Chapter 794 Petechiae on the skin, the next clue

This is a symptom that cannot occur naturally...

The only possibility is man-made.

Shi Lian was already impatient: "Teacher, I'll go ask about the medical history!"

Xu Qiu nodded.

After a moment, she came back with a wry smile.

"Teacher, I've found out..."

"What's going on?"

"Plum blossom needle. The old prescription over there says to prick wherever there is a problem. Her legs have been swollen for a long time, so she asked someone to prick her with plum blossom needles more than a dozen times."

It turned out to be plum blossom needles... Xu Qiu understood.

This is a Chinese medicine treatment, also called skin needle.

The instrument used is a row of short needles shaped like plum blossoms. Because the puncture is very shallow, it can pierce the skin without hurting the flesh. It belongs to the cluster needle shallow puncture method, which is an advanced treatment of ancient "half needle" and "floating puncture" acupuncture methods. It is indeed very wide in scope.

However, its main function is to stimulate the body surface, relieve headaches, insomnia, etc. It is still rare to use it to treat edema.

"Skin bruises can be excluded..."

So where do these inflammatory indicators come from?

Xu Qiu fell into deep thought.

At this time, he found another clue in the medical record.

The patient has a history of constipation...

In other words, Xie Yunshi is constipated frequently?

He quickly retrieved the patient's abdominal CT scan and carefully examined it, and found that her transverse colon segment actually had a mild obstruction.

The degree of obstruction is very mild, and it cannot be found without a suspicious look.

In other words, even if the doctor sees it, he probably won't pay much attention to it.

This degree of obstruction is not an organic lesion, nor is it enough to cause disease, so there is no need to pay attention to it.

But when combined with constipation, the situation is different.

"It's not a problem with the transverse colon..."

Xu Qiu looked at the surrounding tissues.

A few minutes later, he finally found the problem.

The patient's retroperitoneal fibrous adipose tissue proliferated abnormally, and some tissues began to fibrosis.

"Retroperitoneal fat hyperplasia and fibrosis?"

Xu Qiu's eyes lit up... Isn't this retroperitoneal fibrosis RPF?

RPF is a rare disease, belonging to non-specific non-suppurative inflammation.

Idiopathic RPF is related to autoimmune or allergic diseases.

The patient has autoimmune hepatitis, which is likely to be retroperitoneal fibrosis. It is also because of RPF that Xie Yunshi has elevated various inflammatory indicators.

And constipation is because when the peritoneum thickens, the abdominal pressure increases and the abdominal intestinal tube is squeezed...

...

"What is the cause of the coma?" Then, Xu Qiu began to explore the next symptom.

He looked at the patient's cardiac ultrasound again.

The imaging doctor only gave two results, but more can be seen in the ultrasound.

For example, the right heart is enlarged...

Combined with the patient's own situation, it is likely to indicate pulmonary hypertension.

Although no thrombus was seen in the main trunk of the pulmonary artery, what about the subsegment?

If there is thrombus in those places, causing subsegmental pulmonary embolism, it may also lead to the current situation.

The second is liver failure.

This is Xie Yunshi's old problem. If she has developed to the stage of liver cirrhosis, it is very likely to cause hepatic encephalopathy, which will lead to loss of consciousness...

"If the coma is caused by hepatic encephalopathy, then the heart problem can also be explained." Xu Qiu pondered.

If it has developed to hepatic encephalopathy, the body will also have hepatorenal syndrome, which will cause heart failure and become the main cause of heart enlargement.

Soon, he locked his target on dyspnea.

Although the patient had no dyspnea before, after waking up from loss of consciousness, the patient had this symptom, and the blood oxygen saturation could only be maintained when connected to a ventilator.

This made Xu Qiu keenly aware that dyspnea might be the breakthrough point.

And there are only three reasons that can cause dyspnea.

First, lung infection.

This depends on whether there are rales; whether the infection indicator PCT is normal; whether the CT indicates lung infection; whether there is sepsis; whether there is severe hypoxia and whether the ventilator can be removed within six hours...

Xu Qiu carefully recalled the details of Xie Yunshi's physical examination.

When she was auscultated at that time, there were indeed rales, and the infection indicator PCT was also abnormal, and the CT also indicated infection.

However, there was no sepsis, nor severe hypoxia.

Judging from Xie Yunshi's current situation, it would be very easy to remove the ventilator within six hours.

After comprehensive analysis, lung infection is basically not the main cause of dyspnea.

Then, what about hepatic encephalopathy?

This is also the point that doctors Wang Ping and others are most suspicious of.

However, just when he thought of this, Shi Lian received a call, and after hanging up, he said to Xu Qiu: "Teacher, the respiratory department and the cardiology department have called and said that this patient is very valuable for learning, and they want you to hold a joint consultation..."

"Oh, okay."

Xu Qiu came back from his contemplation... It just so happened that he had already made further judgments in his mind. If nothing unexpected happened, he should have a diagnosis.

He glanced at the time. At this time, there was still more than an hour before the afternoon work.

Xu Qiu said: "Let's do it now, let them come quickly."

...

Soon, all departments received consultation invitations from the emergency department.

Seeing that it was Xu Qiu who convened, everyone was very excited.

For other hospitals, if anyone convenes a hospital-wide consultation, it basically means that there are difficult cases to deal with, and no one will be very happy.

But clinical medicine is different.

Meetings with Xu Qiu are all for everyone to learn from...

"It has to be Doctor Xu!"

"Hehe, I said I would apply to the emergency department! I think Xie Yunshi's case is very typical. We can use her to learn, which will have a great training effect on the diagnosis and treatment ability of our doctors!"

"I don't know if Doctor Xu has found the cause of the disease. I'm still a little confused now."

"Yes, Xie Yunshi's medical history is too messy, there are too many diseases, but the right medicine doesn't have much effect. She also lost consciousness today. It's troublesome!"

The doctors were discussing.

However, as Xu Qiu entered the meeting room, all doctors, including the heads of various departments, immediately quieted down, and their eyes all moved to Xu Qiu.

"Doctor Xu."

The head and other doctors stood up to greet him.

"Yeah."

Xu Qiu didn't say much nonsense, and he started explaining as soon as he sat down.

Infection indicators, skin bruises, and plum blossom needles were all quickly pointed out by him.

Everyone was a little surprised.

"It's actually a plum blossom needle?"

"Oh my god, take a closer look, the shapes of these bruises are exactly the same, and there is a sense of order in the chaos. Can Dr. Xu see this?"

"The patient's mental state has always been very bad, and he is unwilling to cooperate with our consultation. Even Dr. Xu didn't ask this detail... In the end, the abnormality was found directly from the photo!"

"What is the God of Medicine? This is it!"

The conference room was filled with compliments, and the directors praised Xu Qiu with proud smiles on their faces.

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