Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Chapter 112 Give me an hour! (Please subscribe!)

Director Cai of the dermatology department pulled Lin Yi aside, and said to him with a solemn expression:
"I don't have a clear idea of ​​the patient's condition now, but I can see that her condition is very urgent. If it continues like this, she may not be able to survive a day."

"Under such circumstances, it is impossible for us to test her item by item. There must be too little time!"

"So...the only way I can think of to save her life is to remove the necrotic muscle tissue on her body."

At this moment, Yin Liang also came over and said to Lin Yi:

"Brother Yi, I injected her with heparin just now, but it doesn't seem to have any effect now, which means it's not warfarin's problem."

Lin Yi nodded slightly after listening, then looked at Director Cai and said:

"Director Cai, continue talking."

Director Cai nodded, frowned and said:

"It's just that if it is removed, the abdomen and back are fine, but she also has a piece of breast, and the removal requires the removal of two breasts..."

"Such a small child is really..."

Speaking of this, Director Cai couldn't help but sighed.

Lin Yi pondered for a moment, then nodded in agreement:
"That's right. Judging from the degree of necrosis of her skin, the necrotic cells must have invaded the fat tissue. If the mastectomy is performed, it will definitely not be preserved."

"Unless we can find out what her real cause is and treat it so we can avoid surgery."

"Besides, I don't think surgery is a good solution. Once the resection is incomplete, it will take less than two days for the necrotic tissue to reappear."

Director Cai shook his head and said:

"That's what it says."

"But the cause of the disease is so easy to find out, there is really not much time left..."

Lin Yi didn't speak, but lowered his head and kept thinking.

After a while, Director Cai sighed and said:
"It's the only way to go. I'm going to tell the patient's mother now, and let her start the operation as soon as possible after she signs it."

After speaking, Director Cai went directly to the hospital bed and explained the situation to Hanhan's mother.

When Hanhan's mother heard it, she shouted excitedly:

"What? Cut off the breasts?!"

"Are you kidding! Hanhan is only 13 years old! How do you let me spend the rest of her life, huh?"

Looking at Hanhan's mother who was out of control, Director Cai was also very helpless, so he had no choice but to comfort her:
"Ma'am, we understand how you feel."

"But the top priority now is to save her life. This is the most important thing."

"Otherwise it will be too late, you should think about it carefully."

Then Hanhan's mother cried and made noises, but no matter how she vented, the matter still needed to be resolved.

"Okay, I'll sign."

After a long while, she stared straight ahead with blank eyes, and murmured.

"it is good………"

Director Cai nodded slightly, then turned his head and shouted to the dermatologist who came with him:

"Xiao Tang, come and make arrangements for the operation!"

"Yes!"

The doctor agreed and immediately turned and walked out of the ward.

"Wait a minute, Director Cai!"

At this moment, Lin Yi who was standing aside suddenly opened his eyes wide and shouted at Director Cai.

"Huh? Doctor Lin, what's the matter?"

Director Cai turned to look at Lin Yi in doubt, and asked in puzzlement.

"Director Cai, don't arrange surgery yet, give me an hour, I may already have some ideas!"

Lin Yi stared at him and said.

"This... the patient's current situation is very critical. We need to race against time. Every minute more is more dangerous."

Director Cai hesitated.

"I know that, but let's wait."

Lin Yi continued to insist.

Seeing this situation, Hanhan's mother immediately stepped up and asked excitedly:

"Doctor, what do you mean? Do you have a clue about Hanhan's cause?"

"Then...or else wait a little longer."

After all, breast removal is required for surgery, and of course she really doesn't want to do this in her heart.

Seeing a glimmer of hope at this time, she immediately had fantasies and expressed her opinions.

Seeing this situation, Director Cai had no choice but to nod helplessly and said:
"Okay then, but Doctor Lin, you must hurry up."

"Ok, I know."

Lin Yi nodded, then turned to Wu Jiang and the others and said:

"Let's go first."

After speaking, the group returned to the office.

"Brother Yi, if you have any ideas, tell them quickly."

