This doctor has a system

Chapter 584 647. Killed by Thunder
This is a new situation that He Xiaolei never mentioned in previous inquiries.

Many patients are like this. They will not tell the doctor if they think something is unimportant.

"Is there a fever?" Gao Feng nodded thoughtfully. He thought for a while, and suddenly a flash of lightning flashed in his mind.

"What was the patient's blood pressure just now?"

"130/80 mmhg." Sun Zhengming replied, "Any questions, Director?"

"I remember his father said his blood pressure was a little low this morning, at 105/70." Gao Feng stood up. "Was it measured on the same arm?"

Sun Zhengming quickly called the nurse over, but she said she couldn't remember clearly.

"Measure the blood pressure of both upper limbs now." Gao Feng said, "It may be large arteritis!"

Takayasu arteritis is a chronic inflammatory disease of the aorta and its main branches. The cause is still unclear, but it may be related to genetics, immunity, high estrogen levels and other factors.

This disease may have non-specific systemic symptoms such as general discomfort, fatigue, fever, loss of appetite, and nausea.

At the same time, depending on the affected blood vessels, symptoms and signs of ischemia of the corresponding organs may appear. For example, patients with type I may experience varying degrees of ischemia in the brain and upper limbs.

Patients with cerebral ischemia experience dizziness, headache, memory loss, black spots on one or both sides of the vision, decreased vision, narrowed visual field or even blindness, weak chewing muscles and chewing pain.

Patients with severe cerebral ischemia may experience repeated syncope, convulsions, aphasia, hemiplegia or coma.

If He Xiaolei really has Takayasu arteritis, then his symptoms can be completely explained.

"The blood pressure on the left side is 134/88 mmHg, and on the right side is 100/64 mmHg." The nurse reported after taking the measurements.

Gao Feng suddenly felt relieved. The systolic blood pressure difference between the patient's bilateral upper limbs was >10 mmHg, which was consistent with the symptoms of large artery inflammation.

"Check for anti-endothelial cell antibodies and anti-aortic antibodies." He thought for a moment and said, "Oh, and also check the neck blood vessels with color Doppler ultrasound, or do a magnetic resonance imaging directly."

Two days later, the results of the blood test and MRI came out. Anti-endothelial cell antibodies and anti-aortic antibodies were positive. The MRI of the neck showed obvious stenosis of some blood vessels, and one branch of the left carotid artery was even blocked.

This also explains why He Xiaolei faints from time to time: it is caused by ischemia.

For mild Takayasu arteritis, the general treatment is corticosteroids and immunosuppressants, but the patient's condition was obviously serious, and after evaluation, the vascular surgeon recommended surgical treatment.

"The main surgical method is to remove the diseased section of the aorta and replace it with an artificial blood vessel." Director Liu of the Vascular Surgery Department communicated with He's father, "This section of the lesion is long, so we will choose aortic bypass surgery."

"I don't understand what you are saying." Father He felt a little unsure.

"That's right, you don't understand." Director Liu said. He has been doing this for decades and has just figured out the tricks.

"I have to have surgery anyway, otherwise it won't work."

Since the doctor said so, He's father didn't think any more about it and finally agreed to transfer to another department for surgery.

After this patient was solved, the only one left was the 35-year-old female doctor.

"Doctor, it's been so many days, why haven't you found out the cause of the disease yet?" The patient's mother was a little anxious. Originally there was another patient who could accompany him, but now that the diagnosis has been confirmed and he's going to have surgery, they are the only patient left in this ward.

"Don't worry, we are trying to find a solution." Sun Zhengming comforted.

"Oh my, how can I not be anxious?" the patient's mother said worriedly, "Is my daughter suffering from Alzheimer's? Her memory is getting worse and worse!"

"My mother has Alzheimer's. Could it be inherited from her?"

"Or is it overusing your brain?"

"Oh my! I shouldn't have asked him to take the doctorate exam. Now he has ruined his brain!"

"Hey!"

"Auntie, don't worry. Director Gao is analyzing it right now," Sun Zhengming consoled her again, "Please hold on a little longer."

Sometimes, the patient's mood is okay, but the family members are anxious and jump up and down like monkeys, especially the parents, who love their children very much.

