Feng Xuhui was shocked by Su Yun's words.
Wasn't the diagnosis clear? Although he was not a doctor, Feng Xuhui knew about the adrenal crisis. The illness was very serious and urgent. That was for sure. However, it was undeniable that the medical standards of the First Affiliated Hospital of Provincial Capital Medical University were high. The person should not be in danger.
However, Brother Yun said that it was a big deal!
"It seems to be a reasonable diagnosis. Renal venous thrombosis causes an adrenal crisis. There's even a hematoma caused by bleeding. This is simply too coincidental. It's the same as a little boy's metastatic right lower abdomen pain being diagnosed with acute appendicitis. There's nothing to think about at all. "
Feng Xuhui looked at Su Yun in a daze. When it came to the patient's medical history, symptoms, objective examination, and final diagnosis, he could not interrupt at all.
"It's good that this kind of thing is fine. Once something happens, it's a big deal."
"For example?"
"For example, renal venous thrombosis can be said to be caused by oral contraceptives. We've also done this kind of patient before. It's that medical university student who fell, "Su Yun said while gesturing.
While explaining the condition to Feng Xuhui, Su Yun was organizing his thoughts.
Feng Xuhui had an impression of this surgery. Boss Zheng had removed a 12cm large thrombosis. He still remembered it vividly.
"But it's too coincidental. I feel uneasy looking at it." Su Yun smiled.
Brother Yun's judgment was too idealistic. Feng Xuhui did not believe it. He still felt that the adrenal crisis alone was enough.
"The patient has repeatedly had upright syncope for the past seven days. There's hyponatremia. The diagnosis of adrenal crisis is clear. Low blood pressure is the main cause of syncope," Su Yun nagged casually. "Yes, you're the one who said hyponatremia, and it's not very obvious. This diagnosis can't be considered for the time being.
"Adrenal cortical insufficiency leads to adrenal crisis. The common causes of primary adrenal cortical insufficiency include adrenal tuberculosis, fungal infection, solid tumors, and autoimmune diseases.
"I reckon that the First Affiliated Hospital of Provincial Capital Medical University will also be checked one by one."
Su Yun nagged until this point and stopped talking. There was no point in continuing. It was just a waste of saliva.
Everything had to wait until he saw the limited test results.
Zheng Ren and the professor operated together. Their speed was not very fast. Because the professor was about to leave, Zheng Ren was especially serious. He had to repeatedly correct every problematic step.
After the surgery was completed, Zheng Ren walked out of the operating theater. All kinds of information from Lin Yuan's side was also sent over.
Su Yun dragged Lin Yuan into the group. The moment he entered, Chu Yanran's profile picture flashed.
The series of welcoming words made Lin Yuan feel that it was definitely worth it to ask his old master for help this time.
Only by joining the group would one be considered one of them.
She hurriedly uploaded the information and watched as Gu Xiaoran escorted the patients away and scrubbed her hands for the next surgery.
"There are no major problems with the blood test," Su Yun said to Zheng Ren.
"Cortisol 0.74.
Μg/dl, ACTH
PG/ml, normal thyroid function; RAAS showed plasma renin activity 3.29.
Ng/(ml · h), aldosterone < 59
Pg/ml; Upright RAAS Display PRA
6.37
Ng/(ml · h), ALD
78.1
pg/ml。”
Zheng Ren just nodded, looking like he was deep in thought.
In addition, the enhanced CT scan of the abdomen showed the same results — diffuse swelling and enlargement of the bilateral adrenal glands, with the left and right sides respectively 3.2.
cm×3.4
Cm, 2.5
cm×4.9
The boundary was clear and the density was uneven.
The CT value was 36-65 HU. There was no clear enhancement on the enhanced scan, so the possibility of adrenal hematoma was high.
The left renal vein was dilated, and there was an irregular low-density lesion in the lumen, about 2.3
Cm; there was also a low-density plaque in the right renal vein, about 0.8
Cm, and the possibility of thrombosis was high.
"Boss, do you see the problem?" Su Yun asked when he saw that Zheng Ren did not speak.
"The case said that the patient has pigmentation," Zheng Ren said.
The physical examination by the First Affiliated Hospital of Provincial Capital Medical University was very detailed. It described the suprasternal fossa, armpits, waist and abdomen, ear and palm lines, skin pigmentation on the back of the index finger, lips and oral mucosa.
Scattered herpes could be seen on the left alar of the nose. The skin of the lower jaw was pigmented, and scattered papules could be seen. Some of the surface was broken.
These were not described by Feng Xuhui.
"I saw it. Tuberculosis is not considered, adrenal fungal infection …"
"I won't consider it either," Zheng Ren said with certainty.
"The adrenal tumor has also been ruled out, so it might be an autoimmune system disease." Su Yun smiled. "We should ask Big White to take a look."
"There's no need. The condition … I'll think about it again," Zheng Ren said.
"Everything that can be ruled out has been ruled out. I think it's anti-phospholipid syndrome."
"Yes, it's secondary," Zheng Ren added.
"Do you have any thoughts on the treatment?"
Zheng Ren thought for a moment and began to discuss with Su Yun.
This time, it was a very professional conversation. Feng Xuhui could not keep up from the beginning.
In the conversation between Zheng Ren and Su Yun, every noun had to be pondered for a long time. Before he could understand the content of the first sentence, Chief Zheng and Brother Yun had already reached the tenth sentence.
Forget it. Feng Xuhui gave up on using his brain to understand the matter. In the end, he only needed Chief Zheng and Brother Yun to give him an answer.
However, it was still quite interesting to watch the two of them discuss the condition.
Chief Zheng was still the same Chief Zheng from Sea City. He was honest and honest. When he spoke, he was like an old professor in his twilight years, quoting classics. Brother Yun did not change much either. If he did not refute Chief Zheng in three to five sentences, he would feel uncomfortable all over.
The two of them seemed to be quarreling and talked for nearly half an hour. Xie Yiren was used to it. She did not listen to what the two of them were saying at all and kept staring at the surgery inside.
After the surgery, the two of them were still arguing. From the sound of it, they were speculating about the possible tests that had not yet returned based on the existing test results.
This was an inhuman operation. Feng Xuhui was a little at a loss. Was this the right thing to do?
After the surgery, Chief Zheng took advantage of the interval in between to explain the surgery to Lil Fugui. Meanwhile, Brother Yun found a pen and paper and began to write something.
Faced with Su Yun's coquettish operation, Feng Xuhui had no idea what he was doing.
Just like that, time flew by as Zheng Ren and Su Yun argued about the condition and watched the surgery.
After the last surgery, Su Yun held a stack of papers and said with a smile, "That's it. The diagnosis is secondary anti-phospholipid syndrome."
"Yes."
"Secondary anti-phospholipid syndrome. The possibility of systemic lupus erythematosus is high. Bilateral adrenal venous thrombosis followed by adrenal hematoma. Primary adrenal cortical insufficiency. Adrenal crisis."
Su Yun wrote as he spoke. The black hair on his forehead fluttered in the wind. He looked very proud.
When Su Yun finished writing, Zheng Ren took a look and added a smiley face at the end.
"Boss, I already said it's useless for you to do this."
"I'm used to it." Zheng Ren smiled and handed a dozen pieces of A4 paper to Feng Xuhui.
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