I Can See Health

   Chapter 275 Shocked in a cold sweat

   "Lu Chen, go see the patient first." Li Yao looked at Lu Chen.

  Lu Chen nodded knowingly.

   Yin Chao on the side was slightly surprised.

   Let a graduate student see this patient?

   Would it be a bit sloppy?

  This patient has been in their department for three days, but there is still no clear diagnosis.

   Even the blood pressure has not dropped yet!

   Or maybe, Professor Li should just let Lu Chen practice his hands, Yin Chao thought, he should check it himself later.

  …

  Lu Chen walked to the patient's bedside and began to ask the patient's medical history.

   Hypertension patients mainly ask about the course of hypertension, the highest blood pressure, specific oral drugs and blood pressure control level, etc.

   After asking about the general medical history, Lu Chen did not find any special illness.

   The patient felt dizziness, headache, and occasional edema in both lower extremities in the last month. Then he went to a clinic near his home to measure his blood pressure, only to find that his blood pressure was extremely high.

   The patient has no previous medical history, no history of genetic disease, heart disease, etc.

   After asking about his medical history, Lu Chen started a physical examination.

   He picked up the stethoscope and placed it in the auscultation area of ​​the heart and lungs, and heard no special murmur.

   The only sign of significance was mild edema in the patient's lower extremities.

  The two most common causes of edema are cardiac and nephrogenic.

   In addition, the patient is a typical abdominal obesity with a large belly.

   "Heart, lung and abdominal auscultation was negative, and mild edema of both lower extremities."

  Lu Chen reported the abnormal situation he found during his physical examination.

   "The basic clinical skills are quite solid."

  Yin Chao was quite surprised to see Lu Chen asking about his medical history and physical examination.

   Today's younger generation of doctors are increasingly relying on imaging techniques, thereby ignoring the most basic physical examination.

   When seeing a patient, many doctors prescribe CT and ultrasound, omitting physical examination and medical history.

   "Dr. Lu, if you have finished reading, let's go back to the office to see the patient's examination results." Yin Chaodao.

  The basic situation of the patient has been understood. According to the routine process, it is to check the results of blood drawing and examination after the patient is hospitalized.

   Especially in patients with refractory hypertension, it is necessary to exclude secondary hypertension through tedious examinations.

   However, Lu Chen shook his head and refused.

   "Director Yin, I have one more question, I'll end it after asking."

  Yin Chao was taken aback for a moment, then smiled, "You ask."

  Lu Chen noticed that there was a little girl about five years old sitting at the end of the bed.

  The little girl is dressed in pink and jade, and her appearance is very cute, but she doesn't look like the patient in the hospital bed at all.

   "I want to ask about your marriage history and menstruation." Lu Chen said.

   In clinical practice, as long as women are of childbearing age, they must ask about marriage, childbirth and menstruation.

   When the patient heard this, he whispered, "I am married, but I have not had children."

   "What about menstruation?"

   "Menstrual periods are very irregular, sometimes once a month, sometimes once every two or three months. If I drink traditional Chinese medicine to regulate menstruation, it will be more regular. However, I have not taken traditional Chinese medicine for a long time."

   "When was the last time you had your period?" Lu Chen asked.

   The patient thought about it and said, "It was probably two or three months ago. I don't remember much."

  Lu Chen nodded and looked at Li Yao and Yin Chao beside him: "I'm done asking."

  Yin Chao smiled, he thought Lu Chen was going to ask some serious questions, but it turned out that he was just asking about the history of marriage and childbirth and menstruation.

   This question was asked before.

   "Then let's go back to the doctor's office?" Yin Chao looked at Li Yao and asked for her opinion.

   "Okay." Li Yao nodded.

  Yin Chao led Li Yao and Lu Chen to the doctor's office of the Cardiology Department.

  …

   As soon as you walk into the doctor's office.

  Yin Chao greeted him: "Xiao Lin, bring the medical records of the 31-bed patients, and print out the test sheets and examination sheets!"

   "Okay!" A resident physician named Xiaolin responded quickly.

   At this time, other doctors in the department also saw Li Yao and Lu Chen who came.

  Li Yao and Lu Chen sat at the table in the center of the office.

  Yin Chao clapped his hands and motioned the people present to be quiet: "Today, Professor Li Yao came to our department to guide the work, everyone is warmly welcome."

  There are not many doctors in the office.

As soon as the    voice fell, there were sparse applause in the department.

   "Professor Li will take a look at the situation of the 31 beds first, and then start our teaching rounds today."

   Dr. Lin quickly handed over the medical records of the 31-bed patients to Li Yao.

  Li Yao turned her hand and handed it to Lu Chen next to her.

  Doctor Lin looked a little dazed. Who is the overly young doctor next to him?

  Yin Chao explained in a low voice, "Xiao Lin, this is Director Li's graduate student, Lu Chen, the two of you can have a good conversation."

   Xiaolin is a graduate student who just graduated this year. Because his home is in Fengm County, and he doesn't want to be too far from his parents, he stayed at the County People's Hospital.

   "Tell Professor Li and Dr. Lu about the patient's diagnosis and treatment in the past three days."

   "Okay." Dr. Lin nodded.

  Lu Chen was reading through the cases while listening to Dr. Lin's report.

   The patient's three-day diagnosis and treatment is very simple.

   is mainly to improve the examination of secondary hypertension.

   In terms of treatment, it is to give urapidil and oral antihypertensive drugs to lower blood pressure.

   Dr. Kobayashi continued: "The patient's blood pressure has been hovering around 180/100mmHg, and the systolic blood pressure occasionally rises above 200mmHg."

   "Currently, the patient's creatinine is high, and the urine protein and urine occult blood are positive. In addition, other test results, including potassium ions, are normal."

   "We consider that the diagnosis may be secondary hypertension to be discharged, hypertensive kidney damage. The confusing part is that the patient's blood pressure has not been able to drop."

  Lu Chen frowned.

   The patient's serum potassium is normal, which excludes many diseases of the endocrine system.

   Echocardiography and renal ultrasound were also normal, temporarily ruling out coarctation of the aorta, renal artery stenosis and other diseases.

   The most difficult problem is that the patient's blood pressure remains high.

   No matter what kind of high blood pressure it is, with so many antihypertensive drugs, blood pressure should also drop!

   "Professor Li, do you have any comments on our diagnosis and treatment process?" Yin Chao asked aside.

  Li Yao smiled and turned to look at Lu Chen, "Lu Chen, talk about it first."

  Yin Chao raised his brows.

  It's all over now, this Professor Li is still testing his students?

  Lu Chen pondered for a moment before slowly opening his mouth and said, "According to the current examination results, our common secondary hypertension factors, such as pheochromocytoma, protoaldehyde, adrenaline, etc., can be ruled out."

   Kobayashi nodded, this is where he was confused.

  The common secondary hypertension factors have been ruled out. Is this patient primary hypertension?

   However, Lu Chen's next sentence caused all the doctors in the Cardiology Department of Fengm County to break out in a cold sweat.

   "However, you missed one condition, and that is gestational hypertension!"

   Forced to go out for shopping... Late update

   (end of this chapter)