"Didn't the MRI report anything?" Gao Feng asked. He had said at the time that the patient should have an enhanced MRI.

"I was allergic to the gadolinium and the scan failed," Sun Zhengming reported.

Gadolinium is a contrast agent used for magnetic resonance imaging. It is a non-magnetic substance that is not affected by magnetic fields and can therefore be used safely in MRI scans.

It is injected into the body intravenously and collects in certain tissues, such as diseased tissue or blood vessels, during MRI scans. This collection effect allows gadolinium to enhance MRI images, helping doctors better identify the location, size, and shape of lesions.

"Allergic to gadolinium?" Gao Feng was a little surprised. Gadolinium can indeed cause allergic reactions in patients, but the probability is very low, much lower than the probability of iodine contrast agents causing allergic reactions in patients.

"Is it serious?"

"Halfway through the scan, the patient developed large rashes all over her body and had obvious symptoms of difficulty breathing," said Sun Zhengming, scratching his head. This scared the doctor in the imaging department, who quickly gave the patient a push and sent her back to the ward.

"Halfway through?"

"Yes, there is no film." Sun Zhengming replied, "It should be because the scan is incomplete."

"Let's go to the imaging department." Gao Feng said after thinking for a while. He wanted to try his luck and maybe he would find something.

Soon they arrived at the Radiology Department, which should be one of the busiest departments in the hospital. The appointment registration desk was full of patients' families, and there were people arguing nearby.

"Why do you cut in line?"

"I'm not cutting in line. I just took my number."

"It's not okay even if you've queued up, you're not allowed to stand in front of me!"

"I gave you face, didn't I?"

As soon as these words came out, the two middle-aged men immediately got entangled with each other. The nurse next to them was so worried that she hurried forward to persuade them to stop.

"Little girl, get out of the way. I'm going to teach him a lesson today!"

"A toad yawns - he's quite arrogant!" The other party sneered disdainfully, "It's up to you whether I shave you or not!"

Gao Feng found it a bit funny, but what made him feel even funnier was the performance of the security guard nearby. The old man stood there motionless, looking very much expectant of the fight that was about to take place.

"Stop!" He walked up, "If you want to fight, go outside and do it. Don't disturb other patients here."

"Who the hell are you? Get lost!" the man in the jacket shouted at him. The other man was also angry, and both were very unhappy with his appearance.

Good guy, you dare to curse!
Gao Feng walked up to the man in the jacket and grabbed his arm. Before the man could say anything else, he exerted force.

Suddenly, a scream rang out from the reservation registration desk. The man in the jacket wanted to hit Gao Feng with his other fist, but he was held down by Gao Feng and hit him hard again.

Now the man in the jacket became completely obedient, and his expression became calm.

"Do you have anything else to say?" Gao Feng asked.

"Let go of your hands first," the man in the jacket said in a timid tone, "Let's talk properly, don't do it!"

"Is it necessary to scream so miserably when someone just pulled your arm?" someone nearby asked, "What's the matter? Are you still trying to blackmail me?"

"That's right. He was so awesome just now, and he's still acting now."

“It should be a histrionic personality.”

The man in the jacket was almost pissed off by this group of people, so he simply kept silent.

"Everyone, please communicate well. Fighting is not allowed here." Gao Feng said and let go of the jacket man's arm.

"Hello, Director Gao." Director Zhou from the Radiology Department came forward and greeted him with a smile, "What can I do for you?"

"It's like this. A few days ago, I had a patient who was undergoing an enhanced MRI."

"Oh, I know about this." Director Zhou opened the patient's image on the computer. "She was allergic at the time, and our technicians were also very worried."

The technician was more than just worried. He was almost scared to death and wanted to kick the patient back to the ward.

"Plus, the patient was moving a lot inside, so the film was not very clear, so I didn't upload the film."

Of course, they also don't charge patients any fees.

Gao Feng swiped the mouse to look at the dozens of pictures. The image quality was indeed poor, with many artifacts, and it was simply unbearable to look at.

But since he was here, he still had to take a closer look to see if he could find any problems.

You know what, after taking this look, he actually discovered something.

"Director Zhou, is there something wrong with this?" Gao Feng asked, "Abnormal signal shadow?"

