Chapter 467: Clearing the fog to see the essence, checking three types of antibodies
This step is considered a significant progress, but the cause of the disease has not yet been confirmed.
Celiac disease is also only suspected.
In addition, this disease is closely related to genetics and immune deficiency.
According to research, gluten enteropathy is closely related to eating wheat flour, and gluten may be the pathogenic factor of this disease. The cause of the disease is the result of the interaction between genetics, immunity and gluten diet.
Rich people are particularly particular about their diet, and sometimes what they think is a healthy diet may not really be healthy.
This refers to some wealthy families with a good background, and the nouveau riche are not included.
It took three generations of officials to learn how to dress and eat.
What this means is that only after three generations of wealth can one understand what kind of clothes are good clothes, what foods are truly good for the body, and how to eat to enjoy the best deliciousness.
Even if the child really has celiac disease, it is definitely not enough to rely solely on a gastroscopy and duodenal mucosal pathology test to get a confirmed diagnosis.
The children reported symptoms such as abdominal distension and lower limb edema, which are consistent with celiac disease.
Some patients with this disease may experience obvious abdominal distension, nausea and vomiting, weight loss, fatigue, emaciation, weakness and edema.
Zhou Can already seriously suspected that the patient was suffering from celiac disease, even though he did not have diarrhea but only bloating. In the diagnosis of symptoms, one must not be dogmatic and mechanically apply the knowledge in textbooks.
For the same disease, each person may experience slightly different symptoms.
This is closely related to personal immunity, physical fitness, tolerance, severity of the disease, and location of the lesion.
Due to different physical conditions, some people may just feel nauseous and may not even vomit.
Some people may experience nausea, vomiting, diarrhea, etc.
This child's family is very well off, and he must have good food and clothing. Judging from his weight and height, his physique should be quite good.
It is precisely because of his good physical condition that the symptoms of nausea and vomiting appeared as his lower limbs had been swollen for nearly seven months.
Therefore, sometimes people with too good a physique may also have some shortcomings.
Minor illnesses can hardly cause any trouble for such people, and it is even difficult for them to invade their bodies. If a serious illness comes, it is also likely to progress slowly.
If it is cancer, the earlier it is discovered, the better.
However, because the patient's constitution is too good, the symptoms may be mild and the cancer cells may grow slowly. By the time they are discovered, the most terrifying thing is that the cancer cells have already spread.
Of course, in general, the stronger your physique, the better.
Theoretically, the stronger a person's physique is, the less likely they are to develop serious illnesses or malignant cancers.
Although Zhou Can had already made a certain diagnosis of the cause of the child's illness, he still remained patient and continued to check.
After the expert made the second major discovery, he immediately performed a full colonoscopy on the child.
I could feel the expert's enthusiasm and urgency at that time.
He must have wanted to rush to diagnose the cause.
The results of the full colonoscopy were normal.
At this point, the second expert seemed confused again. How could the colonoscopy be normal, but the stool was intermittently positive for occult blood?
Because the patient had already undergone full gastrointestinal tract radiography, gastroscopy and colonoscopy, there was no need to do another colonoscopy.
I guess the family members also put a lot of pressure on this expert.
Finally, the child was prescribed medicine according to enteritis.
This really surprised Zhou Can. He didn't know what the second expert was like at the time, but he prescribed drugs for enteritis to the child. One thing is certain, because when doing the duodenal mucosal pathology, severe acute and chronic inflammation was found, which may be the basis for medication.
Also, after reading the medical records, Zhou Can keenly suspected that it was celiac disease, but this does not mean that other experts' diagnostic ideas and conclusions are consistent with his.
Because one of the most typical symptoms of celiac disease is diarrhea.
and iron deficiency anemia.
People with severe diarrhea may have diarrhea dozens of times a day.
When watching costume dramas, you can often see two kinds of magic medicines. One is the knockout drug, which will make you unconscious and at the mercy of the enemy. It is the most common drug used by black shops to rob people of their money and sex.
The second one is croton, which is a medicine for diarrhea, and is used specifically to punish people who have a grudge.
The underworld is about revenge and satisfaction.
If one is less powerful than the other party, or less strong than the other party, and has been wronged, grinding croton seeds into powder and secretly putting it into the other party's food is a common form of revenge.
It is very rare to see people being hacked to death or poisoned for no reason.
Even in ancient times, the king's law still had a strong deterrent effect on the public.
Making the enemy suffer from diarrhea until they collapse will generally not attract the attention of the government. Few people will report to the authorities, so the risk is relatively small.
Patients with celiac disease are much more miserable than those who ate croton seeds in ancient times.
