(Thanks to my friends for their encouragement, thank you for your book friend 20180602234317808, I love to read, and I am waiting for the encouragement of the monthly pass)

Liu Banxia was also startled by the patient's sudden hematemesis, and in the past cases of pellagra, there were no symptoms of upper gastrointestinal bleeding.

"Doctor, what's the matter...... Why did you vomit blood? The patient's husband asked in a panic.

"Don't worry about it first, it should be upper gastrointestinal bleeding, the amount of bleeding is not large at present, let's do a gastroscopy to see." Liu Banxia said.

"I'll do it myself. Wang Huan answered.

"It's not funny, it seems that niacin deficiency is not the main cause of her. Liu Banxia said with a frown.

"Now it's come full circle and back, and this pellagra is probably a complication of her main cause. If the main cause is not found, I am afraid that our long-term niacin supplementation will not achieve the effect of radical cure. ”

"That's a question, what's the difference?" Wei Yuan also frowned.

I was already relieved just now, and the patient's condition was much better after supplementing niacin. That's when another upper gastrointestinal bleeding came, telling everyone that you were on the wrong track.

"It's really stressful for the patient's husband. Liang Xiaolin sighed.

"I just got married, and before I could live a happy life, my wife got such an illness. I am afraid that in order to repay the loan, the quality of life will not be very high. ”

"Wait. Liu Banxia, who was pondering, pinched his chin and said something after hearing Liang Xiaolin's words.

"No, Mr. Liu, do you have an idea?" Wei Yuan's eyes brought a hint of surprise.

"With a little bit of an idea, we have to think about the patient's situation as a whole. Liu Banxia said.

"First of all, the patient does have pellagra, right? Normally, she is a newlywed, and her diet should be very regular and good. But why did you get this disease? ”

"The second point is that the patient's blood calcium is somewhat high. Why is it high? We haven't figured it out. So you can start with a small question mark. ”

"Dr. Liu, can't you just say it? Liang Xiaolin said helplessly.

Liu Banxia shrugged his shoulders, "The patient has two diseases, which do not exist in isolation, I judge that one of them causes the other. And these two diseases are very similar, so it interferes with our judgment. ”

"As you just said, the patient just got married and was supposed to be enjoying a happy life. However, if the young couple buys a big house, the burden on their lives will definitely be a little heavy. ”

"Then the husband of the patient just said that he plans to have a child. How much money does it cost to raise a child? Our Lao Wang and Sister Li have just put forward a plan. They're both on an income level, right? Now they have to dig their pockets. ”

"That's the pressure, the stress that makes an otherwise good life stressful. The pressure of life, no longer spending money as before and not caring about it. The pressure of having a child, the daily consumption required to have a child is also very objective. ”

"Under such pressure, it is likely that the patient's celiac disease is induced. Over time, it has evolved into what it is now, and it has become more and more serious. ”

"Celiac disease? No, isn't celiac disease gluten intolerant, and what does it have to do with the current disease?" Liang Xiaolin asked with a frown.

"Because the patient has diarrhea, we just see the symptoms of diarrhea as the symptoms of pellagra, what if it was before pellagra?" Liu Banxia said with a smile.

"Why do you get pellagra? Because you can't absorb as much niacin, and the body's organ responsible for absorbing nutrients is the small intestine. Coincidentally, celiac disease can cause damage to the small intestine and dysfunction. ”

"Celiac disease is a genetic disease and an autoimmune disease. Many people carry this gene? But that doesn't mean you have a seizure with this gene. ”

"It's similar to urticaria, in the case of extreme fatigue and anxiety, the autoimmunity is reduced? Such a condition is likely to flare up. ”

"Patients must be very tired on their honeymoon, right? You have to count the money to get by. Do you have to save money for your future baby, and you will be under pressure? My own immunity has decreased a lot. ”

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"Another basis for judgment? It is the patient's high blood calcium concentration. And what about high blood calcium concentrations? There are many reasons for this, but one is a very iconic cause? It's just that there is a malignant tumor. ”

"It's not a coincidence? The probability of celiac disease patients suffering from malignant tumors is more than 7%, right? And most of them are gastric mucosal tumors? So the patient will have stomach pain. ”

"Hematemesis, this is also related to celiac disease. The small intestine is damaged, and it is not only niacin that is absorbed less, but also a small number of vitamins. For example, vitamin K? Because vitamin K is also absorbed less, the patient's blood clotting time is longer. ”

"Do you have these signs at the time of the blood test? However, it is only at the edge of the benchmark range, so it has not attracted our special attention. ”

"Of course, that's just my guess at the moment. After Wang Huan finished the gastroscopy after a while, he should be able to see the situation in the stomach clearly? At the very least, you can see if there is an endometrioma. ”

"Then you can do another stool test and X-ray to see how your small intestine is doing. If celiac disease can be diagnosed, then all the symptoms can be explained. If not, let's move on. What are you all looking at me like that?"

