(Thanks to my friend kpkkan, men's line, and Yimeng prodigal son monthly pass for encouragement)

After thinking about it for a while, Liu Banxia felt that he still didn't add it up. These things can't be done by yourself, and you can treat patients with peace of mind.

"Mr. Liu, the patient with acute abdominal pain I just received was diagnosed with appendicitis, please take a look at the test report. At this time, Xu Yinuo walked in.

Liu Banxia took it and took a look, and the indications on the B-ultrasound and CT images were clear, "Explain to the patient according to the process, then make an appointment in the operating room, go directly to the stage, and just look at the doctor casually." ”

"Thank you, Mr. Liu. Xu Yinuo happily responded.

"It's a nice job, it's your responsibility to take care of the patients now. How much experience you can accumulate and when you will have a higher level of surgery depends on your luck. Liu Banxia said.

Xu Yinuo ran out happily, compared with her classmates, they may not be the first to have surgery, but they must be the most surgeries among their classmates.

She has now performed six surgeries, five appendectomys and one gallbladder. This is also a relatively common operation among emergency patients, and the next surgery has to wait for Liu Banxia to arrange for them.

"Mr. Liu, come over for a consultation, I can't figure out this case. At this time, Wei Yuan walked over.

"Ah, Brother Wei, what's the situation? I didn't hear much movement just now. Liu Banxia said in surprise.

"The patient is a 33-year-old female, 11 years old. I had a convulsive attack while taking a bath at home, and my husband called 120 directly and sent it to our hospital. Wei Yuan said.

"I was treated with Wang Huan, and my vital signs were stable, but I had intermittent spasms, and now I have been given medication. I did a quick blood test, and the blood calcium concentration was somewhat high, the niacin was somewhat low, and the coagulation time was slightly longer. ”

"Then I did a CT scan of the head and found no lumps or cysts, just a little subarachnoid hemorrhage, but it wasn't serious. I think I hit my head when I had a spasm in the bathtub. ”

"I also looked for a god, such a little bleeding does not need surgery, but it needs to be monitored. Now it's just that we don't know how to diagnose it, and we have some psychiatric symptoms. ”

In her husband's words, his wife had always had a good attitude before marriage and on her honeymoon, but now her temper has become very bad. Losing your temper at every turn can even be regarded as an active provocation. ”

Liu Banxia nodded, "This situation is quite complicated, no wonder you can't eat it accurately." Did you do an MRI? Will there be a small lump that the CT didn't scan?"

"I've pushed it over, so I'm not going to come to you. You can also look at her brain hemorrhage, if it's okay first. Wei Yuan said.

"What about your thoughts? It can't be nothing, right?" asked Liu Banxia.

Wang Huan judged that it might be because the blood calcium concentration was too high? That's why the blood vessels in the brain are constricted? This leads to spasticity in the patient. Wei Yuan said.

"If you can't control it well, it won't be long before you have brain hemorrhage. It is more likely to worsen the current hematoma and threaten lives. ”

"By the way? According to the patient's husband? The patient also has recent diarrhoea and heavy stools. The diet has also become very irregular, and I love to eat snacks. We also did an exam for hyperthyroidism? Feminine. ”

"Done? I'll go outside with you and wait for the results. But don't really expect me, I don't even know anything about how you describe me. Liu Banxia said.

Isn't it because of the improvement of diagnostic skills? He usually participates in the consultation, and many times he can come up with a constructive opinion.

Anyway, it has become a habit in the emergency center to consult him now, no matter which department it is, occasionally Kaminai will come to him.

What is the patient's condition today? It can also be said that many departments are involved. But the emergency center is not so fine-grained? It's all over when the big guys come together.

After the new MRI results came out, it was the same as the CT results just now, but there was a little bit of bleeding? It will not have an impact on patients now.

After the patient was pushed back, Liu Banxia also carefully observed it, and the patient's condition was very bad. Where is it like a newlywed, it is similar to say that this is a person who has been lying in bed for months.

"Brother Wang, Brother Wei? Why don't you do a blood biochemistry again? See if the concentration of calcium in the blood has dropped. Liu Banxia said after observing for a while.

"Actually, I thought there might be a brain tumor. Otherwise, it will not cause a difference in mood. It's okay to say that there is a little difference, but it is not so big. ”

Wang Huan nodded, "We also think so, but CT and MRI have not scanned out brain lesions at present." ”

At this time, the patient lying on the hospital bed began to hum again, and his mouth was babbling and not knowing what he was saying. Liu Banxia also listened closer, but he didn't hear clearly.

"Do you have such symptoms at home?" asked Liu Banxia's husband.