After taking croton, the diarrhea will be gone in one or two days at most.
Before treatment, patients with celiac disease will have diarrhea every day, and the diarrhea will become more and more serious. They may spend at least eight or nine hours in the toilet out of 24 hours a day.
The child's condition was rather complicated and confusing. The experts were used to being cautious and careful, and their way of thinking was very different from Zhou Can's.
If you treat it as enteritis, the effect can be imagined.
Finally, after the child's family found that the treatment was ineffective after many days, they began to doubt the treatment level of the Provincial Children's Hospital, so they took the child to the pediatric department of Tuya Hospital for treatment.
It is estimated that if the cause of the disease cannot be found in Tuya and no obvious therapeutic effect is achieved, the patient will most likely be transferred to a large hospital in the imperial capital or the magic capital for treatment.
Relatively speaking, the large hospitals in the Imperial Capital and the Magic Capital have more advanced medical equipment.
This advantage is not reflected in a single inspection instrument or surgical equipment, but is comprehensive.
In addition to advanced equipment, they also have a stronger team of experts. They can even achieve joint diagnosis and treatment among multiple departments and close cooperation. Many diseases that are difficult to diagnose and treat can be cured in the big hospitals in the imperial capital, precisely because there are more top experts in the imperial capital.
In the sub-fields of medicine, the experts in the capital are divided into more detailed categories.
Even in the gastroenterology department, there may be nearly twenty different specialists in different medical fields.
For example, digestive enzymes are a very subtle and inconspicuous sub-item of gastroenterology.
The capital's top hospitals have doctors who specialize in digestive enzymes.
Let's take a look at Tuya Hospital, which is already one of the top provincial hospitals. Whether it is gastroenterology or surgery, gastrointestinal tract is rarely separated. The top experts in these two departments are almost all good at the two sub-fields of stomach and intestine.
Just the intestinal area can be subdivided into the small intestine, appendix, cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum, pylorus, duodenum, etc.
As the saying goes, "biting off more than you can chew", Tuya's experts focus their energy on multiple sub-fields of the gastrointestinal tract. However, the top experts in the capital only do one thing in their lifetime. Those who study the appendix specialize in studying the appendix, and then use the appendix as the core to conduct in-depth research on organs and tissues related to the appendix, as well as the role of the appendix in the functioning of the body.
It is conceivable that there must be a big gap between Tuya's experts and the top experts in the imperial capital.
"After the child was referred to our hospital, we mainly checked his protein, right?"
After reading all the information, Zhou Can still firmly believed that the child was likely to have celiac disease.
This diagnostic ability can be understood as a talent.
It’s not that other experts are worse than him, it’s just that when diagnosing this type of disease, they don’t have the same high sensitivity and comprehensive diagnostic ability as Zhou Can.
Zhou Can also had his moments of failure in diagnosis.
It is difficult to say whether this child will ultimately develop celiac disease.
"We checked the patient's protein loss isotope. The intraperitoneal blood perfusion was diffusely abnormally increased, but no obvious signs of protein loss were found. Blood protein electrophoresis showed M protein. Blood immune electrophoresis showed an increase in LGCK monoclonals, and a decrease in LGM and λ..."
LgM refers to a type of immunoglobulin.
After consultation, Tuya's experts found that the child had hypoalbuminemia and the disease was chronic.
The patient also has a relatively thin body, enlarged spleen, edema of the lower limbs, and intermittent abdominal distension.
Therefore, the main diagnostic focus was shifted to severe hypoalbuminemia and increased blood monoclonal immunoglobulin.
The experts' consultation and discussion records mainly focused on the reasons for the decrease in serum albumin.
Each of them held his own opinion and made multi-faceted judgments and analyses.
The first one is that the patient has poor absorption of serum albumin. The patient has intermittent abdominal distension and vomiting after eating, and has lost weight. Combined with the decrease in the D-xylose test, although the stool did not detect positive fat , it is still considered that the child has small intestinal malabsorption syndrome.
The second possibility is insufficient intake, which is almost unanimous among experts. The patient's own account, as well as the accounts of his family and nanny, all indicate that the patient's appetite is OK. Nutrition is even more needless to say.
A family like this can eat almost anything they want.
The third type is synthetic disorder. No abnormalities were found in liver function tests and common liver virus indicators were negative, which basically ruled out synthetic disorder.
The fourth is protein loss in the body. The patient's albumin loss pathways are mainly kidney and gastrointestinal tract. Urine protein has been checked long ago and is negative, which can rule out the possibility of albumin loss in the kidney.
The gastrointestinal loss route can also be basically ruled out because a protein loss isotope imaging test did not reveal any obvious protein loss .