As soon as he arrived in the office, Wu Jiang couldn't wait to ask.

"I think my train of thought was wrong from the beginning!"

Suddenly, Lin Yi said directly.

"Ah? What's wrong?"

The first sentence was to deny himself, and Wu Jiang immediately continued to ask.

"Her obesity and skin necrosis are most likely not caused by one cause!"

Lin Yi stared, and said in a deep voice,
"When we look at these symptoms together, we have no clue to find the cause."

"But if you look at it separately, there are multiple possibilities."

"There are many causes of obesity, hormonal influences, abnormal brown tissue fat, and genetics."

"As for heredity... I didn't think about it enough before."

Afterwards, Lin Yi's eyes flashed, and he murmured.

"Genetics don't take into account? How?"

As soon as he finished speaking, Wu Jiang made a rebuttal,
"Didn't you just consider whether her heart disease was hereditary at first, but her mother directly denied it, saying that no one in their family has heart disease."

"I don't mean heart disease."

Lin Yi shook his head.

"It's not heart disease, is it obesity? Or skin necrosis?"

Wu Jiang couldn't help raising his eyebrows after hearing this, and then said:

"In the case of obesity, we did find that her mother was also obese before, but her mother took diet pills and it worked, but she didn't. That's why we analyzed that her obesity is pathological."

"After talking for a long time now, why did you say it again?"

"If you're saying that skin necrosis is hereditary... then it's unlikely, her mother doesn't have this symptom either!"

Lin Yi shook his head and said:
"You didn't get my point. What I meant by heredity was her height."

"What? Height?"

This time, Wu Jiang and the others were even more confused, not knowing what Lin Yi was going to say.

Why does this bring height into it for no reason? Does it have anything to do with her illness?

"Yes, the patient is 13 years old. Although she is fat, her height is a bit short for her age."

Lin Yi nodded and said.

Yin Liang pondered for a moment and nodded and said:

"Well, that's right, it's a bit short. I noticed it, but I felt that nutrition was used to grow flesh, and I didn't grow taller, so I didn't care."

Lin Yi continued:

"But her mother's height is nearly 178cm. In the previous chat, she also inadvertently mentioned that the father of the patient who has divorced her is taller than her."

"So from a normal genetic point of view, the patient shouldn't be so short!"

"But what does it matter...?"

Everyone was confused and asked in doubt.

They can no longer keep up with Lin Yi's train of thought!
"Shouldn't being short have anything to do with her skin necrosis? Why do you bother with her height?"

Afterwards, Wu Jiang raised his doubts.

"Of course it does!"

Lin Yi said directly,

"She is surprisingly short, which could be a developmental delay."

"And once it can be proved that she has a developmental delay, then her cause can be solved!"

"Delayed development? I don't understand what you mean."

Wu Jiang and Yin Liang looked at each other and said truthfully.

Lin Yi patiently continued to explain to them:
"If you think about it, if a patient has developmental delays, obesity, high blood pressure, and blood clots at the same time, what might be the disease?"

"this………"

After Lin Yi finished speaking, several people immediately began to think in their brains.

But after a while, they frowned tightly, their expressions a little embarrassed.

I can't think of it at all!
"Brother Yi, just say it directly, and don't let us think about it."

Afterwards, Wu Jiang said to Lin Yi with a smile.

"Cushing's disease!"

Time was running out, so Lin Yi didn't hold back and told him directly.

"Cushing's disease?"

Several people in Wu Jiang asked back in unison.

Because this Cushing's disease is an extremely rare disease, they have a little impression, but they don't know much about it.

Afterwards, Wu Jiang pondered for a while and immediately said:
"Brother Yi, I have some impressions of this disease before, but I remember that this disease will not cause skin necrosis in patients, right?"

Lin Yi nodded and said:
"That's right! Cushing's disease does not cause skin necrosis, but in certain special cases, it can cause hypercalcemia."

"And hypercalcemia can cause skin necrosis!"

After Wu Jiang heard this, he remembered something.

Hypercalcemia is a disease in which the calcium ion concentration in the serum is abnormally elevated.

