I Can See Health

   Chapter 112 is over, remember to look back!

  Lu Chen took a few tissues, wiped his greasy mouth, and walked quickly to the doctor's office.

   "There is a gout patient in bed 30."

   Walking into the doctor's office, Min Ling was already sitting in front of the computer.

   "Well, I'm going to see the patient and ask about the medical history." Lu Chen nodded, grabbed the stethoscope, and walked towards the 30th bed.

   While walking, Lu Chen recalled the concept of gout.

  Gout is a disease caused by the deposition of uric acid crystals in the joints due to excessive blood uric acid levels. The deposited crystals cause painful inflammation in and around the joints.

   With the prolongation of human life expectancy and changes in diet and lifestyle, this data shows an upward trend year by year.

  The age of gout patients is gradually getting younger, the male to female ratio is 15:1, and more than 50% of gout patients are overweight or obese.

  …

   Came to the ward where the 30th bed was.

   As soon as he entered the ward, Lu Chen saw a very young male patient lying on the bed.

   He was about 30 years old, with a thin body and a morbidly pale complexion.

  Lu Chen walked to the bed, he was holding his right leg, grinning, his face full of pain.

  Gout is not a serious disease, but it hurts really badly!

   "Doctor, can you give me some painkillers first?"

   Seeing Lu Chen walk into the ward, the patient quickly raised his head and said.

   "The nurse is dispensing the medicine and will give you the medicine right away." Lu Chen said, "I will now ask you about the specific process of your illness."

   "Hey, I'm sick, and it happens many times a year." Xia Jinhua sighed, exposing his ankles on both sides, and then extending his right hand.

  Lu Chen saw that there were raised bumps on the skin of both his ankles and his right hand.

   This is tophi!

  Tophi is a characteristic clinical manifestation of gout, commonly found in the auricle, metatarsophalangeal, fingertips, metacarpophalangeal, elbow and other joints, Achilles tendon, patellar bursa, etc.

   The tophi of the patient in front of me is not too small, about the size of a ping-pong ball.

   "Then your medical history is really not short. The tophi is so big." Lu Chen sighed.

   He is also the first time to see a patient with such a big tophi, and the patient is still so young.

"Oh, I used to be young and naive. I drank and ate seafood, and I didn't control my diet." Xia Jinhua shook his head. "In the beginning, it happened five or six times a year. In recent years, it has happened several times a month, and I can't stand it. !"

  The disease of gout, in addition to genetic and environmental factors, is most related to personal eating habits.

   Now that living conditions are better, more and more young people will get gout.

   At the same time, Lu Chen noticed that the patient's HP was 62 in yellow.

   This value is somewhat unusual, it is only one step away from the red warning line.

   "Can gout reduce HP to around 60?" Lu Chen was a little puzzled.

   There were also gout patients in the ward. Lu Chen noticed that the health of the others was around 70 or 80.

   But the patient in front of him is so young, his HP is only 62, and it is hard to guarantee that his HP will continue to decline.

  Lu Chen inquired about the patient's disease process in more detail, followed by a physical examination.

   "Have you always been so pale?"

   As soon as he entered the door, Lu Chen noticed that the patient's complexion was a little morbidly pale.

   I thought that he was caused by a pain attack.

   However, I feel that this "pale complexion" may be unusual.

   The patient is not only pale, but also the bulbar conjunctiva is white, and the whole person is in a state of anemia.

  Xia Jinhua paused and recalled: "It's been about half a year, and my colleagues next to me say that I look a little pale."

  Lu Chen frowned.

   Is it chronic anemia?

   "How is your diet lately?"

   "Hey, since the frequent gout attacks, I have strictly controlled my diet." Xia Jinhua said, "I don't eat any meat dishes, I usually eat some vegetarian food."

  Lu Chen raised his brows. Anemia caused by malnutrition?

   "Have you ever been anemic before? Maybe the last time you were hospitalized, did the doctor tell you that you have anemia?"

   "Anemia?" Xia Jinhua was stunned, "I don't think so. Doctor, you mean, I have anemia now?"

   "Not necessarily, a blood test can be used to confirm the diagnosis." Lu Chen said.

  Xia Jinhua nodded, and then recalled: "I have occasionally suffered from fatigue and dizziness in recent months. I have never had it before. Could it be caused by this anemia?"

   "If anemia is diagnosed, it may be caused by anemia."

  …

   Back to the doctor's office.

  Min Ling has finished all the doctor's orders.

   "How is the patient's condition?"

   "It's mainly bilateral ankle pain. I'm currently considering an acute attack of gout." Lu Chen paused, "But..."

   "Is there anything else?" Min Ling looked back at Lu Chen.

   After getting along several times, Min Ling has already valued Lu Chen's opinion.

   If it's an ordinary graduate student, Min Ling can just listen to his opinion, don't worry about it.

   But Lu Chen's words, Min Ling paid more attention.

   "During my physical examination, I found that the patient had obvious anemia, but the patient denied any previous history of anemia."

  Min Ling nodded and said, "I looked at the patient's previous medical records. He was also in the hospital half a year ago. At that time, it was a mild anemia, and the patient should not care."

  Lu Chen approached Min Ling's computer and saw the patient's laboratory test at that time, hemoglobin Hb105g/L.

   However, other indicators of blood routine, including mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC), were all mildly decreased and did not reach the level of microcytic hypochromic anemia.

   Generally mild anemia is difficult to find on physical examination.

   What's more, the patient is currently showing obvious anemia.

   "I just checked the blood routine urgently." Min Ling said, "Let's see the results and then talk about it."

   "Yes." Lu Chen nodded.

  …

   After half an hour.

  The blood from the urgent investigation came out, and the hemoglobin was HB85g/L.

   Moderate anemia!

   Hemoglobin dropped further.

   "Looking at this blood routine, it should be microcytic hypochromic anemia." Min Ling frowned.

   "The patient has strictly controlled his diet recently, and hardly eats any meat dishes." Lu Chen said, "Could this be the reason?"

  Min Ling was silent for a long time before speaking.

   "Malnutrition does cause anemia, but moderate anemia is relatively rare."

  Unexplained anemia is generally more severe in males than in females.

  Female patients have a fixed blood loss every month, which is likely to be anemia caused by this reason.

   But male patients do not have this route of blood loss.

   Therefore, general male patients may have digestive tract diseases.

   "Could it be chronic gastrointestinal bleeding?" Lu Chen wondered.

  Min Ling said: "Does the patient have black stools?"

  Lu Chen frowned, "Occasionally, but the patient didn't pay much attention."

   "When the patient's gout gets better, I'll arrange a gastroenteroscopy for him." Min Ling thought for a while and then said.

   Every time the tuba ends, it is important to look back!

   Pay particular attention to the shape and color of the stool.

   If there is blood in the stool, it may be bleeding from hemorrhoids.

  If the stool is black and not shaped, it is likely to be gastrointestinal bleeding, including gastrointestinal ulcers, and even the possibility of gastrointestinal malignant tumors.

  …

   (end of this chapter)