The genius doctor trained by his own hospital is honored...

"In the end, it turned out to be retroperitoneal fibrosis?"

"A rare disease..."

"When I was studying at Union Medical College more than ten years ago, I saw a case of retroperitoneal fibrosis with the director at that time... In Union Medical College, there are only about 40 or 50 cases that can be found in China.

about."

Everyone sighed.

If you have a rare disease, you still have to find Xu Qiu...

Many doctors may stop here by eliminating skin pepsy.

But Xu Qiu was different. Based on the patient's various infection indicators, he continued to search for clues from the medical records. Finally, he found the word "constipation". Then he reversed the CT and found the thickened retroperitoneal fat tissue and fibrosis.

etc., thus confirming the diagnosis.

Who could have thought that constipation could prompt so many things?

The slight obstruction of the transverse colon, which was ignored by imaging doctors, turned out to be the implicating reaction caused by retroperitoneal fibrosis...

However, after a brief shock, the directors corrected their sitting posture again.

The focus this time is not on postabdominal fibrosis. In contrast, finding the main cause of dyspnea may be the key to solving the problem.

"It's not a lung infection..."

"Where is hepatic encephalopathy?"

The director of the respiratory department looked at the film in his hand and analyzed: "The patient has cirrhosis and his physical condition is not good. He is a high-risk group for hepatic encephalopathy."

Wang Ping also nodded.

If there is cirrhosis and inducing factors, it is very likely that it is dyspnea caused by hepatic encephalopathy.

But the director of the Department of Hepatobiliary Frown said with a frown: "It's too arbitrary. The patient's blood ammonia test and EEG were not found, and there was no sufficient conclusion to support it."

He has seen many hepatic encephalopathies.

According to the classification, if there is mild cognitive impairment at level 1, the highest level 4 hepatic encephalopathy will cause coma.

However, many hepatic encephalopathies often do not reach level 4 immediately, but progress slowly from level 0 to the end, during which various manifestations will occur, such as wing-like tremors, personality changes, disorders of direction, etc.

The patient suddenly loses consciousness and then suffers from dyspnea. Although hepatic encephalopathy can be explained by hepatic encephalopathy, the onset process does not conform to the progression of hepatic encephalopathy, and it is likely to be ruled out.

Xu Qiu nodded and recognized the view of the director of hepatobiliary department.

Specializes in profession...

Doctors in other departments do not have a deep understanding of hepatic encephalopathy. From a professional perspective, the probability of Xie Yunshi having hepatic encephalopathy is very small.

"Doctor Xu said it was not, so I will rule it out!"

"It's not hepatic encephalopathy!"

The directors quickly changed their minds.

The director of the hepatobiliary department's face turned green... I analyzed a lot of them, and you all had doubts on your face. Doctor Xu nodded and you admitted your mistake!

The cardiologist thought for a long time and said, "It seems that it is a heart problem?"

A considerable proportion of clinical dyspnea is acute heart failure.

Xu Qiu whispered: "Acute heart failure mainly depends on four diagnostic conditions: dyspnea, type b natriuretic peptide, electrocardiogram and echocardiography."

Everyone quickly looked at the medical records, with a little surprised expression.

Completely matched!

"It's acute heart failure!" The director of the Department of Cardiology couldn't wait to give the conclusion.

But, this is just a general direction that causes dyspnea and what about the more detailed cause?

Is it acute decompensated heart failure, or acute pulmonary edema, cardiogenic shock, or isolated right heart failure?

"Acute decompensated heart failure has a characteristic - it is progressive when it occurs, but the patient's disease progresses rapidly and can be ruled out." The director of the Department of Cardiology shook his head.

Another cardiology doctor also said: "Although acute pulmonary edema occurs rapidly, patients generally have increased afterload, diastolic dysfunction of left ventricular function and valvular disease. Although Xie Yunshi has mild mitral valve and tricuspid valve

Incomplete closure is not enough to be an element of acute pulmonary edema. It can also be ruled out."

"Cardiac shock?" The respiratory doctor felt a little headache.

If it is cardiogenic shock, the problem is very serious. This disease is generally related to acute coronary syndrome, pericardial tamponade, explosive myocarditis, etc. There are all acute and severe cases that can kill people at any time.

"No, no." Xu Qiu called out a movie.

He slowly said: "Patients with cardiac shock usually have severe cardiac insufficiency, but the patient is still young. Although his heart function is not as good as those of his peers, he is far from severe heart failure."

"Then..." Director Wang Ping's face changed slightly.

If it is not cardiogenic shock, it is likely to be isolated right heart failure.

Acute pulmonary embolism is one of the common causes of isolated right heart failure. If it is caused by pulmonary embolism, it may be too late to rescue it at this time...

Xu Qiu said calmly: "It is indeed isolated right heart failure. The good news is that it has nothing to do with acute pulmonary embolism. The real cause lies in pulmonary hypertension."

Pulmonary hypertension causes isolated right heart failure, leading to acute heart failure, and eventually causing the patient to fall into a coma and symptoms of dyspnea...

One after another, very closely connected.

Everyone was shocked.

But the doctor's meticulous thinking still made them notice something was wrong.

The director of the Department of Cardiology was the first to question: "But, where does the patient's pulmonary hypertension come from?"

There are many causes of pulmonary hypertension, among which acute pulmonary embolism is an important pathogenic factor.

But this is easy to rule out, and you can clearly understand it by using pulmonary artery enhancement CT.

Of course, there is also the simplest way to eliminate it - the patient is still alive and is likely to die of pulmonary embolism in half an hour.

Then there are only two reasons left.

Lung diseases, as well as heart diseases.

The former is used for arterial blood and qi, which can be diagnosed by chest CT, and it is a CPET.

The latter heart has been diagnosed with cardiac color ultrasound, electrocardiogram, etc.

All the results have come out long ago. It turns out that the patient does not have serious lung diseases, nor does he have heart disease that can cause pulmonary hypertension...

In this case, where does pulmonary hypertension come from?

Everyone present was in deep thought.

Xu Qiu's previous diagnosis logic was very strict, and it can be said that he could not find any faults.

The only drawback is that it cannot explain where pulmonary hypertension comes from!

"Why do you have a cardiac catheter?" someone suggested.

Cardiac catheter examination is an invasive examination and requires inserting a catheter into the femoral vein of the patient's leg that can test pressure. It is generally rarely used in clinical practice.

But it is also the most intuitive way to test pulmonary artery pressure, and it is also the gold standard.

Just like a blood pressure meter, a cardiac catheter examination can directly measure the pressure of the pulmonary artery. Whether it is pulmonary artery hypertension is clear at a glance.

Xu Qiu ignored these suggestions and called out Xie Yunshi's patient.
Chapter completed!