After finding this step, it can be regarded as a relatively large progress, but the cause of the disease has still not been diagnosed.

Celiac disease is also only a suspicion.

In addition, the disease is closely related to genetic and immune deficiencies.

According to research, glum enteropathy is closely related to the consumption of wheat flour, and glutam may be the causative factor of the disease. The cause is the result of the interaction of genetics, immunity, and the gluten diet.

Wealthy families are very particular about their diets, and sometimes what they think is healthy is not necessarily healthy.

This still refers to some wealthy families with more background, and the nouveau riche is not among them.

Three generations of eunuchs know how to dress and eat.

It means that only after three generations of wealth can they know what kind of clothes are good clothes, what foods to eat are really good for the body, and how to eat to enjoy the best deliciousness.

Even if the child really has celiac disease, if you want to get a diagnosis, it is definitely not enough to rely on a gastroscopy and duodenal mucosal pathological detection.

The child responded with abdominal distension and edema of the lower limbs, which is comparable to celiac disease.

Some people with this condition have significant bloating, nausea, and vomiting. Weight loss, lethargy, emaciation, fatigue, edema.

Zhou Can already seriously suspected that the patient was likely to have celiac disease, although the patient did not have diarrhea, only abdominal distention. In the diagnosis of symptoms, we must not be dogmatic and copy the knowledge from textbooks.

For the same disease, each person's symptoms may be different.

This is closely related to an individual's immunity, physical fitness, tolerance, severity of the disease, and the location of the lesion.

Depending on the physique, some people may just be nauseous or even vomit.

Others may have nausea, vomiting, diarrhea, all of them.

This child's family background is excellent, and his food and clothing are certainly not bad. Judging from his weight and height, his physique should be quite good.

It is precisely because of his good physique that the lower limbs have been edema for nearly seven months, which has led to nausea and vomiting.

Therefore, sometimes people who are too good in physique will also have some shortcomings.

Minor ailments can't stir up waves in such people, and it's even difficult to invade their bodies. When a major illness comes, it is also possible that the process will be slow.

If it is cancer, the sooner it is detected, the better.

However, because the body is too good, the symptoms may be mild and the cancer cells will grow slowly. By the time they are discovered, the scariest thing is that the cancer has spread.

Of course, in general, the stronger the physique, the better.

Theoretically, the stronger the physique, the more likely it is to develop serious illness and malignant cancer.

Although Zhou Can had already made a certain diagnosis of the cause of this child, he was still patient and continued to look down.

The specialist made a second major discovery, followed by a full colonoscopy.

You can feel the enthusiasm and urgency of this expert at that time.

He must have wanted to rush to diagnose the cause.

The result of total colonoscopy, normal.

Checking this, the second expert seems to be a little confused again. The colonoscopy is normal, but the fecal intermittent occult blood is positive, so how to explain it?

Because the patient has already done a full gastrointestinal angiogram, gastroscopy and colonoscopy, and then other colonoscopies are no longer necessary.

It is estimated that the family also put considerable pressure on the expert.

Eventually, the child was prescribed medication for enteritis.

This really surprised Zhou Can. I don't know what kind of situation the second specialist was in at that time, so he prescribed drugs to treat enteritis for the child. One thing is certain, because severe acute and chronic inflammation is found during duodenal mucosal pathology, which may be the basis for medication.

In addition, after reading the information in the medical records, Zhou Can keenly suspected celiac disease, but it does not mean that the diagnostic ideas and conclusions of other experts are consistent with his.

Because celiac disease has one of the most typical symptoms, and that is diarrhea.

and iron deficiency anemia.

People with severe diarrhea can have up to dozens of times a day.

When watching costume TV series, you can often see two flavors of Jianghu magic medicine, one is sweat medicine, you will fall into a coma if you eat it, and you are at the mercy of the enemy. Robbing money and robbing color, black shops use this medicine is the most common.

The second is Croton, which is a medicine for diarrhea, which specifically punishes people who have a holiday.

The rivers and lakes pay attention to happiness and revenge.

If the power is not as good as the other party, or the force is not as good as the other party, if you are wronged, you will grind it into powder with croton and secretly put it in the other party's food, which is a more common way to retaliate.

It is very rare to hack people to death and poison them at every turn.

Even in ancient times, the royal law was still a strong deterrent to the public.

Letting the enemy diarrhea to the point of prostration generally does not cause the government to track down. There are also very few people who will report to the government, and the risk is relatively small.

Patients with celiac disease are much more miserable than those who ate croton in ancient times.

After eating croton, it will be fine to pull it for a day or two at most.

