountered such a case, it must be a difficult case.

In most cases, it is necessary to find doctors from other departments to come for consultation.

For example, the cause of kidney enlargement may also be caused by cardiovascular disease or liver disease.The organs of the human body are each a 'city', but they are directly or indirectly connected with each other, and they are very close.

To use the most simple analogy, if the heart stops beating, the organs of the whole body will soon die together.

Because after the heart stops beating, blood circulation stops and all organs lose their 'energy' supply.

For another example, if there is a problem with the lungs and the breathing stops, the whole body organs will still have bad luck and all the organs will die.

Because the lungs are an important organ for blood oxygen exchange.

It stops working, which means the blood cannot get fresh oxygen.

The body can only stop.

Therefore, every organ of the human body is extremely ingenious and closely related to each other.They are like the various parts of a precision instrument, maintaining the operation of the instrument.

The condition is as fierce as a tiger, and it is progressing rapidly every minute.

Dr. Tan Shuilin is in a hurry. If this patient falls into his hands, will the hospital allow him to see him again in the future?

And this is a life!

He was anxious, and the director of the Department of Urology, as well as the superior doctor, Director Zhang Zhongsheng, were also anxious.

The department is a whole, if something happens, everyone will be unlucky.

In order to solve it as soon as possible, the director of the Department of Urology made a difficult decision.

Report to the medical department, and then report to the dean, who will come forward to organize the hospital's strength consultation.This solution is very attractive, but the price is also very high.

The best way is to be able to figure it out in private.

Pushing the patient out is definitely not an option.

Therefore, the director of the Department of Urology and Director Zhang Zhongsheng began to use their personal connections to seek help from the chief doctors of some departments in the hospital.

There are many hidden causes that can cause renal edema.

Just a few chunks.

The chief physicians of cardiovascular medicine, respiratory medicine, and gastroenterology have all become targets of help.

Director Mu was invited over.

Let's talk about Director Mu. Although he wants to save face, he is indeed very righteous.

After the past consultation, I felt that this patient might be caused by a respiratory disease, but I was not too sure.If it's an ordinary and cunning chief physician, I can only mention it at most.

Director Mu asked for the patient's information, saying that he would bring it back to the department for discussion with the chief physicians of the respiratory department.

Although everyone is a colleague of the same department, how can it be so easy to invite a chief physician level!

You said let everyone come together and discuss it?

is it possible?
Just a few words, I'm going to attend an academic conference tonight, or I have something important to do, I'm sorry, I just dismissed it.

Director Mu can only chew on this hard bone by himself.

He is not a patient in the Department of Internal Medicine himself, maybe his colleagues will secretly scold him for meddling in his own business.

Li Jingsheng could understand Director Mu's difficulties. He was sitting in the reception hall, silently analyzing the case alone.

Since the real cause is not renal failure and acute nephritis, what disease could it be?
The patient's symptoms are the manifestations of renal failure and nephritis!
After the Department of Urology invited a cardiologist for consultation, he performed an echocardiogram for the patient.

It suggested slight thickening of the ventricular wall and interventricular septum.

Then a synchronous ECG was done again, suggesting sinus tachycardia with normal ST-T.

The results of abdominal ultrasonography showed that the abdominal mass was bilateral kidney enlargement, and the liver, gallbladder, pancreas, spleen and other organs were normal.

The patient had a chest X-ray showing a little patchy shadow in the left lower lung.

The diagnostic conclusion leans toward the presence of an infection in the lungs.

This is also the main reason Director Mu took over this job.

At present, the patient has been given anti-infection treatment, and continues to be treated with diuresis, antihypertensive, antiemetic, pain relief, and Shenan injection.

It's just that the curative effect is not good.

In Li Jingsheng's mind, he repeatedly played back the patient information and various inspection reports he had read in Director Mu's office.

The Department of Urology now believes that the patient has polycystic kidney disease. In fact, judging from the results of B-ultrasound, the possibility of polycystic kidney disease is very small.

Polycystic kidney disease is generally congenital.

Severe polycystic kidney disease, according to the description in the book, can weigh more than 2.6kg.

Li Jingsheng believes that the possibility of polycystic kidney disease is very small. If the patient really has this disease, he should have developed it long ago.

Is it idiopathic retroperitoneal fibroproliferation?
He couldn't help but think of a disease with a high degree of symptom matching.

This disease is also known as vaginal obstruction periureteritis, which is related to connective tissue lesions, and sometimes also has a certain relationship with infection.

Considering that the patient's chest X-ray showed lung infection, Li Jingsheng suspected it was the disease.

However, the patient's abdominal mass has been confirmed to be the kidneys, there is no water accumulation inside, and the serum protein and immunoglobulin are not abnormal, so the possibility of this disease is also very small.

Since the above two diseases have been ruled out, the only thing that can be thought of is the primary renal tumor.

In this disease, there will be three combined symptoms of low back pain, abdominal mass, and hematuria.

Generally, men over the age of 40 are most prone to it.

To confirm the diagnosis, the patient's consent must be obtained for a kidney biopsy.

Li Jingsheng decided to think about it from another angle. The patient reported pain in his right lower extremity, which was actually a good breakthrough point.

Is it sciatica, or is it caused by the compression of the lumbar tumor?
He believes that the possibility of tumor compression is relatively large.

