I Can See Health

"Lu Chen, you go and see the patient first." Li Yao looked at Lu Chen.

Lu Chen nodded knowingly.

Yin Chao on the side was slightly surprised.

Let a master's student see this patient?

Wouldn't it be a little hasty?

This patient has been in their department for three days, but there is still no clear diagnosis.

Even my blood pressure hasn’t dropped yet!

Or maybe Professor Li should just let Lu Chen practice his skills, Yin Chao thought, and he would check it out himself later.

…

Lu Chen walked to the patient's bedside and began to ask about the patient's medical history.

Patients with hypertension are mainly asked about the course of hypertension, maximum blood pressure, specific oral medications, blood pressure control level, etc.

After asking about the routine medical history, Lu Chen didn't find any special illness.

The patient had felt dizzy, had a headache, and occasionally had edema in both lower limbs in the past month. Then he went to a clinic near his home to have his blood pressure measured, only to find that his blood pressure was extremely high.

The patient had no previous medical history, including genetic diseases, heart disease, etc.

After asking about the medical history, Lu Chen began to conduct a physical examination.

He picked up the stethoscope and placed it on the auscultation area of ​​the heart and lungs. No special murmur was heard.

The only meaningful sign was mild edema in the patient's lower limbs.

The two most common causes of edema are cardiogenic and renal.

In addition, the patient has typical abdominal obesity and a rather large belly.

"The auscultation of the heart, lungs and abdomen was negative, and there was mild edema in both lower limbs."

Lu Chen reported the abnormalities found during his physical examination.

"The basic clinical skills are quite solid."

Yin Chao was quite surprised when he saw Lu Chen asking about medical history and physical examination.

Nowadays, the younger generation of doctors relies more and more on imaging technology, thereby neglecting the most basic physical examination.

Many doctors prescribe CT and ultrasound as soon as they see a patient, directly omitting the physical examination and asking for medical history.

"Dr. Lu, if you have finished reading, we will go back to the office to check the patient's examination results." Yin Chao said.

The basic situation of the patient has been understood. According to the routine process, the results of blood draws and examinations after the patient is hospitalized are checked.

Especially patients with refractory hypertension need to undergo cumbersome examinations to rule out secondary hypertension.

However, Lu Chen shook his head and refused.

"Director Yin, I have one more question. I'll be done with it after I ask it."

Yin Chao was stunned for a moment, then smiled, "Just ask."

Lu Chen noticed that there was a little girl about five years old sitting at the end of the hospital bed.

The little girl wore pink makeup and looked very cute, but she looked nothing like the patient in the hospital bed.

"I would like to ask about your marital and childbearing history and menstrual status." Lu Chen said.

Clinically, as long as women are of childbearing age, they must inquire about their marriage, childbirth and menstrual status.

When the patient heard this, he whispered: "I am married, but I have never given birth to a child."

"Where's menstruation?"

"Menstruation is very irregular. Sometimes it comes once a month, sometimes once every two or three months. If I take Chinese medicine to regulate menstruation, it will be more regular. However, I haven't taken Chinese medicine for a long time."

"When was the last time you had your period?" Lu Chen asked.

The patient thought for a while and said, "It was probably two or three months ago, I don't really remember."

Lu Chen nodded and looked at Li Yao and Yin Chao standing aside: "I'm done asking."

Yin Chao smiled. He thought Lu Chen was going to ask some serious questions, but it turned out that he was just asking about the history of marriage and childbirth and menstrual history.

They have asked this question before.

"Then let's go back to the doctor's office?" Yin Chao looked at Li Yao and asked her opinion.

"Okay." Li Yao nodded.

Yin Chao then led Li Yao and Lu Chen to the cardiology doctor's office.

…

As soon as I walked into the doctor's office.

Yin Chao greeted: "Xiao Lin, bring over the medical records of patients in bed 31 and type out the laboratory test sheets and examination sheets!"

"Okay!" A resident doctor named Xiao Lin responded quickly.

At this time, other doctors in the department also saw Li Yao and Lu Chen coming.

Li Yao and Lu Chen sat at the table in the center of the office.

Yin Chao clapped his hands and signaled everyone present to quiet down: "Professor Li Yao came to our department today to guide the work. Everyone warmly welcomes him."

There aren't many doctors in the office.

As soon as he finished speaking, there was sparse applause in the department.

"Professor Li will first take a look at the situation of bed 31 before starting our teaching rounds today."

Dr. Lin quickly handed Li Yao the medical records of 31 patients.

Li Yao turned around and handed it directly to Lu Chen who was standing aside.

Dr. Lin looked a little dazed. Who is the young doctor next to him?

Yin Chao explained in a low voice: "Xiao Lin, this is Director Li's master's student, his name is Lu Chen. You two can have a good chat."

Xiao Lin is a master's student who just graduated this year. Because his family is in Fengm County and he doesn't want to be too far away from his parents, he stayed at the County People's Hospital.

"You can give Professor Li and Dr. Lu a good account of the patient's diagnosis and treatment in the past three days."

"Okay." Dr. Lin nodded.

Lu Chen was reading the medical records while listening to Dr. Lin's report.

The patient's diagnosis and treatment during the past three days was very simple.

The main purpose is to improve the examination items for secondary hypertension.

In terms of treatment, urapidil and oral antihypertensive drugs are given to lower blood pressure.

Dr. Kobayashi continued: "The patient's blood pressure has been hovering around 180/100mmhg, and the systolic blood pressure occasionally rises above 200mmhg."

"The patient's creatinine is currently high, and urine protein and urinary occult blood are both positive. In addition, other test results, including potassium ions, are normal."

"We are considering that the diagnosis may be secondary hypertension and renal damage due to hypertension. What is more confusing is that the patient's blood pressure has never been lowered."

Lu Chen frowned.

The patient's serum potassium was normal, which ruled out many endocrine system diseases.

The heart ultrasound and kidney ultrasound were also normal, and diseases such as aortic coarctation and renal artery stenosis were temporarily ruled out.

The most difficult problem is that the patient's blood pressure remains high.

No matter what kind of hypertension it is, if so many antihypertensive drugs are used, the blood pressure should be able to drop!

"Professor Li, do you have any comments on our diagnosis and treatment process?" Yin Chao asked from the side.

Li Yao smiled and read www. uukanshu.net Turned to look at Lu Chen aside, "Lu Chen, let's talk about it first."

Yin Chao raised his eyebrows.

At this time, Professor Li is still testing his students?

Lu Chen pondered for a moment and then slowly said: "Based on the current examination results, our common secondary hypertension factors, such as pheochromocytoma, pro-aldehyde, epinephrine tumor, etc., can all be ruled out."

Xiao Lin nodded, this was also what confused him.

Common secondary hypertension factors have been ruled out. Could it be that this patient has essential hypertension?

However, Lu Chen's next words made all the doctors at the cardiology department in Feng M County break into a cold sweat.

"However, you missed one condition, which is gestational hypertension!"

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