People with celiac disease have diarrhea every day before treatment, and it gets worse and worse. Maybe twenty-four hours a day, at least eight or nine hours in the toilet.

The child's symptoms are more confusing, and the experts are used to being cautious and cautious, and the way of thinking is very different from Zhou Can.

According to the treatment of enteritis, the effect can be imagined.

Eventually, after the family found that the treatment was ineffective for many days, they began to doubt the level of treatment at the Provincial Children's Hospital, so they took the child to the pediatric department of Tuya Hospital for medical treatment.

It is estimated that if the cause of the disease cannot be found in Tuya, and no obvious curative effect is seen, most of them will be transferred to the big hospitals in the imperial capital and the magic capital for diagnosis and treatment.

Comparatively speaking, the big hospitals in the imperial capital and the magic capital have more advanced medical equipment.

This advantage is not reflected in a single examination instrument or surgical equipment, but in all aspects.

In addition to advanced equipment, they also have a more powerful team of experts. It can even realize multi-department joint diagnosis and treatment, close cooperation. Many diseases that are difficult to diagnose and difficult to treat can be cured in the big hospitals of the imperial capital, precisely because there are more top experts in the imperial capital.

In the field of medical subdivision, the experts in the imperial capital are more detailed.

Even if it's just a gastroenterology, there may be as many as as nearly twenty different specialists in different sub-fields of medicine.

For example, digestive enzymes are a very small and inconspicuous subdivision of gastroenterology.

The top hospitals in the imperial capital have doctors who specialize in digestive enzymes.

Look at Tuya Hospital, which is already one of the provincial head hospitals. Whether it is gastroenterology or surgery, the gastrointestinal tract is rarely separated. Almost all of the top experts in these two departments are good at the two subdivisions of stomach and intestines.

Just one intestinal field can be subdivided into small intestine, appendix, cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum, pylorus, duodenum, and so on.

The so-called greedy and chewy too much, Tuya's experts focus on multiple subdivisions of the gastrointestinal tract. The top experts of the imperial capital only do one thing in their lives, and those who study the cecum specialize in the cecum, and then take the cecum as the core to develop the organs, tissues related to the cecum, and the role of the cecum in the operation of the body, and conduct in-depth research.

It is conceivable that there must be a big gap between Tuya's experts and the top experts in the imperial capital.

"After the child was referred to our hospital, his protein was mainly checked, right?"

After reading all the information, Zhou Can still firmly believed that the child was likely to have celiac disease.

This diagnostic ability can be understood as a gift.

It's not that other experts are worse than him, it's just that when diagnosing this type of disease, they don't have Zhou Can's high sensitivity and comprehensive diagnosis ability.

Zhou Can also had a rollover in the diagnosis.

It is difficult to say whether this child will eventually have celiac disease.

"The child's protein loss isotopes were examined, and the intra-abdominal blood perfusion was diffusely abnormally increased, but no obvious signs of protein loss were found. Blood protein electro-ice, M protein can be seen. Monoclonal increase in LGCK and decrease in LGM and lambda by ......"

LgM refers to a type of immunoglobulin.

Tuya's experts consulted and found that the child had hypoalbuminemia and a chronic course.

At the same time, there is a relatively thin body, splenomegaly, edema of the lower limbs, and intermittent abdominal distention.

Therefore, the main diagnosis idea was put on severe hypoalbuminemia and elevated blood monoclonal immunoglobulin.

The discussion record of the expert consultation mainly focused on the cause of the decrease in serum albumin.

Each insisted on his own opinions, and made many judgments and analyses.

First, it is thought that the patient is malabsorbed with serum albumin. The patient has intermittent post-eating bloating, vomiting, and weight loss, which, combined with a low D-xylose test, is considered to have a small bowel malabsorption syndrome despite the fact that the stool is not positive for fat.

The second, the possibility of insufficient intake, experts are almost unanimously lined up. The child's self-report, as well as the accounts of family members and nannies, indicate that the child's food intake is acceptable. Not to mention nutrition.

Such a family can eat almost whatever it wants.

The third type is synthetic disorders. and the liver function test found no abnormalities, and the common liver virus indicators were negative, which can basically rule out synthetic disorders.

Fourth, proteins are lost in the body. The patient's albumin loss is mainly through the kidneys and gastrointestinal tract. Urine protein has been tested for a long time and is negative, which can rule out the possibility of albumin loss in the kidneys.

The gastrointestinal route of loss can also be basically ruled out, because the protein loss isotope scintigraphy examination is done, and no obvious protein loss is found.

At this point in the consultation, the problem can basically be identified in the small intestine.

