Chapter 796 Only 666 left on the screen
Xu Qiu spoke slowly: "You have all overlooked a very important point."
Everyone's expressions became serious.
A large number of diseases also popped up on the screen in front. It was Xie Yunshi's diagnosis. There were more than ten items, which was extremely confusing.
When they first saw this medical record, two words popped into everyone's mind... big head.
No palace fight drama is this messy.
"This is……"
"Are these related to pulmonary hypertension?"
Many doctors thought carefully.
However, the patient's lung and heart diseases have long been ruled out. How is it possible to find the cause of pulmonary hypertension from the previous diagnosis?
Xu Qiu circled several of them, namely chronic liver failure, alcoholic cirrhosis, and autoimmune hepatitis.
Liver Disease?
Everyone's hearts were shocked.
Xu Qiu continued: "The patient's liver failure, etc., leads to portal hypertension. There is a special type of pulmonary hypertension, which is portal hypertension-related pulmonary hypertension!"
After saying this, the conference room fell into silence.
Everyone looked at the introduction about special type of pulmonary hypertension on the screen in astonishment...
“Portal hypertension-associated pulmonary hypertension is a specific type of pulmonary hypertension…
"It is characterized by increased pulmonary artery pressure and increased pulmonary vascular resistance on the basis of portal hypertension, while the pulmonary capillary wedge pressure is normal. The characteristic of pulmonary hypertension related to portal hypertension is that the vascular lesions are located in small arteries and small arteries, and arteries may appear. Plexiform lesions, intimal fibrosis, adventitial hyperplasia, and fibrinoid necrosis of arterioles are difficult to detect by routine examination.”
"..."
"It's actually this!" The director of the Department of Cardiology suddenly stood up, his pupils wide open in shock.
Portal hypertension-related pulmonary hypertension is rare, and it is difficult for clinicians to link liver disease, portal hypertension, and pulmonary hypertension.
Moreover, portal hypertension-related pulmonary hypertension has a relatively small impact on right ventricular function and morphology, so this disease is not easy to diagnose through examination.
Even as the director of cardiology, he has only seen a few cases in the literature.
However, this does not mean that it is less dangerous.
On the contrary, the mortality rate of portal hypertension-related pulmonary hypertension is much higher than that of idiopathic pulmonary hypertension!
The expressions of everyone present were also filled with astonishment.
Who would have thought that the culprit of the disease is hidden in the seemingly confusing diagnosis!
Leukopenia, hypoalbuminemia, mild spleen enlargement, and elevated tumor markers are caused by nonspecific inflammatory retroperitoneal fibrosis.
Loss of consciousness and dyspnea are caused by autoimmune liver disease, liver cirrhosis, liver failure, etc., which together lead to portal hypertension, which then leads to pulmonary hypertension, which then progresses to acute heart failure...
At this moment, as Xu Qiu analyzed it layer by layer, the progress of Xie Yunshi's condition was clearly revealed to everyone.
The new diagnosis was finally made clear.
The primary diagnosis was replaced: pulmonary hypertension associated with portal hypertension.
This is followed by cor pulmonale, acute right heart failure, and retroperitoneal fibrosis.
Then came the earlier diagnoses of autoimmune liver disease, alcoholic cirrhosis, etc…
Soon, this medical record was compiled and uploaded to the clinical internal group.
After a few minutes, only 666 were left on the screen.
"It's so complicated!"
"I thought the petechiae on my skin were caused by idiopathic purpura. If I were asked to come, I would never think of plum blossom needles!"
"Yes, and it's useless to just rule out skin petechiae. You also need to identify the infection indicator as inflammation in the body. Combined with constipation and slight transverse colon obstruction, retroperitoneal fibrosis can be suspected!"
"It's too convoluted. If I were to treat this patient, I would have no clue at all!"
"A coma and difficulty breathing are actually related to so many causative factors... Is this treating a doctor or solving a crime? Why is it different from the diseases I learned in school?"
Xie Yunshi's medical records made everyone see the gap between them and Xu Qiu.
In textbooks, the diagnostic criteria for retroperitoneal fibrosis are clearly written.
Similarly, the diagnostic ideas for pulmonary hypertension associated with portal hypertension are also noted in the literature.
But in real clinical practice, doctors face an "uncomfortable" patient.
In addition to knowing that you are uncomfortable, most of the information needs to be explored and summarized by yourself, and sometimes you even have to find useful clues from various symptoms like solving a crime...
Finding clues that point to a diagnosis from all kinds of information is what separates experienced doctors from top doctors.
…
After the diagnosis was clear, Xu Qiu also made new adjustments to Xie Yunshi's treatment plan.
Three days later, the patient improved and was discharged.
After obtaining the consent of the family, this medical record was posted on Xu Qiu's personal popular science account, and was forwarded by Linyi, Baiyun Provincial Medical Channel, etc., and the number of views exceeded 100,000 within an hour.
For popular science articles with a high threshold and strong professionalism such as medicine, it is almost impossible to reach 100,000 views in one hour.
Even in a few top medical forums, it takes several days or even a week or two for the same data to appear.
However, the name Xu Qiu is worthy of several popular science titles on head medicine.
Soon, in the second hour, the number of comments exceeded 1,000.
[Name not anonymous: non-medical professionals, please pay homage to Mr. Xu Qiu! This patient’s diagnosis made his head hurt. The diagnosis was completed on the second day after coming to the doctor. It’s incredible! 】
[Limited clinical experience for many years: Otherwise, Dr. Xu would be an academician...]
[Medical knowledge lasts forever: learn it. However, the popular science medical records that Dr. Xu provides each time are things that many doctors will never see once in their lifetime. Does this really make sense? 】
[Milk-white Yukiko: Why is it meaningless? Do you still expect ordinary doctors to encounter such patients? What we need to learn is Dr. Xu’s diagnostic thinking, which is to look at constipation from various symptoms, and then combine it with CT scans to diagnose retroperitoneal fibrosis! There are also portal hypertension-pulmonary hypertension-isolated right heart failure-acute heart failure-loss of consciousness and dyspnea. Such a complete logical chain is simply a joy! 】
[Dr. Xu’s Dog: Support! Doctor Xu is invincible! I really hope I can get Dr. Xu’s attention once too! 】
[Drink up her bath water: Let’s change the wish upstairs... If you can get Dr. Xu’s attention, you might be gone before the doctor comes! Also, can your name be more normal? Unbelievable ID! 】
…
Clinic, in the dean's office.
Wang Shengde scrolled his comments up and down, twitching his lips from time to time, but he soon sat upright again.
"Dean Wang, the director of the Provincial Department of Health is here!" The assistant came over to report.
Wang Shengde stood up immediately.
A few days ago, Fu Qing and the director of Baiyun Provincial Health Department called him, and the latter made an appointment with him to meet today.
Although he still doesn't know what it is, Wang Shengde has a strong idea. The only one who can attract the attention of these two big guys is Dr. Xu Qiu...
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