This Doctor is Great

"Ah? Impossible..."

Chen Jinhong's originally sluggish body suddenly revived.

As a woman, I am very concerned about this 'smell'.

But after smelling it, I still didn't smell it.

But Zhou Mo was very sure, after smelling it carefully, he was sure that it had a 'fishy smell'.

Sometimes, body odor is a sign of illness.

For example, the smell of rotten apples may be diabetes; the smell of urine is abnormality of the urinary system and bladder; the chest still emits a bad smell, which may be due to magnesium deficiency in the body; body odor and bad breath at the same time may be a problem with liver metabolism; long-term bad breath Long-term bad breath needs to be alert to gastroesophageal reflux, gastric ulcer, Helicobacter pylori invasion or gastric cancer, etc...

And the fishy smell, what is it?

Zhou Mo suspects it is - liver stink!

Liver odor means that the blood ammonia in the body is too high.

Then, it will be easy to produce - hepatic encephalopathy!

Zhou Mo still remembers that on the first day he entered the Department of Gastroenterology, teacher Zhang Luojia took the three of them to round the wards, and when they tested the level of Zhou Mo and the three of them in the middle, they came up with a topic-hepatic encephalopathy! (Chapter 129)

(with photos)

"Wait...hepatic encephalopathy..."

"its not right!"

Zhou Mo thought of another question: when the blood was drawn, there was a blood ammonia value, and it didn't increase at that time.

Zhou Mo took out the blood test report.

Indeed, the blood ammonia value did not rise much.

Moreover, blood ammonia to the point of liver stink often only occurs in the late stage of liver cirrhosis, while the patient Chen Jinhong's liver cirrhosis is still in the compensatory stage, so it is not so serious.

"Did I smell it wrong?"

Zhou Mo was confused.

At this moment, an embarrassing voice came from the bed 77 next door (the curtain was drawn).

"Sorry, doctor, the smell of fish may be from our side. We went to the market today and bought a pound of dried sea fish..."

"ah?"

"ah?"

The atmosphere in the entire ward suddenly became awkward.

Wrong smell!

Zhou Mo is embarrassed!

Chen Jinhong's husband is also embarrassed!

"Ahem... I'm sorry..." Zhou Mo sighed for a while, what a pity, he thought he had found a key clue.

"It's okay, it's okay..." Chen Jinhong breathed a sigh of relief. Fortunately, I am not smelly.

With pity, Zhou Mo came to bed 77 to round up the patient who bought salted fish.

really,

A more intense fishy smell hits the face.

Zhou Mo hurriedly said: "It's better to wrap your fish quickly, the taste is too strong."

The family members of the 77-bed patient looked embarrassed and blushed: "I'm sorry, I'm sorry..."

Just when the family members were preparing to clean up the sea fish...

"Huh……"

Zhou Mo suddenly had a flash of inspiration!

"Although it's not 'hepatic encephalopathy', it seems to be 'hepatolenticular degeneration'."

Why did Zhou Mo think of this disease?

Because of hepatic encephalopathy and hepatolenticular degeneration, these two diseases have neurological symptoms: mental emotion and movement accuracy will be affected to a certain extent.

"Hepatolenticular degeneration?"

Zhou Mo couldn't help but look at the patient's hand.

"Um?"

"trembling?"

Zhou Mo saw the patient Chen Jinhong, whose hands were shaking unconsciously.

This happens to be one of the features of hepatolenticular degeneration (hepatic encephalopathy also has this feature).

Zhou Mo asked the patient Chen Jinhong: "Do you usually have this hand tremor?"

Chen Jinhong: "Huh? Shaking hands? No?"

Then the hand stopped shaking immediately.

Zhou Mo looked at her husband: "Have you noticed?"

The husband thought hard for a while, and finally shook his head: "Sorry, I haven't paid attention to it..."

Zhou Mo nodded: "Okay... I can probably guess what your wife's illness is now..."

Then he introduced 'hepatolenticular degeneration'.

During the introduction, Zhou Mo began to pay attention to the patient Chen Jinhong's hand again, and then saw 'it' shaking secretly.

