I Can See Health

  Chapter 242 The End Point of Diagnosis (Second Update)

   Everyone went back to the doctor's office, first revised the doctor's order that Li Yao ordered, and then began to write the course record.

  Lu Chen specially instructed the nurse on duty to pay attention to the doctor's orders for blood draws for the 10-bed patients.

   Because these correspond to different time periods, it is easier to miss.

   This morning, Lu Chen was quite busy, and basically had no time to rest except going to the toilet.

   Of course, Cardiology itself is one of the busiest departments in the internal medicine system.

   As long as Lu Chen is still in the Cardiology Department, this kind of busy clinical life is a common occurrence.

   In contrast, Zhou Wei lived a life of "raising mice" ahead of schedule.

  Although Zhou Wei is also a postgraduate student, his mentor is in the rising stage of his career, and there is a shortage of people in the laboratory. After various coordination, he was temporarily transferred to the laboratory.

  So, Zhou Wei stayed in the laboratory every day, basically not in the clinical department.

   But although the clinical work is hard, the scientific research life in the laboratory is not much better!

   "I also want to go to the clinic! Raising mice is not only troublesome, but also really stinky!"

   During lunch, Zhou Wei couldn't help but complained to Lu Chen.

   "And no matter what I say now, I'm a master's degree holder. In the future, I will still have to take the final exam for regulated training. If I can't pass the exam, then I won't be able to get my graduation certificate!"

"Don't worry, your instructor won't keep you in the lab all the time." Lu Chen comforted, "You are equivalent to double cultivation. In the future, you can not only do clinical studies, but also do scientific research, find a job or study for a Ph.D., which will all be beneficial. of."

   Zhou Wei sighed lightly: "That's all I can think about now. But I won't even think about coming out of the lab within half a year."

   "Strive for an SCI article, if you can, then you're worth it!" Lu Chen smiled.

   "Hey, SCI is not something you can post if you want!" Zhou Wei shook his head and smiled wryly, "What's more, I'm just a chorus, can you bring my name, let's talk about it!"

  Lu Chen smiled helplessly.

   This is also an embarrassment for most graduate students.

  Do nothing, nothing!

   done, may be useless.

  Before you really master the key technology, whether you can publish an article or not depends on the character of the tutor.

  …

   In the afternoon, as soon as Lu Chen came to the department, he received a surprising and happy news from Sun Guoguo.

  Dong Hao's radiofrequency ablation was scheduled for the day after tomorrow.

   At that time, Lu Chen can go to the catheterization room on the fourth floor together to watch the entire operation process up close.

  For a graduate student, this opportunity is extremely rare!

  According to Sun Guoguo, this opportunity was won by Teacher Li Yao with him.

   This is also a reward for winning the first place in the case discussion last weekend!

   Compared with the two thousand dollars, Lu Chen was more willing to choose this opportunity to observe the operation.

   What's more, electrophysiological surgery is almost free of radiation effects.

   Today, Lu Chen was busy all day.

  …

the next day.

   The test results of 10 patients came out!

  The final result confirmed the analysis of Director Li Yao and Lu Chen.

The cortisol (hormone) of the patient was 402 μg/L (reference value 55-168 μg/L) at 0:00 am, 450 (reference value 150-552 μg/L) at 8 am, and 578 (reference value 55) at 16:00 pm -248μg/L).

   It is obvious that cortisol levels at 0:00 and afternoon are much higher than normal.

   and adrenocorticotropic hormone (ACTH) determination <1.0 (reference value 25-100ng/L).

   This is also in line with Cushing's syndrome!

  ACTH is secreted by the pituitary gland to control the secretion of hormones by the adrenal glands.

  Theoretically, the more ACTH is secreted, the more hormones the adrenal glands secrete, because the pressure on the top is great.

   But now the patient's ACTH is obviously less.

   This is easy to understand. It shows that the patient’s increased cortisol secretion has nothing to do with the pituitary gland. It is not the pituitary gland that makes the adrenal gland secrete more hormones, but the adrenal gland secretes so many hormones on its own initiative.

