This Doctor is Great

the next day,

The third week, Monday.

Zhou Mo got up early, because he was going to have a big round of wards in Ke Nei today, so he needed to prepare early.

Come to Gastroenterology.

"morning!"

"morning!"

"Zhou Mo, I just received news that the colchicine patient yesterday was not rescued in the early morning and died." Li Dongmei saw Zhou Mo and informed him of a message.

"okay."

Zhou Mo replied calmly.

Not surprisingly.

After eating so much, and it took nearly 5 hours, it is strange to be able to live.

Zhou Mo's ward round, 80 beds were vacated yesterday, and only 79 beds of Li Bingmei (type 1 diabetes + ketoacidosis), so there is nothing to check, just a few minutes.

8:10,

The big rounds begin.

In the conference room, the selected case management doctors went to the ppt to report.

Zhou Mo was no exception. He reported a special case of tuberculous liver abscess (liver tuberculosis).

"Tuberculosis liver abscess is the term for extrapulmonary tuberculosis only announced in my country in 2019..."

"Blah blah blah..."

Because this disease is a relatively rare disease compared with bacterial and amoebic liver abscesses, Zhou Mo focused on reporting its symptoms, diagnostic methods, identification, epidemiology, etc.

Finally, the chief director commented: "This case is worth learning from everyone... When considering liver abscess in the future, in addition to bacterial and amoeba, we should consider liver tuberculosis..."

Zhou Mo came down.

Then the next resident doctor, Chen Yiquan, took the ppt to report the case.

"Hello, all leaders... I am reporting a very special case today. The cause has not yet been found. I am in hospital. I hope to brainstorm and find the cause..."

A 37-year-old married man was admitted to the emergency department with sudden abdominal pain and high fever.

"At the time of admission, the body temperature was 38.5, the pulse was 126, the respiration was 24, the consciousness was clear, the spirit was poor, the whole abdomen was tense, accompanied by tenderness and rebound tenderness in the middle and lower abdomen, the bowel sounds were weakened, and peritonitis. The body temperature rose rapidly within 30 minutes of emergency admission. Up to 40.2"c without chills. "

"Emergency blood routine: slightly increased white blood cells, no other abnormalities. Crp increased."

"Two months ago, because of the same symptoms, I was admitted to the gastrointestinal surgery department of a hospital, and had an exploratory laparotomy, but the cause could not be found..."

"This time, I still have the same symptoms and abdominal symptoms..."

The report ppt is completed.

In the conference room, many doctors began to meditate.

A doctor: "Are you sure it's not gastroenteritis?"

Dr. Chen Yiquan shook his head: "Unlike gastroenteritis, the patient complained that he had not eaten anything special, and there was no problem with his liver and kidney function."

Another doctor: "Have you had a colonoscopy? Stomach perforation? Peritonitis, gastric perforation, ulcers, etc. can be considered..."

Dr. Chen Yiquan still shook his head: "I have had a gastroscope and even a capsule, but I still don't see anything special."

A female doctor: "Is there any problem with the liver and kidney function? Is there any problem with the pancreas?"

Dr. Chen Yiquan: "I've checked everything, including blood draws, B-ultrasounds, and CT scans, but I haven't found any problems."

Other doctors have expressed their own consideration,

Including inflammation and infection of abdominal organs (eg, acute appendicitis, acute cholecystitis, acute pancreatitis, colonic diverticulitis), gastrointestinal perforation (stomach, colon cancer perforation), intestinal ischemic disease (strangulated ileus, mesentery) Thrombosis, ischemic colitis, etc.) Intraperitoneal hemorrhage (rupture of liver and spleen, rupture of small intestine)

Most are not in line with that patient's condition.

However, Dr. Chen Yiquan is not without gains, such as intestinal ischemia, which he did not consider before.

When you go back, you can do an angiogram to the patient to see if which part of the intestine is ischemia.

At this moment,

"I have a different idea..."

Zhou Mo suddenly thought of a disease and raised his hand. Gu Jin

The previous doctors considered the main feature of peritonitis as the starting point, and the fever was considered to be caused by inflammation.

However, Zhou Mo thought of a disease.

This disease was the information that the talent (system) gave him when he was diagnosed with colchicine yesterday.

"Everyone should know that there is a disease called "familial Mediterranean fever"! "

Now,

Most of the doctors looked at Zhou Mo.

Familial Mediterranean fever? ?

Many doctors were stunned.

Many doctors also quickly remembered what familial Mediterranean fever is.

Zhou Mo said: "Familial Mediterranean fever" is a spontaneous autosomal recessive disease of unknown etiology, most of which occurs in people of Mediterranean ancestry, especially non-Central European Jews, Armenians, Turks, Levantine Arabs..."

"And it has a very obvious feature: it is mainly characterized by repeated fever and peritonitis."

"Isn't that just right for this patient?"

Dr. Chen Yiquan hesitated: "But... Chinese people's genes should not have this disease..."

Yes, this disease is rare in China.

What is reported is also Western countries such as Europe and ugly countries.

This is also a lot of domestic doctors, do not know the reason for it.

And Zhou Mo, why did he know about it?

Because, colchicine, is the only drug used to treat familial Mediterranean fever!

only!

Very special!

Zhou Mo suggested: "You can ask the patient whether his ancestors have genetic origins from the Mediterranean region. If so, the possibility is very high..."

"Also, most of the patients with this disease have similar symptoms since childhood, and you can ask about the medical history in childhood."

"In addition, the patient should still have a fever and peritonitis, right, then give him colchicine to see if it can control the patient's condition. If at present, the treatment effect of colchicine is very good, and the ancestors have the Mediterranean Sea. The blood relationship, then the high probability can be judged to be "familial Mediterranean fever". "

Many doctors were surprised.

Colchicine?

Chen Yiquan nodded, feeling that what Zhou Mo said made sense.

At last,

Professor Liu commented: "This case is very interesting. When the ward round is next, you can go there..."

"In addition, the "familial Mediterranean fever" mentioned by Zhou Mo is of great clinical significance. In the future, when we diagnose patients with peritonitis and fever, we can consider this... my country has a vast territory and a complex population. patients..."

It is a kind of affirmation for Zhou Mo.

Huang Yiming, Li Dongmei, Huang Zhichao and other medical students were all envious.

Damn it,

It was installed by Zhou Mo again! !

10:00, the conference room ppt report ends.

Then a few more special cases were selected and went to the ward rounds.

Among them was the patient who was suspected of "familial Mediterranean fever"~www.readwn.com~ Doctor No. 10, a group of chief professors, and the entire ward was blocked in a mighty manner.

The 37-year-old patient shivered when he saw such a big battle, wondering if he was about to die?

Then asked about family history, childhood illness history.

The patient told the truth.

"My grandfather did have a grandmother from Europe, but I don't know if it is..."

"When I was a child, I did have it, but I don't have it anymore..."