Now,

The probability of 'hepatolenticular degeneration' has been greatly increased!

Add in cirrhosis and it's even more like that!

"'Hepatolenticular degeneration' is an autosomal recessive genetic disease. Due to a gene mutation, it leads to bile copper excretion disorder, and excessive copper is deposited in the liver, brain and other tissues to cause the disease..."

In layman's terms, it means that during the metabolic process, due to the problem of gene expression, copper ions are ignored, resulting in the failure of copper metabolism.

At this time, Zhou Mo's confidence increased greatly as the patient's hands trembled.

"To confirm whether it is the disease, it is very simple, to do a few tests..."

"One is "K-F ring (corneal pigment ring)", one is urine copper, and the other is liver copper test (former gold standard)..."

There are 5 commonly used methods for diagnosing this disease, but they all have certain errors. Do a few together, if they are all positive, then there is no problem.

Among them, urine copper is the fastest and easiest!

Secondly, when there is too much copper in the K-F ring, a large amount will be deposited near the cornea, and then a "K-F ring", a green-brown ring, can be found by a slit lamp microscope!

Finally, the liver copper test was the gold standard in the past, and the most accurate later became a genetic test.

Back to the duty room,

Zhou Mo reported his condition to Mr. Zhang Luojia.

"Hepatolenticular degeneration?"

"Yes... I suspect that the patient's amenorrhea also occurs because of it."

"Specifically?"

"Maybe it's because too much copper is deposited on the pituitary gland, which then leads to endocrine disorders..." Zhou Mo analyzed.

"It makes sense. I don't know the reason for this. I haven't seen the relevant literature. If the patient is cured, and later follow-up finds that the Yuejing has been restored, this can definitely be written as a paper..." Zhang Luojia pointed out.

Zhou Mo smiled and said, "My thoughts are the same as the teacher's!"

The title of the thesis is well thought out - "A case of hepatolenticular degeneration with amenorrhea as the first symptom"!

...

the next day,

morning,

Teacher Zhang Luojia helped Zhou Mo contact the ophthalmology department non-stop, sent the patient there, and made a slit lamp microscope.

Soon, the results came out!

Sure!

"K-F Ring"!

At this time, urine copper test and liver copper test are also in progress.

...

day three, afternoon

The urine copper test and liver copper test are basically out.

Officially diagnosed: 'hepatolenticular degeneration'!

In other words, the patient's liver cirrhosis should not be caused by some folk prescription or other reasons, but the liver cirrhosis caused by 'hepatolenticular degeneration'.

Find the cause, then you can treat the symptoms and reverse liver cirrhosis!

When Zhou Mo told the couple the result of 'hepatolenticular degeneration', the husband and wife were overjoyed.

did not expect!

When I came to the gastroenterology department, I just wanted to do rehabilitation to treat liver cirrhosis, but I didn't expect to find out the cause instead. Especially after Zhou Mo also said that it may also be the culprit of amenorrhea, it was even more surprising!

Surprise! !

"Thank you doctor!"

"Thank you doctor!"

The husband took Zhou Mo's hand, incoherently excited! !

Zhou Mo comforted: "Don't get excited... I'm just guessing. The real reason can only be determined after your wife's excessive copper is cured and whether it can recover!"

The husband was happy: "Dr. Zhou is so good, he must have hit the mark!"

Zhou Mo couldn't help laughing and said: "I also hope that you can have a precious son early, haha~~~~"

Next,

It is treatment.

Solution: prevent copper absorption (zinc gluconate) + copper excretion (D-penicillamine) + liver protection.

As for the diet in the future, copper intake should also be reduced as much as possible.

...

sunday,

The couple was discharged from the hospital. After discharge, they still needed liver protection treatment to reverse liver cirrhosis.

In addition, after calling back to her hometown, she found that the elders of the patient Chen Jinhong did have liver cirrhosis, but she didn't know about it.

.

This chapter has been written for a long time, but I still feel that the state is still not good, and I feel very awkward, so I will just update it tonight. Sorry, I'll try to adjust tomorrow.