Chapter 543 Exclusion! Misconceptions in clinical thinking!
There are several common clinical symptoms, such as hydrocephalus, intracranial tumors, meningitis, etc., but the physical examination did not find the classic sunset sign, etc., which is not very meaningful.
Or in other words, Xu Qiu has not found the real cause of these abnormal changes.
It's a bit of a headache...
Originally, I came to check Yuan Yu's liver damage, but ended up connecting to a child with the same liver damage. Now I found that in addition to liver damage, the child also has bronchitis, cranial enlargement, developmental delay and other abnormalities.
The more I look at this disease, the more complicated it becomes, and the more difficult points there are.
Mo Wan said in a small voice: "At present, the metabolism and transport process of substances in liver cells and the mechanism of bile acid enterohepatic circulation are not fully understood. If we encounter a new hereditary liver disease, it is not impossible..."
She was the only person present who could understand the various rare hereditary liver diseases mentioned by Xu Qiu before.
Mo Wan continued, "If you really have no idea, you can do a whole genome sequencing."
The first generation of whole genome sequencing costs $3 billion per person; now the second generation technology is mature, and the third generation sequencing technology is in Daxia, Meiguo, and the British Empire, and the price has been reduced to less than 10,000 yuan.
In the future, it is expected to become a routine diagnostic measure for various genetic diseases.
Now all provinces in Daxia have also carried out it. As long as you have money, you can get the results in three or four days.
Xu Qiu did not speak.
Whole genome sequencing is the last resort. If possible, he hopes to detect a certain type of disease in a targeted manner.
On the one hand, it saves money, and on the other hand, it is fast.
"Wait."
At this time, Xu Qiu suddenly paused. He frowned and looked at the child, saying: "Is the distance between the eyes of the child a little wide?"
Li Xue looked carefully, and her face changed slightly: "It seems that there are some... not very obvious, but according to the growth and development of the child, the distance between the eyes is indeed wider."
Xu Qiu was silent, and the symptoms of Yuan Yu and the child flashed in front of him one by one.
Finally put together.
Yuan Yu:
Heavy bleeding after miscarriage, endometrial exfoliation;
Jaundice, dark complexion, swollen legs...
Children:
Jaundice;
Swelling of legs;
Enlarged brain, prominent cheekbones, widened eyes;
Developmental delay;
Mental depression (no crying or making a fuss)...
...
"The inference of hereditary liver disease should be correct. The liver damage of mother and child is highly similar." Mo Wan said after analysis.
Xu Qiu came back to his senses and said slowly: "Try hydrochlorothiazide, sodium nitroprusside and milrinone."
"Okay!" Yunmei wrote it down immediately.
But everyone had a puzzled expression on their faces.
Hydrochlorothiazide is a diuretic;
Sodium nitroprusside is a vasodilator.
As for the last milrinone, it is a cardiotonic drug similar to digoxin.
These three together mean that Xu Qiu's treatment measures are aimed at heart failure, not liver disease!
Diagnostic treatment, actually chose to relieve heart failure?
Mo Wan couldn't understand why Xu Qiu had spent so much energy to identify hereditary liver disease, but the medical advice he gave at the last minute had nothing to do with hereditary liver disease!
Could it be that this is not hereditary liver disease? !
No, no... Mo Wan shook his head frantically.
The symptoms of the mother and the child are highly similar. In addition, the biological parents of the child have not undergone a premarital examination, nor have they undergone a prenatal examination during pregnancy. It is unreasonable not to consider hereditary liver disease.
However, Xu Qiu's prestige in the emergency department is deeply rooted, and no one will question his decision.
Mo Wan couldn't help asking about this until the rounds were over and he returned to the office.
Xu Qiu said: "Three common hereditary liver diseases have been ruled out, so we should consider other diseases."
Mo Wan said unconvinced: "In addition to the three major categories, there are other rare and uncommon hereditary liver diseases."
Xu Qiu shook his head.
Unfortunately, when Creutzfeldt-Jakob disease was diagnosed, Mo Wan was not in clinical practice.
Otherwise, she should still remember what she said - the rare clinical manifestations of common diseases appear much more often than the common manifestations of rare diseases.
Clinical diagnosis is not the compilation of the "World Rare Diseases Encyclopedia".
Some rare diseases are encountered by doctors across the country no more than a handful of times in their lifetime. How can they be so easy to encounter?
As the saying goes, there must be something fishy when it comes to the evil.
When a disease seems strange and difficult to treat, it is very likely that the clinician has overlooked some important information or has fallen into the inherent clinical thinking error.
For example, now, when seeing the mother and son showing the same symptoms of liver damage, everyone seems to have only hereditary liver disease in their minds.
However, as long as it is liver damage, the manifestations are just a few: jaundice, elevated transaminase, lower limb edema, who can guarantee that the mother and son are not suffering from liver damage caused by different diseases?
"Is that so..." Mo Wan still didn't believe it.
Shi Lian stood aside and didn't speak.
As a bystander, she saw it most clearly.
Mo Wan did fall into the trap of inertial thinking.
This is also closely related to the gap between her and Xu Qiu.
Mo Wan is a hepatobiliary doctor, specializing in, or only proficient in, hepatobiliary diseases.
Therefore, when encountering any patient, the first thing she notices is the hepatobiliary problems. Yuan Yu's previous multiple miscarriages, endometrial ablation, heavy bleeding, etc., are all for Mo Wan to diagnose hepatobiliary diseases.
But Xu Qiu is different.
Teacher Xu has dabbled in various fields, and his experience, theory, and clinical skills are extremely solid. He can analyze Yuan Yu from the perspectives of gynecology, obstetrics, hepatobiliary, cardiac surgery, etc., and draw a more comprehensive conclusion.
And this is a diagnostic method that other doctors can never imitate.
Shi Lian took a deep breath... No wonder the diagnostic level of other doctors is still so far away from that of the teacher. It seems that there are a few simple diagnoses, but there is a gap in the integration of clinical thinking and ability of countless departments!
"Wait and see the treatment effect." Xu Qiu did not explain too much to Mo Wan.
The other party is also a genius, and it is too difficult to convince her, so she can only speak with facts.
...
End of a morning outpatient clinic.
Good news came from the nursing department: Yuan Yu's condition began to improve. Although her skin was still yellowish, the degree of edema in her legs was visibly reduced.
Director's office.
"The edema has been reduced?!" Mo Wan jumped up directly from the sofa.
Shi Lian had a calm expression on his face.
At the beginning of the year, she was still a young intern who would blush after a few words.
After being with Xu Qiu for a long time, she became bolder and more temperamental.
Shi Lian looked as if she was used to it... When Teacher Xu stepped in, the result should be like this. Sister Mo still hasn't realized the highest secret of the emergency department, "holding the teacher's thigh tightly."
"Generally speaking, the cause of hepatic edema is insufficient albumin, and albumin needs to be supplemented, but now it has been relieved?" Mo Wan's pupils dilated, and his face was full of disbelief.