"It looks a bit similar, but it's not very clear." Director Zhou was quite puzzled as he was not good at looking at such blurry images.

"The affected areas are the brain stem and putamen, and the cerebellum is a little atrophied." Gao Feng frowned. This was a bit unusual for a 35-year-old man.

The imaging department was indeed very busy, and he did not want to disturb them too much, so he simply picked up his mobile phone, took a few photos, and then said goodbye to Director Zhou who was accompanying him.

Back in the department, Gao Feng fell into deep thought. He rethought the patient's condition from an anatomical perspective.

First of all, increased muscle tone and limb tremor should be located in the extrapyramidal system.

Secondly, the active tendon reflexes of the limbs were localized to the bilateral corticospinal tracts. The left Pussep sign was localized to the right corticospinal tract. The right Babinski sign (+) was localized to the left corticospinal tract.

The right Rossolimo sign (+) was localized to the left cortico-brainstem tract.

The decline in computing power and memory is localized in the cortex and subcortex.

Thinking of this, he suddenly stood up.

"Zhengming, is there any problem with the patient's liver?"

"No." Sun Zhengming was confused when he answered. He was thinking about diseases related to the nervous system, so how did it suddenly jump to the liver?

“Are there liver palms?”

This question really stumped Sun Zhengming. “I don’t care too much.”

But even if there is one, it should not be very typical, otherwise he would not have no impression of it.

The so-called liver palms are mainly manifested by the appearance of patchy congestion, or red spots and plaques in the thenar eminence, hypothenar eminence and palmar surfaces of the fingers. They may turn pale when pressure is applied and return to red after the pressure is released.

The principle is that when liver function is impaired, the inactivation effect of estrogen is weakened, leading to increased estrogen levels in the body, which in turn causes dilation of small arteries, which manifests as liver palms in the palm area.

However, not all people with palmar erythema have severe liver disease. Some healthy people may also experience symptoms similar to palmar erythema under certain specific circumstances.

"Let's go and take another look." Gao Feng said.

The patient's palms were a little congested, which could barely be considered palmar erythema.

"Director, why did you suddenly think of this?" Sun Zhengming asked the question in his mind.

"I just thought of a disease, hepatolenticular degeneration." Gao Feng said, holding his chin, "I think it can explain the patient's current symptoms and imaging results."

Wilson's disease is an inherited copper metabolism disorder caused by abnormal copper deposition in various tissues in the body. Characteristic clinical manifestations include acute or chronic liver disease symptoms, progressively worsening extrapyramidal symptoms, psychiatric symptoms and corneal pigment rings.

Other common clinical symptoms include hemolytic anemia, bone and joint symptoms, hematuria, etc.

The patient currently only has mental symptoms, which may seem a bit far-fetched, but for some reason, Gao Feng is very confident in his judgment.

Wilson disease should be considered in patients with unexplained liver manifestations, neurologic symptoms (particularly extrapyramidal symptoms), or psychiatric symptoms.

"Next, check in this direction!"

肝豆状核变性的诊断要素主要有三项：1.K-F环阳性；2.24小时尿铜＞100μg，需除外铜污染；3.肝铜浓度＞250μg干重以上。

The diagnosis of this disease can be confirmed if any of the following three items are met and the serum copper basket protein is decreased.

The possibility of hepatolenticular degeneration should be considered in patients with unexplained liver abnormalities, especially those with liver disease associated with neurologic or psychiatric symptoms, or those with a first-degree relative with hepatolenticular degeneration.

"Does his father have a history of this disease?" Sun Zhengming asked the patient's mother.

"Who knows? The person died a long time ago!" said the patient's mother unhappily.

"He's dead?" Sun Zhengming was surprised. "How did he die?"

"He was struck to death by lightning."

What follows is a story about a man who, due to long-term family conflicts, abandoned his wife and daughter and lived with his mistress.

The patient's mother cried loudly, and Sun Zhengming comforted her.

"If the woman in a family is too strong, the family usually doesn't live well." Back in the office, he sighed a little, but the patient's mother really had a hard time. After experiencing a failed marriage, she did not remarry, but raised her daughter alone.

(End of this chapter)