This Doctor is Great

28 beds,

Wu Xi, male, 42 years old.

Zhou Mo stood by the bed: "Wu Xi, right, can you tell me about your condition?"

"Okay, okay, my situation is like this... When I was exercising at home today, I suddenly felt chest pain, and then I called 120 quickly and came to the hospital..."

"The emergency department diagnosed me as "hypertension complicated with chronic nephritis"..."

"?????"

Zhou Mo was taken aback for a moment.

"Wait, nephritis? Are you sure?"

"Yes, sure, the doctor in the emergency department drew my blood, then did some tests, and then confirmed that I have chronic nephritis..."

Zhou Mo: "..."

Zhou Mo opened the system with his ipad and found the patient's medical records.

Sure enough, there is a kidney function test in it, and many kidney function indicators have increased.

There is also blood routine, the most obvious is white blood cells, which have increased significantly.

As for blood pressure, the admission measurement was 170/110mmhg...

"Is high blood pressure primary?"

"What's the meaning?"

"It means that high blood pressure causes nephritis? Or does nephritis cause high blood pressure..."

There is still a difference between the two.

Hypertension can cause renal function damage for a long time, and chronic nephritis can cause secondary hypertension.

Of course, it is not difficult to judge,

If it is malignant hypertension, renal function can progress quickly.

Blood pressure rises more than 5 years before renal damage; renal function damage is mild and progresses slowly: anemia is late and mild; urine protein is rarely above 2+.

"Hey, do you have a fever?"

"Yes, I had a fever three days ago. I was just taking medicine at home, but I suddenly had chest pains, so I came to the hospital..."

"The emergency department confirmed that you have a fever caused by nephritis?"

"Yes."

After spending an hour in consultation and physical examination, I finally figured out the general situation of this patient.

Ten years ago, the patient Wu Bin had high blood pressure, and two years ago, he had a fever every few months, but he didn't take it seriously.

Since the beginning of this year, Wu Bin has found that when he urinates, there are many bubbles in his urine.

I didn't pay attention to it at first, but after a week or two, the pee bubbles became more and more.

At that time, he wondered why there were so many bubbles in pee.

So I went to the hospital for an examination and found out that it was a kidney problem.

The bubbles are caused by the high protein content in the urine (the specific indicator is the urine protein +++ in the urine routine (the more +, the more serious it is)).

In addition to the two diseases of hypertension and nephritis, the patient Wu Xi also has coronary heart disease (coronary atherosclerosis).

For long-term high blood pressure, Wu Xi did not take medication regularly, resulting in high blood pressure, high pressure on the arterial wall, endothelial cell damage, low-density lipoprotein cholesterol entering the arterial wall, and stimulating the proliferation of smooth muscle cells, thus suffering from Had coronary heart disease.

Then, this time it was coronary heart disease that caused angina pectoris.

"Okay, I'm done checking..."

"Thank you doctor..."

Zhou Mo nodded, and then left the ward.

...

In terms of kidney disease,

Zhou Mo is still not very familiar with it, and he has read relatively few materials, and what he knows is only the knowledge in school, so he needs to spend time to familiarize himself with this area.

In this case, I may have to do a ward round with the nephrology department tomorrow, and if I ask three questions at that time, I will embarrass the cardiology department.

Back to the duty room,

Write the first medical history...

As for the doctor's order, Zhou Mo felt that he should be on the safe side first, and searched for relevant guidelines.

'Hypertension combined with chronic nephritis, if the patient can tolerate it, the blood pressure can be reduced to 130/80mmhg, and if necessary, it can be combined with 2-3 antihypertensive drugs, including a raas blocking drug (acei or ARB) ...'

‘If the kidney function is significantly impaired, or there is a large amount of urine protein, dihydropyridine calcium antagonists should be used first…’

'Precautions for medication:...'

...

"Huh~~~~"

Wang Lilong was at the table next to Zhou Mo, making a surprised sound.

"Zhou Mo, are you seeing a nephrologist?"

"Yes, I just received a case of high blood pressure combined with chronic nephritis, so I need to supplement the information..."

"Haven't you read the materials of nephrology before?"

"No, it's blank..."

"Then you have something to learn, but it's not enough to cram for a while. Nephrology is a separate department. There are thousands of diseases. Nephritis alone has a lot to pay attention to. I'm afraid it's too late now..."

"It's okay, I have my study method..." Zhou Mo said.

When Wang Lilong heard this, his eyes lit up!

Zhou Mo's learning method?

Isn't this what I have always wanted to explore?

I want to learn too!

Wang Lilong immediately pretended to be curious and asked for advice: "Do you have a quick method? Can you teach me?"

Zhou Mo generously: "Yes, my method is to read a lot of relevant textbook knowledge and literature... Just read more..."

"..." Wang Lilong said, "Are you kidding me?" ’ expression.

Isn't this rote memorization?

I will too!

Why can't I study faster than you?

Zhou Mo: "Okay, let's stop talking, I'll read the book first..."

Then,

Started to eat a lot of books.

"Ding...you have read the textbook "Internal Medicine·Urinary System Diseases", you comprehend the essence 100%, and remember it forever..."

"Ding... You read the paper "Precautions for Medication of Chronic Nephritis",..."

"Ding...you read..."

The system kept ringing in my ears.

A lot of knowledge about kidney, nephritis, and chronic nephritis poured in.

While eating, while gnawing a book.

half an hour...

One hour……

two hours...

Wang Lilong was sitting beside him, on the surface he was working hard on the computer, but in fact he was doing two things at once, most of his attention was on what Zhou Mo was doing.

Half an hour: "He is actually reading textbooks..."

One hour: "He read the paper..."

Two hours: "What's going on? Didn't he lie to me? He has always been excellent, but his learning method is just memorization? It's unreasonable, I don't believe it..."

Three hours: "He's still watching! Seeing so much, so fast, won't his head explode? Can he understand it? Can he remember it?"

four hours later,

Wang Lilong doubted his life.

Zhou Mo is really completely reading books, documents, guides...

"Could it be that his learning method is really 'rote memorization'?"

Wang Lilong felt that this afternoon, he observed a loneliness!

"No, maybe he's just confusing me!"

"Don't want me to know his real learning method!"

...

Zhou Mo didn't know that Wang Zhenglong had so many inner dramas, he was withdrawn from the ocean of knowledge 'inside the kidney'.

at this time,

He has basically mastered most of the kidney knowledge, and is more or less sure about medication.

16:10,

He needs to go rounds.

I went to make a round of the ward, checked the 28th and 29th beds, and then came back to write the medical records and doctor's orders.

17:00...

Zhou Mo wrote a detailed medical record for the 28-bed patient, including the detailed diagnosis basis and judgment of chronic nephritis, and then issued a doctor's order, including the control of high blood pressure and the medication of chronic nephritis.

soon,

As the attending teacher, Huang Li, received a doctor's order written by Zhou Mo.

"Huh, chronic nephritis? This needs to be consulted by nephrologist..."

"Zhou Mo's diagnosis seems to be quite familiar with the kidney?"

"Huh, Zhou Mo actually prescribed medicine for nephritis? Does he understand medicine?"

Teacher Huang Li looked surprised.

Then it was forwarded to the doctor on duty in the kidney...

.