This Doctor is Great

Chapter 216 Crohn's disease Differential diagnosis of intestinal tuberculosis

"PPD test - strong positive!"

Zhou Mo: "..."

Feeling bewildered.

He only screened intestinal tuberculosis empirically, but he did not suspect intestinal tuberculosis too much.

did not expect,

It turned out to be intestinal tuberculosis!

And it's still positive.

After the human body is infected with tuberculosis for a period of time, tuberculin can show a positive reaction. The results are judged as follows: within 24-72 hours after PPD injection, the straight meridian of skin induration measured within 5mm is negative (-), 5-9mm is weakly positive (+), 10-19mm is positive (++), and greater than 5mm is negative (-). 20mm or less than 20mm but blisters and necrosis are strongly positive (+++).

A strong positive indicates a more serious infection.

In addition to strong positives, there are also weak positives, which are test results between positive and negative. Sometimes it is meaningful, and sometimes it may be due to the judgment of the test doctor or when the test machine is not clear, a weak positive test diagnosis will be given. . But most of the weak positives are relatively clear cases.

...

Back to the patient Fang Xiaozhong,

Zhou Mo faced two directions.

1. Crohn's disease.

2. Intestinal tuberculosis.

Both are possible.

The first situation: If the diagnosis of Crohn's disease is used as the treatment plan, the most critical drugs are: mesalamine, hormones, and azathioprine.

But there will be a problem in this way. Tuberculosis cannot use hormones, because hormones will stimulate tuberculosis and make the disease progress rapidly.

The second situation: If the treatment plan is based on the diagnosis of intestinal tuberculosis, another problem will arise. The treatment of intestinal tuberculosis will be very slow and a long-term process. If the patient has Crohn's disease, then hit the street.

(To mention: a strong ppd positive does not mean that there must be tuberculosis. It may also be that you have had tuberculosis before, or you have been vaccinated with BCG (BCG is basically a vaccine that every baby will get). So it is possible to have BCG There is a strong positive. In addition, if it is Crohn’s disease, it means that the patient’s immune system is disordered, and it is normal to have a strong positive.)

so,

Zhou Mo was in a dilemma.

The only way is to further diagnose whether it is intestinal tuberculosis or Crohn's disease.

Zhou Mo asked further: "Have you ever had a cough before?"

Because intestinal tuberculosis is contagious, it will spread to the lungs and become pulmonary tuberculosis, liver tuberculosis, and pulmonary tuberculosis will have symptoms such as coughing.

Patient Fang Xiaozhong shook his head on the spot: "No."

Zhou Mo: "Open your mouth and show me."

Crohn's disease is characterized by sores in the mouth (not necessarily).

(If someone has mouth sores that recur frequently, it may be the disease.)

"Ah~~~"

Fang Xiaozhong opened his mouth,

Zhou Mo took a flashlight and looked up.

looked carefully,

Patient Fang Xiaozhong's oral cavity has no symptoms of ulcers.

In addition, whether the patient has abdominal mass, clubbed fingers (toes), skin lesions (erythema nodosum, gangrenous pyoderma), etc...

The final result is: none! !

Zhou Mo was disappointed,

So far, neither side has found any supporting evidence.

It seems that further inspection is needed.

First, for bowel tuberculosis, use another test

——Tuberculosis infection T cell interferon release test (also known as "γ-interferon release test")

The principle is similar to the PPD test, and the accuracy is a little higher.

Unaffected by BCG vaccination and environmental mycobacteria.

After our human body is infected with Mycobacterium tuberculosis, some memory cells will be produced. When encountering the antigen again, the memory cells will respond. The principle of the inspection is roughly the same.

But it still has disadvantages: its positivity can only indicate that the body has suffered from tuberculosis before, and cannot distinguish whether it is currently active tuberculosis.

but,

This check still needs to be done.

In addition, you can also leave sputum and send it for inspection to find out if there are tuberculosis bacteria.

"Doctor, what's wrong with me now?"

Fang Xiaozhong saw that Zhou Mo saw something, so he couldn't help asking.

"It's not confirmed yet, we need to continue to check."

"Huh? Not enough?"

"Okay, there is still some time now, let me tell you something, I currently have two diagnoses for your condition, one is Crohn's disease, and the other is intestinal tuberculosis."

Then briefly introduce it.

After introducing it to the patient, I made a will and did an interferon release test.

...

Zhou Mo returned to the duty room,

While calling the infectious disease department, the department consulted.

Because intestinal tuberculosis is within the scope of the Department of Infectious Diseases, it is best to seek consultation with the Department of Infectious Diseases and let the Department of Infectious Diseases issue a doctor's order.

In addition, call and ask Teacher Zhang Luojia to see what to do in this situation.

Crohn's disease, intestinal tuberculosis, and ulcerative colitis are relatively similar diseases, especially Crohn's disease and intestinal tuberculosis, which are often confused with each other.

soon,

Zhang Luojia gave Zhou Mo a very mature plan——

——Treat Crohn's disease with a non-hormonal regimen, and then see the progress of the patient's condition. Effective, it proves to be Crohn's disease. If it is invalid, it proves intestinal tuberculosis.

At present, in major hospitals across the country, more and more biologics-"regrams" are used to treat ulcerative bowel disease.

Remicade, which can be used for patients with moderate to severe active Crohn's disease who have not responded well to traditional treatments, can relieve symptoms and signs, achieve and maintain clinical efficacy,

However, it has many side effects.

The skin, nerves, cardiovascular system, muscles, defense system, etc., are all likely to be affected.

However, in the case where tuberculosis cannot be identified, it can be used to test, and the dosage can be controlled to minimize side effects.

At this moment,

"Doctor Zhou Mo, the consultant from the Department of Infectious Diseases is here."

"OK."

Zhou Mo walked out of the duty room quickly, already confident in treating patients.

The doctor in the Department of Infectious Diseases is Zhou Meiling, a female doctor here, the attending physician.

"Yo, it's you, handsome boy."

"This teacher is good."

"Call me Teacher Zhou, I have the same surname as you."

Zhou Mo brought Dr. Zhou to Fang Xiaozhong's bedside.

Zhou Mo introduced it.

"Intestinal tuberculosis? Crohn's disease? It's simple, just follow the examination of Crohn's disease and treat it first. If there is a result, it means that it is Crohn's disease. If there is no result, it proves that it is intestinal tuberculosis..."

Zhou Mo listened.

really,

The plan of the doctors in the Department of Infectious Diseases is also to use "classic grams"! ! !

at last,

Zhou Mo called Mr. Zhang Luojia, and together with Dr. Zhou from the Department of Infectious Diseases,

In the end, the plan was rejected.

yes,

No drop.

Because there are too many side effects of class gram treatment, try not to use this method until the last moment. At least this "intestinal tuberculosis" interference item should be excluded.

(A lot of doctors are divided about retinoids. Some doctors think that it should be used at the last moment. Some doctors think that it should be used as soon as possible, which can avoid further deterioration of the disease, reverse the course of the disease, reduce the chance of surgery, etc.)

(Different doctors have different styles, some are conservative and some are radical. If there are two factions in the department, they will definitely fight each other and dislike each other.)

.

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