This Doctor is Great

Gout has a name of "richness's disease".

The poor cannot afford this disease. (??)

Why do you say that?

Because the cause of gout is high purine.

"High purine" foods are generally found in shrimp, shellfish and other seafood and animal offal.

Excessive eating, purine will be too high, and then after the body metabolizes, produces a lot of uric acid, there will be high uric acid levels, which will lead to gout.

In addition to these seafood, there is the most common one in Guangdong - Laohuo Liangtang.

The longer the soup is boiled, the higher the purine.

There is a joke called: "Look, this is a full pot of old fire (purine) soup (purine)."

Therefore, in terms of epidemiological analysis, it can be found that the coastal areas and Guangdong are all places with high incidence of gout.

In addition, drinking alcohol increases the risk of developing gout.

For example, beer has a guanylate in its composition, which can be metabolized in the body to form purines.

At the same time, after alcohol is metabolized by the body, it can also generate "lactic acid", which can inhibit the excretion of "uric acid", thereby increasing the risk of gout.

Analysis of gout,

Generally, the analysis is carried out from two aspects of "high purine" + "excretion".

So beer exists in both aspects, so gout patients should drink as little as possible.

And the patient ate seafood and drank beer again yesterday,

Then high uric acid - the possibility of gout is very large.

also,

Zhou Mo looked at the middle-aged patient Chen Xu in front of him.

is an obese person.

Estimated to be more than 170 pounds.

This body type, climbing knees, will naturally have more serious wear and tear.

in addition,

Obesity also increases the risk of gout.

The specific process is:

——Obese people are prone to insulin resistance, which affects the excretion of uric acid, and also leads to an increase in free fatty acids in the body and affects the activity of xanthine oxidase, resulting in increased uric acid levels...

According to some papers and guidelines seen by Zhou Mo, it is pointed out that the probability of gout in obese patients is 17.8% higher than that of ordinary people.

so,

From this, it can be deduced that the patient Chen Xu is obese, and he ate seafood and beer last night, so the probability of gout is very high.

In addition to the above-mentioned two conditions of gout and joint wear and inflammation,

There is another possibility - rheumatism and rheumatoid.

But these two, generally rely on blood tests.

So far,

Zhou Mo's consultation is basically over.

The analysis is very long, but in fact it only asks a few sentences, less than 30 seconds.

Zhou Mo said to Teacher Zhang Mei, "I'm done asking."

"Specifically, my view is that there is a possibility of wear-and-tear arthritis, gout, rheumatism, rheumatoid ... or even all three."

"It depends on the results of the blood draw to diagnose the real cause."

After listening, Zhang Mei nodded: "Okay, if you come to open, what kind of inspection should you open?"

Zhou Mo: "First of all, a blood routine test must be done, as well as kidney function, X-ray, rheumatism and immunity items of uric acid index... that's all."

Teacher Zhang Mei nodded: "Okay, that's it."

Zhou Mokai's inspection was the same as what she thought.

Thinking of this, Teacher Zhang Mei looked at Zhou Mo with admiration.

4 inspections, within 2 hours, can be all out.

Among them, rheumatism and immunity usually take 3 working days (the inspection process is 2 hours, but it takes 3 working days for queuing, checking, and getting the results), but the emergency department will be a little different, and the results should be available in 2 hours. .

"Thank you doctor."

The patient's wife thanked him, and then helped the patient Chen Xu with difficulty and left the clinic.

Teacher Zhang Mei: "Which do you think it is?"

Zhou Mo shook his head: "It's quite possible, or all three."

Teacher Zhang Mei smiled.

She thinks the same.

...

...

afternoon,

Zhou Mo followed Teacher Zhang Mei to the observation ward.

"doctor!"

The patient Chen Xu's wife, seeing Zhou and Mo, hurriedly waved.

"Doctor, are the results out?"

"it is good."

Zhang Mei and Zhou Mo heard the words and walked over.

Zhang Mei looked at the patient Chen Xu, her face was relatively good, and it was not as painful as it was at the beginning.

"Is it better now?"

"Yes, I don't know why, but in the hospital, it didn't hurt so much. I obviously didn't take medicine."

Patient Chen Xu looked puzzled.

"What about the test results?"

"Here... trouble the doctor..."

Teacher Zhang Mei took a few glances, and then handed the result to Zhou Mo.

"Come and analyze..."

Zhou Mo looked at them one by one.

Rheumatism immunization and rheumatoid tests were all negative.

excluded.

Then blood routine, white blood cells and some items increased, showing inflammation.

X-rays showed that the joints were damaged to a certain extent, but based on Zhou Mo's experience with X-rays, there was no way to judge whether it was wear or gout.

also,

The results that Zhou Mo is most concerned about:

Kidney work!

The uric acid level was 395uol/L (420uol/L is the cut-off for gout).

Teacher Zhang Mei: "How is it? What do you think it is?"

Zhou Mo frowned: "First of all, I can't run because of arthritis. It should be because the mountain climbing yesterday put too much load on the joints, causing wear and inflammation."

Teacher Zhang Mei: "What about gout?"

Zhou Mo thought for a while, then hesitated: "Although the uric acid level has not reached 420, it should be judged that it is not gout, but the standard of 420 is not certain..."

Teacher Zhang Mei is very interested: "Oh? Tell me more specifically."

She also thought that Zhou Mo would fall into this pit.

result,

Zhou Mo actually understood!

This is awesome!

Are you sure it's a medical student? Not the old demon?

Zhou Mo analyzed it in detail:

"Although the patient's uric acid is only ~www.readwn.com~ and can't reach the 420uol/L line, I still think there is a possibility of gout."

beside,

There happened to be an emergency teacher and 3 interns watching the patients on the next bed. The so-called interns are the kind of students who have not graduated from the school and come to the hospital to walk around and see all kinds of things in the hospital. They will not really work in the hospital.

Then when I heard the conversation between Zhou Mo and Zhang Mei, I couldn't help but look over.

When the three interns heard Zhou Mo's words, they couldn't help but chuckle.

joke!

The textbook gout index is 420!

You can't say 420 now, it's also gout?

Who is this person?

Knowledge is not solid at all!

The three interns looked at Zhou Mo with contempt.

The emergency doctor and teacher next to him also felt that Zhou Mo was wrong.

However, the four of them are curious, Zhou Mo is in the end

Zhou Mo said to Teacher Zhang Mei at this time:

"For gout, according to the guidelines and papers I have seen, it is not possible to rigidly use the value of 420..."

"First of all, let's talk about the meaning of 420uol/L, which refers to the saturation concentration of uric acid in the body!"

"When the blood uric acid concentration exceeds 420, it is easy to precipitate "urate". It deposits in the joints and forms tophi over the years. The presence of "uric acid" causes pain symptoms. "

"So, the focus is not on 420, but on the conditions for the formation of "urate". "

said here,

The three interns were stunned.

The emergency teacher was also stunned.

Zhou Mo's words make sense!

Zhou Mo continued to talk eloquently: "So, what are the conditions for the formation of "urate"? "

"It's concentration + temperature!"