The CT scan and gastroscopy denied all the previous guesses. Now, more than ten doctors were staring at each other in shock.
When we returned to the ward, Mr. Qiu still had severe abdominal pain, and the symptoms were getting worse and worse. He was lying on the bed groaning. Mother Qiu was so anxious that she kept questioning him in local dialect.
"I'm wondering if this foreign doctor of yours is any good. How come after examining me for so long, I still don't know what the disease is?"
Qiu Yuxing didn't know whether it was intentional or she was really anxious, she grabbed Chen Xia's hand and said, "Xiao Xia, please, please save my dad."
Chen Chun and the many young doctors next to him looked at him with different eyes. He was flirting with a female classmate in public in the hall?
If Gu Lin was there, she would have slapped the couple to death with one blow.
Chen Xia was also very embarrassed. He pretended to look through the medical records and shook her hand off. He thought, even if you want to take advantage of me, you should do it at night when there is no one around. With so many people watching, this is not the right time.
Dr. Barry Marshall didn't have so many inner thoughts. Instead, he was thinking with his chin in his hand.
"No, no, no, there must be some details we've overlooked. Doctor Chen, could you please ask again for me, does the patient have any underlying diseases?"
After hearing this, Mrs. Qiu thought for a long time. "Two years ago, my husband's blood sugar was found to be high during a physical examination at work. The doctor considered him diabetic at the time, but after a follow-up examination, his blood sugar returned to normal, so we never continued treatment. Does this count?"
Chen Xia immediately looked through the medical records. Mr. Qiu had his blood sugar checked in the emergency room, and the results showed that his fasting blood sugar was slightly elevated, reaching 8mmol/L.
Chen Chun reminded him, "Although complications of diabetes may cause abdominal pain, mildly abnormal blood sugar levels are hard to believe."
Dr. Barry Marshall frowned, thinking that his first ward round in China was going to fail. If he was misunderstood as a liar, it would be difficult for him to participate in experiments in the future.
The group of young doctors next to them also had worried faces. All the conceivable diseases had been ruled out. What should they do?
When Mr. Qiu saw that more than a dozen doctors had been examining him for a long time without being able to determine what was wrong with him, he became even more anxious and shouted even louder: "Ouch, it hurts so much! I'm going to die! Help!"
At this moment, the laboratory called. Huang Xiaoping answered the phone and rushed over: "The results of the arterial blood gas analysis are out, indicating that the patient has severe metabolic acidosis."
Is metabolic acidosis necessarily related to abdominal pain? Could this be the culprit behind this?
Dr. Barry Marshall's eyes lit up like Ikkiu's.
"Yes, clinically, metabolic acidosis can stimulate the peritoneal nerve plexus, causing abdominal muscle tension and pseudoperitonitis. It can also lead to intracellular potassium deficiency and acid-base imbalance, causing gastric dilatation and paralytic ileus, resulting in abdominal pain. In addition, the toxic products of acidosis can directly stimulate the peritoneum and cause abdominal pain."
Chen Chun shook his head and raised the question immediately.
"Dr. Barry, although diabetes can easily cause ketoacidosis, patients with this condition often have significantly elevated blood sugar levels, typically between 16.7 and 33.3 mmol/L, or even higher. This patient's blood sugar level was only 8 mmol/L, a mild abnormality that's truly unbelievable."
The young doctors behind him nodded repeatedly and whispered to each other. It was obvious that Dr. Barry Marshall's inference did not convince anyone.
"No, no, no. Diabetic ketoacidosis is indeed the most common acute complication of diabetes. Under the influence of various factors, patients suffer from severe insulin deficiency and inappropriate increase in glucose-raising hormones, which causes imbalances in sugar, protein, fat, water, electrolytes, and acid-base balance, leading to metabolic acidosis."
Dr. Barry Marshall continued to explain to the patient:
"Therefore, diabetic ketoacidosis can cause pancreatic damage and dysfunction, leading to elevated amylase levels. Therefore, the most common clinical case of diabetic ketoacidosis is hyperglycemia. However, there are also some patients with ketoacidosis whose blood sugar levels are not high, and may even be normal or low."
Chen Chun's eyes widened. "You mean diabetic ketoacidosis that's not caused by hyperglycemia?"
"Yes, the probability is very small, but it cannot be ruled out."
Just as everyone was arguing, the laboratory had already sent someone to deliver the report: blood ketones were significantly elevated, reaching 5mmol/L, urine ketones and urine sugar were both positive, and glycosylated hemoglobin was also significantly elevated.
The diagnosis of metabolic acidosis was established.
In the 1980s, people's living standards were not high, and only a few could see a doctor. Moreover, due to the lack of examination equipment and the poor quality of doctors, people generally rarely thought of ketoacidosis.
Especially the abdominal pain caused by ketoacidosis, which is a problem that no one would have thought of. So this ward round was an eye-opener for everyone, and several young doctors were taking notes desperately.
Let everyone remember one piece of knowledge: all patients with diabetes should have their blood gas checked in the future, especially those with diabetic abdominal pain.
But Chen Xia still disagreed. "Dr. Barry, I think the diagnosis of pancreatitis cannot be ruled out."
Dr. Barry Marshall was just feeling a little smug, thinking he had diagnosed a difficult and complicated disease. Obviously, the young doctors around him looked at him with a little more admiration. Now that Chen Xia suddenly jumped out, he felt a little uncomfortable.
"Doctor Chen, didn't the CT scan just now show no exudation around the pancreas? How can it be diagnosed as pancreatitis?"
Chen Xia is not the little doctor next to him. He is confident in his diagnostic skills and will not blindly follow others. So he explained:
"I can prove this from several points: 1. The patient's abdominal pain is located right where the pancreas is. 2. The elevated blood amylase level is more than five times normal, which, combined with the patient's history of heavy drinking and high blood sugar, leads to hemoconcentration.
3. Pancreatitis has relatively high imaging manifestations within 12-24 hours of onset, and is most obvious between 24-48 hours. Therefore, if CT scan does not show any problems with the pancreas, it may be that the time has not come yet.
4. If the abdominal pain is caused by ketosis, there is a typical characteristic: symptoms and signs do not match. That is, the abdominal pain symptoms are severe, but the signs are mild, and there is often no obvious tenderness or rebound tenderness. Similar to ureteral stones, the symptoms and signs do not match.
The patient had signs of peritonitis, which I think supports the diagnosis of pancreatitis more."
After Chen Xia finished speaking, Dr. Barry Marshall kept thinking, but because many of Chen Xia's arguments came from later views, he was a little confused. Because from his clinical experience, he felt that what Chen Xia said seemed to be right.
The young doctors next to them looked at their idol with admiration. Look at Mr. Chen, he is not at a disadvantage even when facing the foreign doctors. He is really amazing.
Si Gaoyi!
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