"Huh?" Su Yun blew a puff of smoke into Mr. Yu's face very rudely, "It sounds like there's something big going on."
Zheng Ren was also curious.
"The patient's eldest son is Director Liu's friend, and he is now living in the special needs ward." Mr. Yu said, "So the patient is under my care."
This is because he is worried about the rhythm of other professors who lead the team. Something happened to Director Miao and a new director was appointed. There will probably be a fight in private.
Director Liu has just come up, and his foundation is not yet solid. If you think about this kind of thing carefully, you can think about it for a whole day.
But Zheng Ren was not interested in these things at all. What he cared about was what kind of hematuria would make Mr. Yu worry.
Hematuria is usually caused by stones or tumors.
It would definitely not be that simple to put Mr. Yu in a difficult situation. As for some common factors, Zheng Ren did not consider them. This matter is probably very complicated, and may be caused by some rare disease.
"Tell me about the situation." Su Yun asked from the side.
"The patient has no positive signs. The old man was still doing daily work for a listed company before he was hospitalized."
"Oh? It's quite rich. A listed company, tsk tsk." Su Yun praised.
"I'm asking about the medical history. Please pay attention." Lin Yuan said.
"Why am I not paying attention? This is part of the past history." Su Yun said disdainfully: "Do you know how many people you have to meet every day to manage a listed company? How much wine do you drink in a month? Listed companies line up directly to go public. Or is it listed in a shell?"
“…”
"Don't make trouble, listen to what President Yu said." Zheng Ren felt a little annoyed. It was not just Su Yun's nagging. Now that he had an opponent who was not an opponent, he talked even more.
"The patient complained of hematuria for half a month and was admitted to the hospital. Routine urine examination in the outpatient department showed: occult blood (+++) and protein (+++); abdominal ultrasound: an enlarged liver, dilation of the right hepatic vein, splenomegaly, and a small amount of peritoneal effusion. Urinary system Ultrasound: Prostatic hyperplasia and stones.”
"At that time, I was considering whether he had nephrotic syndrome or urinary tuberculosis."
"Urine protein is greater than 3.5g/d; plasma albumin is less than 30g/L. Neither of these two points are true." Lin Yuan asked.
"Listen carefully to the medical history and don't interrupt." Su Yun said contemptuously.
Zheng Ren felt a little headache.
"Well, none of them, tuberculosis is also considered negative." Mr. Yu replied cautiously. He couldn't figure out the origin of this long-legged beauty who was new to the medical team.
Dare to quarrel with Brother Yun, this is not something ordinary people can do.
"Mr. Yu went on to say, leave them alone." Zheng Ren pondered.
"Serum tumor markers: normal range; multiple clean urine smears for acid-fast bacilli: negative; chest X-ray: right pleural thickening and calcification; electrocardiogram: sinus rhythm, normal electrocardiogram; lower abdominal CT: lower cavity The entire vein and branches are dilated, and the branches of the hepatic vein are dilated in a limited manner; a small amount of ascites."
"Wait a minute, does the chest X-ray show pleural thickening? Does the patient have any past history?" Zheng Ren stopped Mr. Yu from talking.
"No, I asked in detail. I also thought there was something wrong with the chest X-ray, so I gave the patient a CT scan. The chest CT showed thickening of the pleura, adhesions and calcification, and a slight thickening of the pericardial wall."
"Watch the movie later." Zheng Ren said.
"What do you suspect?" Su Yun asked Lin Yuan calmly and thoughtfully without arguing.
"It's hard to say, hematuria needs to be checked for congestive heart failure, but there is only a small amount of calcification, which will not cause heart failure. And from the general description, we can guess that the old man is in relatively good health and will not have congestive heart failure. Such a serious problem." Zheng Ren analyzed.
"Well, Boss Zheng is right, the patient is in pretty good health." Mr. Yu said: "Before admission, it was said that he could still play table tennis for two hours."
"I'll go..." Su Yun was surprised, "How old is the patient?"
"72."
It was definitely not congestive heart failure, Zheng Ren concluded.
Heart failure is due to low ventricular pumping or filling function, cardiac output cannot meet the body's metabolic needs, insufficient blood perfusion of tissues and organs, and concurrent congestion of the pulmonary circulation and/or systemic circulation. It is a clinical syndrome in which various heart diseases develop to a severe stage. disease.
Usually when this happens, the patient is already terminally ill.
But I played table tennis for two hours the day before, and I couldn't think of congestive heart failure.
"Let's take a look at the movie first," Zheng Ren said.
"I'll look for it." Mr. Yu turned on the computer in his duty room and started looking for the patient's films.
Zheng Ren thought about the patient's condition in his mind. It wasn't a tumor, it wasn't a stone, it wasn't... what on earth was it
"Mr. Yu, what do you think it is?" Su Yun asked.
"I see the old man every day, but when I went to see him yesterday and today, I always felt that he was pretending to be ill." Mr. Yu did not hesitate and directly expressed his truest thoughts.
"Hematuria?" Su Yun and Lin Yuan asked in confusion at the same time.
"It may be the hematuria caused by oral medication." Zheng Ren said, "Since Mr. Yu has no other diseases to consider for the time being, this one will also be added."
"As for it?" Lin Yuan asked.
"Have you never seen someone cheating on insurance?" Su Yun looked at Lin Yuan with disdain. Seeing her confused look, he knew that she was just a rookie. She only knew from the analysis of her illness that she had not yet evolved to consider human nature.
Mr. Yu tuned out the film and gave up his seat.
Zheng Ren was not polite, sat down on it, and started rolling the mouse wheel.
Watching the film frame by frame, thinking about it bit by bit, Zheng Ren became more and more confused.
The patient's imaging data is just like what Mr. Yu just introduced, there is not much to see. It's definitely not a tumor, but there is a slight problem with the liver, and the portal pressure is not very high.
It is said that there will not be continuous hematuria.
"Mr. Yu, why do you suspect that the old man is pretending to be ill?" Zheng Ren asked.
"My health is so good that I can't find a reasonable explanation." Mr. Yu said: "One time when I went to check the ward, the old man went to the bathroom. I wanted to see how he was urinating, but he just flushed it away with water."
"Is there anything interesting about personal hygiene?" Lin Yuan asked doubtfully: "If you want to see it, just check the urine routine and you will know soon."
"Lin Yuan, that's not the case." Zheng Ren said lightly, "What Mr. Yu said still makes sense, but Mr. Yu, you found that the patient has aminopyrine, phenytoin, rifampicin, phenol red and other drugs around him. What?"
Mr. Yu shook his head.
"That's not right. If it was caused by oral medication, how could there be red blood cells in the urine routine?" Lin Yuan asked, grabbing a flaw.
"Just get some fingertip blood, the kind that measures blood sugar. It's very simple to see red blood cells in your urine." Zheng Ren was still watching the movie, ignoring the light and shadow, so focused.
Lin Yuan was stunned for a moment.
Is it really going to be so complicated? There was even blood dripping from the fingertips in the urine from the routine urine test... But if you think about it carefully, it is really possible.
Except for serious cases in the ICU, urine is reserved by the patients themselves. If you want to do tricks, there are plenty of opportunities.