"I don't know, now we're all sleeping in separate rooms. She also took a long vacation with the company, and she didn't eat at the same table with me, saying that she was annoyed when she saw me. The patient's husband said with a wry smile.

"It wasn't like this before, and he said that he liked to eat the food I cooked the most, and he was worried about gaining weight in the future. We're going to have children, and now I don't know if I'll be able to live this day. ”

"Don't worry, we'll do our best to find out the cause. Now that there has been such a big change in personality, it must be related to some kind of disease. Liu Banxia comforted.

"I'll do another EEG in a moment and see how the EEG performs. The next time you have a spasm, don't give it to see what kind of reaction you have when you get started. Do you find anything else that you need to be aware of?"

The patient's husband thought for a moment and shook his head, "No." We were originally college classmates, and we were in love for a long time after graduation. Later, I finally saved up money to buy a big house, and then I got married. ”

"She likes to live in a big house, although I think it's worth it with a more loan. Paying it back slowly, isn't it a lifelong thing to buy a house? ”

"Leave it to us, and we'll do our best to take care of it. Liu Banxia said comfortingly again.

There's really not much he can say, and now it's an intractable disease. Although there are many diseases that can cause this phenomenon, there are many inconsistencies with her current performance.

"Look, isn't this EEG a little weird? It seems that the brain activity is too flat. At this time, Wei Yuan, who was observing the electroencephalogram, said.

Liu Banxia hurriedly leaned over to take a look, it was really, much weaker than normal people's performance. This is also a new phenomenon, as now the patient also has some slight muscle spasms and has arched his body.

When the body has an uncoordinated response, the brain will definitely release more signals, so the EEG should be active.

"Uh...... , do you think it's pellagra?" Liu Banxia said after observing for a while.

"I started to see that her skin was a little bad, and I thought that the skin care was not done well during this time, but she had two small patches of dermatitis on her elbows. ”

"The niacin level is also a bit low, right? Could it be because the niacin is relatively low? One of the effects of niacin in the human body is to improve the excitability of the central nervous system and protect the cardiovascular and cerebrovascular systems. ”

"This is my current hypothesis, that pellagra can affect both the digestive and nervous systems. At the beginning of the physical examination, these two small pieces of dermatitis can be easily overlooked. If she weren't lying on her side and hunched now, I wouldn't have noticed. ”

Wei Yuan and Wang Huan ignored it and gave a thumbs up, "It should be about the same, you can make up some niacin first." If it's really pellagra, it's okay to pay attention to your diet after adjusting it. ”

"Doctor, really?" said the patient's husband, who was still depressed, suddenly became much more energetic.

"By the same time, we all started out with too much focus on the neurological side and only on the head. Wei Yuan said.

"And whether it has any effect, we can see it by supplementing some niacin. We really should have paid more attention to the skin in the first place, rather than focusing on the outward manifestations of the disease. ”

Pellagra is niacin deficiency, and although the niacin index is not particularly low, it is also below the normal standard. Now that the patient's physical manifestations and symptoms are combined, the probability of this disease is high.

Liu Banxia didn't say anything, and walked back to his office. In fact, he was able to construct the situation in his brain what caused the two of them to not notice the dermatitis of the elbow.

When I first sent it, I must have prioritized spasms before I thought about anything else. And he just took a closer look, except for some dermatitis accidents, the patient did not show angular inflammation and glossitis.

[Mimi Read] ()

And the degree of dermatitis in this patient is also very mild, and there will be some in our daily life. For example, contact with corrosive liquids or gases, bites of small insects, etc.

He also knew that even without him, the two brothers would think of this disease if they studied it slowly. It's just too worried about the patient, after all, there is still an intracerebral hematoma, even if it's just a little bit.

After niacin supplementation, the patient's condition is much better. The body was finally able to lie down properly, the expression on his face was softened, and he was able to nagged normally.

Ding! Patient reception is done

Gain 200 XP and 100 Diagnostics Skill Mastery

Looking at this system reward, Liu Banxia also knew that it was not difficult to diagnose this pellagra, but it was just a matter of focus.

"How is it? Now it's a little more comfortable, are there any abnormalities in the past? such as visual hallucinations, auditory hallucinations?" asked Liu Banxia.

"I seem to have heard a sound, and I often have stomach aches. The patient said.

Although it is still a little weak, it can still be expressed normally.

Liu Banxia nodded, "When I go back, eat more liver, lean meat, eggs, soy products, peanuts and vegetables, and I will be able to regulate my body." ”

"Hmm. ...... vomit"

The patient vomited as soon as he nodded his head, and blood stained from the corners of his mouth.