Especially the duodenum.

After a big circle, Tuya's experts discussed it and found that the results of the diagnosis were overlapping with those of the experts at the Provincial Children's Hospital.

The experts of the Provincial Children's Hospital have tried to treat duodenal ulcer and enteritis, but there is no effect.

Tuya's experts treat these two diseases again, and even if the family members don't scold people in front of them, they will definitely scold them behind their backs.

"The lesion is most likely in the small intestine!"

Zhou Can is still quite cautious when he speaks, and he doesn't say what the disease is, but first says what he can be sure of.

"The results of everyone's discussion also basically determined that the child had a problem with the small intestine."

Director Tang Fei's phoenix eyes narrowed slightly, and he just looked at Zhou Can.

With her understanding of Zhou Can, Zhou Can must have a following.

"Is it difficult for the family members of the children to speak?"

Zhou Can's following is actually this.

She couldn't help stroking her forehead and said with a smile, "One of the family members is an official, and the official position is not low." The other is a female president of a large company, with a net worth of more than one billion, and a bit strong, that's for sure. I've talked to the parents of the children, and I'm quite reasonable! ”

The difference between a net worth of more than 100 million and more than 1 billion is quite big.

People with a net worth of one billion are basically middle-level tycoons in the business world. With a net worth of more than 10 billion, he is already a top boss in China.

It may feel that the evaluation of the family is not specific enough, which will cause Zhou Can to have some concerns when diagnosing the cause.

"Their child has been taken care of by the nanny, and the child's lower limb edema occurred for more than half a year, until one time after eating a lot of meatballs, nausea, vomiting, the nanny called them to say that the child's body was wrong. But they didn't complain about why the babysitter didn't find the child's lower limb edema earlier. In addition, their child has been treated at the Provincial Children's Hospital for nearly two months, and they have been cooperating with the doctors. Later, it was found that the effect was not significant, and the child was transferred to the hospital without any aggression against the doctor. ”

"In the conversation with me, there was no mention of the poor level of experts at the Provincial Children's Hospital. They even admitted that the child may have a relatively rare disease, which makes our doctors worry a lot. It is best to find out the cause of the disease, but it really can't be found, it doesn't matter, they just take the child to the imperial capital for medical treatment. After being transferred to our hospital, there were many kinds of examinations, and they all actively cooperated. ”

Director Tang Fei's evaluation of the family is quite good.

Zhou Can's worries were dispelled a lot.

"Director Tang, there are no outsiders here, so I'll just say it. I highly suspect that this child is likely to have celiac disease. Although the child's symptoms are atypical, the likelihood of celiac disease is highly elevated based on a combination of factors. ”

After listening to Zhou Can's answer, Director Tang Fei was stunned, and there was a slight disappointment in the depths of his eyes.

She had great hopes for Zhou Can, thinking that by inviting Zhou Can over, she would be able to find out the cause of the child's illness.

Zhou Can's diagnosis was celiac disease, which was indeed a bit unexpected.

"When I discussed it with other experts, I also suspected it. It's just that the symptoms are a bit wrong, and the current examination is mainly based on duodenal inflammation and severe hypoalbuminemia. ”

When they discussed, they had already ruled out the possibility of celiac disease.

There is no doubt about the level of these specialists, especially in cases that have been seen by the group, and there are generally very few omissions.

"Yes, the child did not have the most obvious symptom of diarrhea. However, I read the examination records, and the first time the child had nausea and vomiting was because he ate a lot of meatballs. It's equivalent to eating a lot of meat, and then vomiting. In addition, the child's diet is more reasonable, and every meat is eaten with wheat food. Celiac disease is mainly caused by eating wheat, coupled with the immune deficiency in this area. ”

Zhou Can stated the basis for his diagnosis.

"The child used to eat wheat food, so why did he never get sick?"

Director Tang Fei asked sharply.

"Just because you didn't get sick doesn't mean you don't get sick. It's just that the disease itself is a chronic disease, and the child's physique is very good, so the onset is late. In addition, there is a way to diagnose the disease. ”

Zhou Can's eyes were clear and firm.

When it comes to diagnosing, he does have a talent that no other doctor can match.

This was evident when he was an intern.

As for his surgical talent, it's more of a bonus to the medical experience point system. Of course, his own talent is not bad.

"What's the solution?"

Director Tang Fei asked.

"The child should be given further serological and imaging tests to check for anti-gluten antibodies, anti-endomysial antibodies, and screen-printed protein antibodies."

Zhou Can suggested checking three antibodies in one breath.

This is the fastest way to get a diagnosis.

(End of chapter)