At this point in the consultation, it can be basically determined that the problem occurs in the small intestine.
Especially the duodenum.
After going around in circles and discussing it, Tuya's experts found that the diagnosis results overlapped with those of the experts from the Provincial Children's Hospital.
Experts from the Provincial Children's Hospital have tried treating it as duodenal ulcer and enteritis, but to no avail.
If Tuya's experts continue to treat these two diseases, even if the family members don't curse them to their faces, they will definitely call them a group of quacks behind their backs.
"The lesion is likely in the small intestine!"
Zhou Can was quite cautious in his words. He did not say what the disease was, but only stated what he could confirm first.
"As a result of our discussion, we basically concluded that the child had a problem with his small intestine."
Director Tang Fei narrowed her eyes slightly and just looked at Zhou Can.
Based on her understanding of Zhou Can, there must be more to come.
“Are the family members of the sick children particularly difficult to talk to?”
Zhou Can’s next words turned out to be this.
She couldn't help but stroke her forehead and smiled, "One of the family members is an official with a high position. The other is the female president of a large company with a net worth of over 10 billion. They are definitely a bit strong. I have talked to both parents of the child, and they are quite reasonable!"
There is a big difference between having a net worth of over 100 million and over 1 billion.
People with a billionaire fortune are basically mid-level business leaders. People with a fortune of over 10 billion are considered top-level business leaders in China.
Perhaps he felt that the evaluation of the family members was not specific enough, which caused Zhou Can to have concerns when diagnosing the cause of the disease.
"Their child had been taken care of by a nanny, and the child 's lower limb edema had occurred for more than half a year. It was not until one day when the child ate a lot of meatballs and felt nauseous and vomited that the nanny called them to say that something was wrong with the child. But they did not blame the nanny for not discovering the child's lower limb edema earlier. In addition, their child was treated in the Provincial Children's Hospital for nearly two months, and they had been cooperating with the doctor. Later, when they found that the effect was not significant, they just took the child to another hospital and did not attack the doctor in any way."
"During the conversation with me, they didn't mention that the experts at the Provincial Children's Hospital were bad. They even said frankly that the child might have a rare disease and asked us doctors to worry more. It would be best if we could find the cause, but if we couldn't, it didn't matter, they would just take the child to the capital for medical treatment. After being transferred to our hospital, they ordered a lot of tests, and they actively cooperated."
Director Tang Fei spoke very favorably of the family members.
Zhou Can's concerns were largely dispelled.
"Director Tang, there are no outsiders here, so I'll be frank. I highly suspect that this child may have celiac disease. Although the child's symptoms are atypical, based on the comprehensive manifestations of all aspects, the possibility of celiac disease is extremely high."
After hearing Zhou Can's answer, Director Tang Fei was stunned, with a hint of disappointment in her eyes.
She had great hopes for Zhou Can and wanted to invite Zhou Can to find out the cause of the child's illness.
The diagnosis Zhou Can gave was celiac disease, which was indeed somewhat unexpected.
"When I discussed this with other experts, I also suspected this disease. It's just that the symptoms don't match. The current examination is mainly based on duodenitis and severe hypoalbuminemia."
During their discussion, they had already ruled out the possibility of celiac disease.
There is no doubt about the level of these experts, especially in cases that have been jointly consulted, omissions are generally rare.
"Yes, the child does not have diarrhea, which is the most obvious symptom. But I have read the medical records. The first time the child had nausea and vomiting was because he ate a lot of meatballs. It is equivalent to eating a lot of meat, which caused vomiting. In addition, the child's diet is relatively reasonable. Every time he eats meat, he will eat wheat products. Celiac disease is mainly caused by eating wheat, and he has immune deficiency in this area."
Zhou Can stated the basis for his diagnosis.
"The child used to eat wheat products, so why didn't he get sick?"
Director Tang Fei asked incisively.
"Just because the disease didn't occur before doesn't mean that there is no disease. It's just that the disease itself is a chronic disease, and the child has a good constitution, so the disease develops later. In addition, there is another way to diagnose the disease."
Zhou Can's eyes were clear and firm.
When it comes to diagnosis, he does have a talent that other doctors can't match.
This was revealed when he was still an intern.
As for his surgical talent, it was mostly due to the bonus from the medical skill experience value system. Of course, his own talent was not bad either.
"What is the solution?"
Director Tang Fei asked.
"The patient will undergo further serological and imaging tests to check for anti-gluten antibodies, anti-endomysial antibodies, and stencillin antibodies."
Zhou Can suggested checking three types of antibodies at once.
This is the quickest way to confirm a diagnosis.