"Teacher Liu, do you want to be so powerful, why are you so clear every time you analyze a case. We can understand it when we hear it, but we can't think of it ourselves. Miao Rui said with a bitter face.

"Thanks to Dr. Leung, if she hadn't mentioned stress, I wouldn't have thought about it. Liu Banxia said with a smile.

"Stress seems to be commonplace, but for the human body, the impact it can have is really too great. It is not only mentally damaging but also physical. ”

"Many people with hives can detect allergens, but when they are healthy and healthy, those allergens will not trigger hives. ”

"This kind of autoimmune disease is often caused by excessive stress. After all, people's lives are better now, and there will be no lack of food and drink. You can't eat those high-end restaurants, but you can still afford ordinary food, right?"

"So we also have to pay attention to adjust our mood at any time, being a doctor is a high-pressure profession. If we can't find a good way to channel our emotions, we will be crushed if we don't do well. ”

"Because many of the patients we receive are facing life and death, how much pressure is there, don't you all send patients away now? There will only be more in the future, not less. Unless you don't do this job, you can take it easy. ”

"Hmm...... We also need to pay attention to the patient. When you are sick and hospitalized, you spend money and suffer crimes, and you are often not in a good mood. Therefore, when we receive a doctor or make room rounds, we also need to pay attention to controlling our emotions. ”

The interns nodded in unison, and Liu Banxia said it was not bad at all. The reason why they have grown so fast is because Liu Banxia still puts a lot of pressure on them.

But the pressure given by Liu Banxia is not always high-pressure, and it makes you breathless. He also often takes everyone to play during breaks and meals, often making small jokes.

Then everyone came over in a daze, not crushed by the tense internship life, but improved their medical skills a lot. If you look back carefully over the past few months, it doesn't seem to be very impressive, but it seems that there are a lot of them.

After waiting for a while, Wang Huan frowned and walked back, "There is a slight damage to the esophagus, but it is not serious, and it can be repaired by itself." But I saw a lump in her stomach, like a lymphoma. I'll be back with you...... What kind of eyes are you looking at?"

He couldn't go on halfway through the conversation, because the big guy's eyes were very weird and looking at him.

Wang Huan carefully checked himself, and there was nothing wrong with him. What are these guys going crazy about now?

"Teacher Wang, I need to do a stool test and a gastrointestinal X-ray. Miao Rui said.

"Why is it the same skin as Banxia?hmm?why?" Wang Huan asked in surprise.

"It may be celiac disease that causes these symptoms and pellagra. Liu Banxia said.

"Damn, it's possible. Wang Huan was stunned for a moment, then turned around and ran away.

It looks like I can't wait to get the patient examined.

He is, after all, an internist and knows a little more than a surgeon. Liu Banxia still needed to explain for a long time just now, and he understood the name of the disease as soon as he heard it.

"Teacher Liu, my surgery is done and I have been sent to the ward. At this time, Xu Yinuo also walked back.

"Hehe, don't look at you going to surgery, I just missed the big drama of Mr. Liu's diagnosis of celiac disease. Miao Rui said.

"Cut, what's the big deal, anyway, Mr. Liu will definitely take us to review this case when he finds time. Teacher Liu, right? Xu Yinuo said.

Liu Banxia smiled and nodded, "Miao Rui, give them a review." But don't patronize the review, the reception and treatment, the tube bed. ”

"Brother Wei, you can do this patient's surgery, and they can pick and choose. I still have a liver cyst removed tomorrow, and I don't know when the director will be able to take me to the transplant. ”

"Banxia, don't be so angry, we can't make it? Now the director of our emergency center, Shi Lei, and you can do a hemiliver resection. What are you still worried about?" Wei Yuan said helplessly.

"Hehe, in fact, I plan to take Brother Wei on stage together, but I don't know if there will be any additional meals in the evening. Liu Banxia pretended to say.

"Yes, yes, there must be. Not only that, but it has to be big. Wei Yuan hurriedly said.

Don't look at Liu Banxia's youth, but he has mature experience in liver surgery. If you can complete it under Liu Banxia's supervision, then you can also try more in this area in the future.

"Kids, are you happy? Dr. Wei will give us a snack in the evening. Liu Banxia said with a smile.

"It has to be added, who doesn't let me be in a hurry. Wei Yuan also said seriously.

After finishing speaking, I also got happy, and occasionally made a fuss, which was really fun.