If possible, it is best to check a pelvic X-ray film and a lateral X-ray film of the lumbar spine.

In this way, it can be determined whether there is a pelvic lesion or the like.

Li Jingsheng felt a little thirsty, so he drank two large cups of boiled water, just to hangover.

There is no scientific basis for the statement of strong tea hangover.

On the contrary, it may increase the burden on the liver and kidney.

He was lying on the back of the chair, with his face propped on one hand, still thinking hard about this female patient with swollen kidneys and lung infection.

In a daze, he just fell asleep sitting up like this.

I worked in the hospital for a day, and after I came back, I organized a dinner for colleagues in the old street in the south of the city, and I was really tired.

After drinking a few glasses of wine, he was even more sleepy.

But after a while, he was woken up by the ringtone of his mobile phone.

When I opened my eyes, I saw that I was still sitting in the reception hall, the lights were on, and it was pitch black outside.

Glancing at the clock, it was eleven forty-two in the evening.

It's almost twelve o'clock in the evening, who called him?
He took out his phone, and it turned out to be an unfamiliar number.

"Hello, who are you looking for?"

"Doctor Li, it's me, I'm Qin Fei. Didn't you tell me to keep an eye on the patient in bed 53 at night? I took his temperature just now, and he really has a fever! 37.4 degrees, a low-grade fever."

Dr. Qin should be very depressed.

Li Jingsheng and him are colleagues in the same department, and he didn't save his phone number.

Fortunately, he still took what Li Jingsheng told him to heart.

It's too heartbreaking.

"Oh, so it's Dr. Qin! What did you say? That male patient with lower body paralysis really has low-grade fever at night?"

"Yes! I've measured it three times, and I'm sure."

Qin Fei was afraid that Li Jingsheng would suspect that he had no hair on his mouth and that he was not doing things well, so he emphasized the measurement process.

"Thanks a lot!"

Li Jingsheng was very excited when he heard the news.

"We are all colleagues in the same department. Dr. Li is a bit out of touch when he says this! I know that the diagnostic ability is not comparable to yours. This difficult case is a key research case of our department. Please pay more attention to Dr. Li."

Qin Fei has changed a lot!

Was this beaten by Director Hua?Then the consciousness improved?
After hanging up the phone, Li Jingsheng rubbed his temples.Tomorrow, I have to go to work in the clinic. There are two difficult cases in the Second Hospital, and none of them have been broken.

He walked to the bathroom, and after urinating, he felt that his bladder was much more comfortable, and his whole body felt relaxed.

Washed my face with cold water.

He decided to go to the inpatient ward of the Second Hospital to see the patient who underwent spinal canal repair surgery.

Obviously the lumbar spinal canal has healed and grown, why is the patient still paralyzed?The neurological examination did not find any obvious abnormalities, so what could be the problem?

The cause of the pain in the lower limbs of the female patient with enlarged kidneys was not found.

It could also be a neurological problem.

Go to the hospital and touch their bones, maybe there will be new discoveries.

Li Jingsheng is more interested in the study of difficult cases, but he has not yet reached the level of 'crazy'.

He is willing to take a taxi there now because he thinks that if he can find the cause, it will not only help the patient relieve their pain, restore their health, and even save the two families.

Especially the male patient, his girlfriend thought he was paralyzed and ran away.

Under the double blow, the possibility of committing suicide in despair is extremely high.

It was really hard to take a taxi in the middle of the night, so Li Jingsheng ran to the street outside the old street and waited for a long time before finally catching a taxi.

There are also two young female passengers on it, painted in smoky outfits, and their clothes are hotter.

Seeing the taxi driver parked in front of Li Jingsheng, they seemed a little unhappy.

Mainly in the middle of the night, I also worry about encountering bad people.

In fact, they are dressed like this, and they haven't come home in the middle of the night. I'm afraid they are not normal girls from a good family.

"Master, can I go to the Second Hospital?"

"Come on! Just drop by, I'll pick you up for a while. You don't need to use the watch, and you can give me eight yuan, okay?"

"No problem! Thank you!"

Li Jingsheng got into the car.

"You two beauties, I'll charge you a few dollars later. It's really not easy to take a taxi at night, let this brother share a taxi."

"Fine!"

One of the beauties agreed.

Listening to this voice, it seems very young.It's not like an aunt over 30 years old.

Dressed like this, young girls these days just know how to play.

Li Jingsheng sat in the passenger seat.

"You went to the hospital so late, what's wrong with you?"

the driver asked him.

"I'm going to see the patient."

Li Jingsheng replied casually.

"Has a friend or relative been taken to the hospital for an emergency?"

"No, I'm a doctor there. A patient has a fever. I'll rush over to have a look."

A black line appeared on Li Jingsheng's forehead.

The driver is still very enthusiastic, but he talks too much.

"Really or fake? All of your doctors are usually extremely cold and don't care about the patient's life or death. Cough...I'm not talking about you, I'm just talking about some doctors."

"Driving carefully!"

Li Jingsheng obviously didn't want to talk more with this driver.

With the continuous improvement of his strength and status, mainly due to the rapid increase in income, his mentality has changed significantly when interacting with people.

I can't say it, it's just a little more calm and calm.

There is a balance in the card, and there is a daily income, which gives him a little more confidence and courage to survive in this society.

(End of this chapter)