blenderwars Chapter 406
Chapter 406
Chapter 406
Wang Qing: “After eating roast goose, I have to say, that Imperial Capital roast goose is not so delicious… I went to barbecue later…”
Lin Feng: “Did you eat seafood?”
Wang Qing: “I didn’t eat…”
Lin Feng: “Did you drink beer yet?”
Wang Qing: “Drink…because I ate barbecue, so I drank a lot of beer, I can drink better, 2 cases (jpg)…”
Lin Feng: “……………………”
What a smug! !
Lin Feng glanced at the patient Wang Qing.
Height 160+, weight 160+……
obviously,
Is an obese person…
On the one hand, at this weight, a lot of exercise can cause knee damage…
On the other hand, it is still related to the problem of gout.
The body of obese people is more prone to “insulin resistance”, which affects the function of “kidney excretion of uric acid”. It also causes the increase of free fatty acids in the body and affects the activity of xanthine oxidase, which leads to increased uric acid levels and induces gout.
Obese people are more likely to develop gout, statistically, the probability is 17.8% higher.
so,
·Conclusion 2: The patient Wang Qing is obese + drinks beer, and the probability of gout is very high.
(Ps: Patients who have suffered from gout for a long time will have tophi (see the picture in the chapter), which is very obvious and easy to touch and see. But if you are a patient who has just developed gout, there is no tophi.)
Next rule out osteoporosis.
“Have you ever thought you had osteoporosis in 080?”
“Osteoporosis? I don’t have one. I have always been in good health, and I often play basketball…”
Wang Qing was very emotional and obviously didn’t want to lose face in front of his girlfriend.
Lin Feng: “Are there any backaches or body aches, or difficulty turning over, sitting up, or walking?”
Wang Qing shook his head repeatedly: “No, no…”
Lin Feng nodded.
·Conclusion 3: Exclude osteoporosis temporarily!
As for the fourth “rheumatoid arthritis,” rheumatism-related diseases are relatively insidious and require laboratory tests to get results, so Lin Feng didn’t ask.
to here,
Lin Feng’s consultation session is basically over.
After the physical examination, the knee joint was pressed, and the patient Wang Qing screamed with pain…
“Okay, let’s get a blood draw and have a checkup…”
Lin Feng’s initial consideration is “gout + joint damage”.
“Go to take blood, do a blood routine, kidney function (uric acid index) check… Then take an X-ray of the knee to see the damage…”
Lin Feng opened 3 orders.
As for rheumatism, it will not be checked, because it will take 2 days to get results.
And Lin Feng feels that the possibility of “gout” is as high as 99%…
“Go check…”
Lin Feng handed the checklist to the patient Wang Qing.
“Thank you Doctor Lin…”
The patient took the check-up sheet, left the clinic, went to pay the bill, check…
…
after an hour,
All the results came out.
·Blood routine: increased white blood cells (inflammation)
·Kidney function: uric acid 390umol/L (420umol/L is the dividing line to define gout)
X-ray film: It can be seen that soft tissue swelling, osteoporosis and subchondral bone sclerosis and/or articular surface cystic degeneration and aggressive bone destruction can be seen after the disease has progressed.
Lin Feng smiled after reading the report.
First of all, needless to say blood routine, suggesting inflammation.
Secondly, X-rays also suggest joint damage, arthritis…
so,
·Arthritis can’t run away!
The key is whether there is “gout”! !
Lin Feng glanced at the student Chen Qingru beside him.
“Xiaoru, take a test for you… After reading these three examination reports, can you rule out that the patient is gout?”
Chen Qingru glanced at the uric acid indicator and replied.
“Teacher, obviously, the patient’s uric acid is only 390umol/L, and it can’t reach the 420umol/L boundary. Obviously it is not hyperuricemia, so obviously it is not “gout.” ”
“Are you sure?” Lin Feng smiled.
“I’m sure!” Chen Qingru still remembered this clearly, after all, it was something in the textbook.
Lin Feng laughed and said, “Then I will tell you the answer… You got the wrong answer… Although the patient’s uric acid index did not reach 420, there is still a possibility of gout…”
“what?”
Chen Qingru was stunned.
“Teacher, what’s the matter?”
Lin Feng smiled: “There are some diseases, you can’t just follow the (aicd) indicator… or you need to analyze the specific problems in detail…”
Then,
Lin Feng started teaching:
“How did the dividing line of 420umol/L come from?!”
“It is the saturation concentration of uric acid in the body!”
“When the blood uric acid concentration exceeds 420, it is easy to precipitate uric acid crystals and deposit on the joints, causing pain. (It is tophi for years and months).”
Lin Feng first talked about its cause.
Then start the analysis:
“When the body temperature is lower than 37°C, the saturation of uric acid in the body will be reduced accordingly. Even if uric acid is less than 420umol/L, urate crystals will be precipitated and deposited in the joint tissues, and gout will occur…”
“It’s October, and the temperature last night was 5 degrees. The human body temperature will definitely decrease, which will reduce the saturation of uric acid and deposit uric acid crystals…” (Therefore, patients with gout should not catch colds)
“In addition, the patient climbed the Great Wall yesterday and exercised a lot, causing joint damage. Naturally, there will be inflammation and infection. Infection can cause tissue cell destruction and a drop in pH (severely metabolic acidosis, which was written near Chapter 219), which induces gout. The onset of…”
Chen Qingru nodded.
understood!
It turns out that there is still such a saying.
Sure enough, what the textbook teaches is still too basic.
Lin Feng called the nurse Xiao Ai at this time:
“Xiao Ai, draw him (patient Wang Qing) for a blood gas analysis…”
In blood gas analysis, there is an indicator, “Blood acidity and alkalinity”
Xiao Ai draws blood…
Put it in the analyzer…
Soon the result came out…
·Blood ph: 7.36……(less than 7.4)
Same as Lin Feng said!
·Comprehensive PH value + low temperature, it is probably deduced that the patient’s condition should be “gout + joint damage”!
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ps: In addition to the soup + seafood + beer + obesity mentioned above, high blood pressure is also a factor.
There is another factor: fructose.
The commercial beverages basically contain a lot of fructose,
Fructose is a carbohydrate that can increase blood uric acid levels, can promote uric acid synthesis and inhibit uric acid excretion (it causes problems with uric acid + excretion, twice the side effects). Therefore, a large amount of fructose-containing beverages can increase blood uric acid levels. high.
This is also a common cause of gout in many young people.
In the past, gout was a disease of older people.
In recent years, young people have started to post more, obviously because of the problem of drinks.
(What is fructose? It is a monosaccharide, an isomer of glucose, and its molecular formula is C6H12O6.)
Therefore, drinking water is healthier than drinking beverages.
ps2: Chapter picture: photos of tophi (choose one that is not so disgusting).
ps3: The update is complete…
. .