Symptoms include unconsciousness and skin necrosis!

But Wu Jiang couldn't help asking in doubt:
"But... If I remember correctly, patients with hypercalcemia should be able to detect abnormal cortisol during blood tests."

"But Hanhan's previous blood test results did not show abnormal cortisol!"

Lin Yi looked at him and said:
"The absence of cortisol abnormalities doesn't mean much."

"Because hypercalcemia is periodic, if it is not detected, it may be that the timing of our inspection is wrong."

That's what it is... .

Hearing this, Wu Jiang and the others couldn't help but nodded slightly.

"Our top priority now is to diagnose Han Han with hypercalcemia as soon as possible and to cure her."

"The speed of her skin necrosis is too fast now, and the time left for us is really running out!"

"Once it is delayed, no one can bear the consequences!"

Lin Yi said solemnly.

"What should I do?"

Wu Jiang raised a question, and then immediately said:
"Then let me arrange a blood test for the patient now to check whether she has hypercalcemia."

"No, it's too late. I told Director Cai just now that it's an hour, and it's been nearly 10 minutes now,"

Lin Yi directly denied it.

"If it's too late, there's nothing you can do. This is the only way to check. If you don't check, you can only go for surgery!"

Upon hearing this, Wu Jiang immediately spread his hands and said anxiously.

Lin Yi didn't reply immediately, but kept searching in his brain.

After a while, his eyes suddenly lit up, and an idea appeared in his mind.

"In such a short period of time, it is really too late to judge whether there is hypercalcemia through blood tests, but we can start from the cause. If we directly find the cause of hypercalcemia, then we can also diagnose it!"

Immediately afterwards, Lin Yi expressed his thoughts to everyone.

Because hypercalcemia is caused by Cushing's disease, but Cushing's disease can only be regarded as a catalyst, while hypercalcemia has a fundamental cause.

"Well... that's fine."

Yin Liang nodded, then asked:
"That's right, but how do we find the root cause of it?"

"NMR."

Lin Yi thought for a while, then blurted out.

"NMR?"

Yin Liang couldn't help but widen his eyes in surprise, and asked back,
"Using MRI to diagnose hypercalcemia? This...how is this going to happen?"

"I mean, use an MRI to find out what caused her hypercalcemia."

"Because hypercalcemia has a probability of more than 95% due to malignant tumors."

"So if we find this, we can also sideline the diagnosis of hypercalcemia."

After listening to Lin Yi's thinking logic, several people couldn't help but nodded in admiration.

His logic is so clear that even in such a tense situation, he can start from the aspect of height inheritance and think of developmental delay.

So as to infer the possible disease based on the symptoms, and then confirm it from the side.

It can be said that the chain is interlocking, and the water does not leak!
"Okay, don't be dazed, act quickly!"

Afterwards, Lin Yi clapped his hands and said to them.

"Okay, I'll take the patient to the imaging department for an MRI right now!"

Wu Jiang immediately agreed, and then walked out.

Back in the ward, Wu Jiang immediately arranged for Han Han to be pushed into the MRI room.

Lin Yi arrived later.

After Hanhan was pushed into the machine, the inspection began!
A picture suddenly appeared on the screen.

Lin Yi and the others stared closely at it.

"There is no problem with the thyroid..."

"Neither did the adrenals..."

Lin Yi stared closely, and kept talking.

But when the picture showed Xiaoshu's pituitary gland, Lin Yi opened his eyes suddenly, and then said loudly to the medical staff of the imaging department:

"Stop! Freeze on the pituitary gland!"

The imaging doctor was a little surprised by Lin Yi's sudden shout, and then quickly followed what he said to freeze the picture!
The Wu Jiang people next to him looked puzzled.

What's the matter, I didn't see anything special just now?
After freezing the frame, Lin Yi immediately pointed to the position of the pituitary gland on the screen, and said:
"Look carefully, the little black spots here!"

Only then did everyone look in the direction of his finger, and when they took a closer look, they saw that there was indeed a small black spot the size of a sesame seed impressively on the pituitary gland.

(End of this chapter)