Chapter 238 The End of Diagnosis

Everyone returned to the doctor's office, revised the medical instructions given by Li Yao, and then began to write the medical records.

Lu Chen specifically asked the nurse on duty to pay attention to the blood drawing instructions for the patient in bed 10.

Because these correspond to different time periods, it is easy to miss them.

This morning, Lu Chen was quite busy. Except for going to the toilet, he basically had no time to rest.

Of course, the Department of Cardiology itself is one of the busiest departments in the internal medicine system.

As long as Lu Chen is still in the Department of Cardiology, this kind of busy clinical life is commonplace.

In contrast, Zhou Wei has lived a life of "raising mice" in advance.

Although Zhou Wei is also a professional master, his mentor is in the rising period of his career. There is a shortage of people in the laboratory. After coordination from many parties, he was temporarily transferred to the laboratory.

So Zhou Wei stayed in the laboratory every day and basically did not go to the clinical department.

However, although the clinical work is hard, the scientific research life in the laboratory is not much better!

"I also want to go to the clinic! Raising mice is not only troublesome, but also too smelly!"

During lunch, Zhou Wei couldn't help complaining to Lu Chen.

"And no matter what, I am a professional master now, and I still have to take the regular training final examination in the future. If I fail the examination, I won't get my diploma!"

"Don't worry, the tutor won't let you stay in the laboratory all the time." Lu Chen comforted, "You are equivalent to double cultivation. In the future, you can do both clinical and scientific research. It will be good for finding a job or studying for a doctorate."

Zhou Wei sighed lightly: "Now I can only think so. But I don't want to get out of the laboratory within the next six months."

"Try to get an SCI article. If you can, then it's worth it!" Lu Chen smiled.

"Oh, SCI is not something you can publish if you want to!" Zhou Wei shook his head and smiled bitterly, "What's more, I'm just a handyman. Whether I can put my name on it is still a question!"

Lu Chen smiled helplessly.

This is also the embarrassment of most graduate students.

If you don't do it, you will have nothing!

If you do it, it may be useless.

Before you really master the key technology, whether you can publish an article depends on the character of your tutor.

...

In the afternoon, Lu Chen just came to the department and received a surprising and happy news from Sun Guoguo.

Dong Hao's radiofrequency ablation surgery was scheduled for the day after tomorrow.

At that time, Lu Chen can go to the catheter room on the fourth floor and watch the entire operation process up close.

For a graduate student, this opportunity is extremely rare!

According to Sun Guoguo, this opportunity was fought for by Teacher Li Yao.

This is also a reward for him winning the first place in the case discussion last weekend!

Compared with the two thousand yuan, Lu Chen prefers this opportunity to observe the operation.

What's more, electrophysiological surgery is almost not affected by radiation.

Lu Chen spent the whole day today in a busy manner.

...

The next day.

The test results of the patient in bed 10 came out!

The final results confirmed the analysis of Director Li Yao and Lu Chen.

The patient's cortisol (hormone) at 0:00 am was 402μg/L (reference value 55-168μg/L), at 8:00 am it was 450 (reference value 150-552μg/L), and at 16:00 pm it was 578 (reference value 55-248μg/L).

It can be clearly seen that the cortisol levels at 0:00 and in the afternoon are far higher than normal levels.

The adrenocorticotropic hormone (ACTH) measurement was <1.0 (reference value 25-100ng/L).

This is also consistent with Cushing's syndrome!

ACTH is secreted by the pituitary gland to control the secretion of hormones by the adrenal glands.

Theoretically, if ACTH is secreted more, the adrenal glands will secrete more hormones, because the pressure from above is high.

But now the patient's ACTH is obviously less.

This is easy to understand, which shows that the patient's increased cortisol secretion has nothing to do with the pituitary gland. It is not the pituitary gland that makes the adrenal glands secrete more hormones, but the adrenal glands secrete so many hormones on their own initiative.

