This Doctor is Great

the next day,

The third week, Monday.

Zhou Mo got up early, because today there will be a big house round in the department, so he needs to prepare early.

Come to Gastroenterology.

"morning!"

"morning!"

"Zhou Mo, I just received the news that the colchicine patient yesterday was not rescued in the early morning and died." Li Dongmei saw Zhou Mo and informed him of the news.

"okay."

Zhou Mo replied flatly.

Not surprisingly.

After eating so much and dragging on for nearly 5 hours, it's no wonder that I can survive.

During Zhou Mo's ward rounds, 80 beds were vacated yesterday, but Li Bingmei (type 1 diabetes + ketoacidosis) only had 79 beds, so there is nothing to check, and it will be done in a few minutes.

8:10,

The big rounds began.

In the conference room, the selected case management bed doctors went to the ppt to report.

Zhou Mo was no exception. What he reported was a rather special case - tuberculous liver abscess (liver tuberculosis).

"Tuberculosis liver abscess is a term for extrapulmonary tuberculosis that was only announced in my country in 2019..."

"Come on..."

Because this disease is relatively rare compared with bacterial and amebic liver abscess, Zhou Mo focused on reporting its symptoms, diagnostic methods, identification, epidemiology...etc.

Finally, the chief director commented: "This case is worth learning from... When considering liver abscess in the future, in addition to bacterial and amoeba, we should also consider liver tuberculosis..."

Zhou Mo came down.

Then the next resident, Chen Yiquan, came to the stage to report the case on ppt.

"Hello leaders, everyone... What I am reporting today is a very special case. The cause has not been found yet, and it is currently in hospital. I hope to brainstorm and find its cause..."

The patient, a 37-year-old married man, was admitted to the emergency department because of sudden abdominal pain and high fever.

"When I was admitted to the hospital, my body temperature was 38.5, my pulse was 126, my respiration was 24, my mind was clear, my spirit was not good, my whole abdomen was tense, accompanied by tenderness and rebound tenderness in the middle and lower abdomen, weakened bowel sounds, and peritonitis. The temperature rose rapidly within 30 minutes of admission to the emergency department. Up to 40.2"C without chills. "

"Emergency Blood Routine: Slightly elevated white blood cells, no other abnormalities. Elevated CRP."

"Two months ago, I entered the gastrointestinal department of a certain hospital due to the same symptoms, and performed a laparotomy, but failed to find the cause..."

"This time, the same abdominal symptoms still appear..."

The report ppt is completed.

In the on-site conference room, many doctors began to meditate.

A doctor: "Are you sure it's not gastroenteritis?"

Dr. Chen Yiquan shook his head: "Unlike gastroenteritis, the patient complains that he has not eaten special food, and there is no problem with liver and kidney function."

Another doctor: "Have you ever had a colonoscopy? Gastric perforation? You have peritonitis. Gastric perforation, ulcers, etc. can be considered..."

Dr. Chen Yiquan still shook his head: "I have done a gastroscopy and even made capsules, but I still haven't seen anything special."

A female doctor: "Is there any problem with liver and kidney function? Is there any problem with pancreas?"

Dr. Chen Yiquan: "I've checked everything, including blood draw, B-ultrasound, and CT, but I haven't found any problems."

Other doctors expressed their own considerations one after another.

Including inflammation and infection of abdominal viscera (such as acute appendicitis, acute cholecystitis, acute pancreatitis, colonic diverticulitis), gastrointestinal perforation (gastric, colon cancer perforation), intestinal ischemic diseases (strangulated ileus, mesenteric Thrombosis, ischemic colitis, etc.) Intra-abdominal hemorrhage (rupture of liver and spleen, rupture of small intestine)

Most of them are not suitable for that patient.

However, Dr. Chen Yiquan is not without gains, such as intestinal ischemia, which he did not consider before.

When you go back, you can perform an angiogram on the patient to see whether a section of the intestine is ischemic.

At this moment,

"I have a different idea..."

Zhou Mo suddenly thought of a disease, and raised his hand.

The above doctors all considered the main feature of peritonitis as the starting point, and the fever was considered to be caused by inflammation.

However, Zhou Mo thought of a disease.

This disease is the information that the talent (system) rewarded him when he was diagnosed with colchicine yesterday.

"Everyone should know that there is a disease called "Family Mediterranean Fever"! "

Now,

Most of the doctors looked at Zhou Mo.

Familial Mediterranean fever? ?

Many doctors were stunned.

Many doctors also quickly remembered what familial Mediterranean fever was.

Zhou Mo said: ""Family Mediterranean fever" is a spontaneous autosomal recessive genetic disease of unknown etiology, most of which occur in people of Mediterranean descent, especially non-Central European Jews, Armenians, Turks, Levantine Arabs..."

"And it has a very obvious feature: it is characterized by repeated fever and peritonitis."

"Isn't that just right for this patient?"

Dr. Chen Yiquan hesitated: "But... Chinese people's genes should not cause this disease..."

Yes, this disease is rare in China.

What is reported is also from Western countries such as Europe and ugly countries.

This is also the reason why many domestic doctors don't know it.

And Zhou Mo, why do you know it?

Because colchicine is the only drug used to treat familial Mediterranean fever!

only!

Very special!

Zhou Mo suggested: "You can ask the patient whether his ancestors have genetic sources from the Mediterranean region. If so, the possibility is very high..."

"Also, most of the patients with this disease will have similar symptoms since childhood. You can ask about the medical history in childhood."

"In addition, the patient should still have a fever and peritonitis right now, then give him colchicine to see if he can control the patient's condition. If the current treatment effect of colchicine is very good, and the ancestors have the Mediterranean side With a high probability, it can be judged to be "familial Mediterranean fever". "

Many doctors were surprised by it.

Colchicine?

Chen Yiquan nodded, feeling that what Zhou Mo said made sense.

at last,

Professor Liu commented: "This case is very interesting. You can go to it during the rounds..."

"In addition, the "familial Mediterranean fever" mentioned by Zhou Mo is very clinically meaningful. In the future, when you diagnose patients with peritonitis and fever, you can consider this... Our country is vast, rich in resources, and complex in population. It may not be that there are no ancestors who have Western blood. patients..."

It can be regarded as an affirmation of Zhou Mo.

Huang Yiming, Li Dongmei, Huang Zhichao and other medical students were all envious.

damn it

It was pretended by Zhou Mo again! !

At 10:00, the ppt report in the conference room ended.

Then a few special cases were selected and went to the ward rounds.

Among them was the suspected "Family Mediterranean Fever" patient.

A dozen or so doctors and a group of chief professors blocked the entire ward.

The 37-year-old patient trembled when he saw such a big battle, wondering if he was going to die?

Then I asked about family history and childhood disease history.

The patient confessed truthfully.

"My ancestors did have a grandparent in Europe, but I don't know if it is..."

"It did exist when I was a child, but it disappeared after that..."

I have to go out to do errands in the afternoon, it will take a long time, I can only update once today, sorry...