  The more hormones the adrenal glands secrete, the more they will be fed back to the pituitary gland. The pituitary gland feels that the adrenal gland has already secreted so many hormones, so there is no need to beat it or put pressure on it, so it secretes less ACTH.

   This is the classic negative feedback regulation in the human body!

   "Junior Brother, do you understand?" Lu Chen told Wei Wenwen all the principles of negative feedback.

  Wei Wenwen shook his head with a confused look in his eyes.

  Lu Chen was not impatient and explained very patiently.

   Junior Brother Wei is a potential source of gratitude, and he has to "take care" carefully!

  Lu Chen thought about it and continued:

"Brother, think about it, the pituitary gland is the boss, and the adrenal glands are the employees. If you want employees to work more (secreting cortisol), the boss has to keep urging them (secreting ACTH, the purpose is to urge the adrenal glands to work). "

   "Now we see employees do a lot of work (secreting a lot of hormones), but the boss doesn't urge them (ACTH is very low), but they don't talk much (ACTH is really too low), why?"

"Because the employees are working like crazy now, working hard and secreting a lot of hormones, after seeing this situation, does the boss have the nerve to urge the employees? There is no reason to urge the employees anymore, so ACTH secretion It’s less. Negative feedback regulation is just that!”

  Wei Wenwen suddenly realized, "Senior brother, it seems that this is what you said."

   "Congratulations, I received a thank you from Wei Wenwen!"

   Sure enough, hard work pays off!

  …

  The next step is to improve brain MRI and adrenal CT.

   A cranial MRI is done to make sure that the pituitary gland is fine.

   Adrenal CT is done to confirm that the problem is in the adrenal gland, whether it is adrenal adenoma or adenocarcinoma, it must be seen clearly.

   In the afternoon, the patient's head MRI was done first, and the results came out.

  The pituitary gland is really innocent, well, without any tumor.

   The patient was a little nervous, and immediately underwent CT of the kidney and adrenal gland.

   In the eight districts in the heart, the doctors of Li Yao's group are all surrounded by a computer.

   Everyone is waiting for the results of kidney CT and adrenal CT.

   When the patient completes CT, the image will be uploaded to the case system.

  Lu Chen immediately clicked on the image and looked at the patient's kidney shape frame by frame.

   "There really is something!"

  Lu Chen noticed that the patient had a small mass on the right adrenal gland, about 3cm in size.

   Needless to say, this small lump must be the murderer of the abnormal increase in hormone secretion!

   About twenty minutes later, the report from the CT room came out.

   The diagnosis of CT report is: right adrenal cortical adenoma (high probability)!

   Since then, the truth has finally come to light!

   When Lu Chen informed the patients and their families of the results, they finally breathed a sigh of relief.

   Because from the film, it looks more like an adenoma than a cancer.

  Adenomas are easier to treat. One cut and it's done.

  …

   "Please come to the Department of Urology for consultation!" Li Yao ordered.

   Soon the urologist was called to the Cardiology Office.

  The doctor outside the department finally decided to transfer the patient to another department, and the small tumor was surgically removed under laparoscopy.

   The patient's family naturally agreed immediately!

  Lu Chen didn't leave any ink, he directly helped him go through the department transfer procedures, and the patient was transferred to the Urology Department on the same day.

   "Congratulations, the completion of the system upgrade has increased!"

The    system beep sounds.

  Lu Chen is one step closer to the next upgrade!

  …

   Eight districts in the heart, the doctor's office.

  Although the patient was transferred to the department, all the doctors in Li Yao's group, including Sun Guoguo and Fan Zhiping, were amazed when they recalled the diagnosis process of this patient.

  From suspected myocardial infarction, aortic dissection, to suspected hypertrophic cardiomyopathy, to finally Cushing's syndrome, adrenocortical adenoma.

   When you think you've reached the end of your diagnosis, it's often just the beginning!

   It's too late to go home today, so I'll just watch two more.

   (end of this chapter)