The more hormones the adrenal gland secretes, the more it will naturally feed back to the pituitary gland. The pituitary gland thinks that the adrenal gland has already secreted so many hormones, so there is no need to knock it anymore, and there is no need to put pressure on it, so it secretes less ACTH.

This is the classic negative feedback regulation in the human body!

"Junior brother, do you understand?" Lu Chen told Wei Zhongwen all the principles of negative feedback.

Wei Zhongwen shook his head, revealing a confused look.

Lu Chen was not impatient, and explained very patiently.

Junior brother Wei is a potential source of gratitude, he must be carefully "taken care of"!

Lu Chen thought about it, and then continued:

"Junior brother, think about it, the pituitary gland is the boss, and the adrenal gland is the employee. If you want the employees to work more (secrete cortisol), the boss has to keep urging them (secreting ACTH, the purpose is to urge the adrenal gland to work)."

"Now we see that the employees have done a lot of work (secreting a lot of hormones), but the boss did not urge them (very little ACTH), but did not talk much (ACTH is really too low), why?"

"Because the employees are working like crazy now, they are working desperately and secreting a lot of hormones. After seeing this, how can the boss still have the nerve to urge the employees? There is no reason to urge the employees anymore, so the secretion of ACTH is reduced. This is the principle of negative feedback regulation!"

Wei Zhongwen suddenly realized, "Brother, it seems to be the principle you said."

"Congratulations, I received the thank you value from Wei Zhongwen!"

Sure enough, hard work pays off!

...

The next step is to complete the brain MRI and adrenal CT.

The purpose of doing a head MRI is to make sure that there is no problem with the pituitary gland.

The purpose of doing an adrenal CT is to confirm that the problem is in the adrenal gland. Whether it is an adrenal adenoma or adenocarcinoma, it must be seen clearly.

In the afternoon, the patient's head MRI was done first, and the results came out.

The pituitary gland is really innocent, fine, and there is no tumor.

The patient was a little nervous and immediately went for a kidney and adrenal CT.

In the eighth area of ​​the heart, the doctors in Li Yao's group were all gathered in front of a computer.

Everyone was waiting for the results of kidney CT and adrenal CT.

When the patient finished the CT scan, the image was uploaded to the case system.

Lu Chen immediately clicked on the image and looked through the patient's kidney morphology frame by frame.

"There's really something!"

Lu Chen noticed that the patient had a small mass on the right adrenal gland, about 3 cm in size.

Needless to say, this small mass must be the culprit for the abnormal increase in hormone secretion!

About twenty minutes later, the report from the CT room came out.

The diagnosis of the CT report was: right adrenal cortical adenoma (high probability)!

From then on, the truth was finally revealed!

When Lu Chen informed the patient and his family of the results, they finally breathed a sigh of relief.

Because from the film, it looked more like an adenoma than a cancer.

Adenoma is easier to deal with. Just cut it off and it's done.

...

"Please ask the urology department to come for a consultation!" Li Yao ordered.

Soon the urology surgeon was invited to the cardiology office.

The doctor of Urology Department finally decided to transfer the patient to another department to remove the small tumor under laparoscopy. UU Reading www. uuｋanshu.net

The patient's family naturally agreed immediately!

Lu Chen did not hesitate and directly helped him to handle the transfer procedures, and transferred the patient to Urology Department on the same day.

"Congratulations, the system upgrade completion rate has increased!"

The system prompt sounded.

Lu Chen is one step closer to the next upgrade!

...

Intracardiac Area 8, Doctor's Office.

Although this patient was transferred, all the doctors in Li Yao's group, including Sun Guoguo and Fan Zhiping, were amazed when they recalled the diagnosis process of this patient.

From suspected myocardial infarction, aortic dissection, to suspected hypertrophic cardiomyopathy, to the final Cushing's syndrome and adrenal cortical adenoma.

Whenever you think you have reached the end of the diagnosis, it is often just the beginning!