The road to the rise of great doctors

Chapter 98 Ending the Nightmare
Liu Dong walked to the door of the ward, knocked on the door, and then walked in.

"Hello, who is the patient?"

He enters the room.Looking around, there were two people in the room. One was lying on the bed, a middle-aged woman, and the other sitting beside her was her husband.They were all wearing regular clothes, and the hospital gowns sent by the nurse were placed aside.

The two people were talking and laughing, with a very relaxed atmosphere. For a moment, Liu Dong was not sure whether the one lying on the bed was the patient.He just forgot to ask the nurse whether the new patient was male or female and what his name was.So, I asked directly.

Upon hearing the question, the middle-aged lady looked up and saw Liu Dong walking into the room. She quickly sat up and said, "I am in the hospital. My name is Wang Rong. I originally planned to change my hospital clothes later. I was busy in the morning." Yes, I'm a little tired, so I plan to lie down and rest before changing."

Liu Dong showed his standardized smile, with a sincere look on his face, nodded, and said: "Hello, Ms. Wang, my surname is Liu, and I am your bedside doctor. You can just call me Dr. Liu. I have some questions that I need to ask. You. After asking, if you have any questions, you can ask me."

The patient nodded in understanding.

"What is the main reason why you came to see a doctor?"

"The doctor at the outpatient clinic said it was hyperparathyroidism," the patient replied, then turned to her husband and said, "I'm right, I remember the doctor said that."

Without waiting for her husband's reply, Liu Dong continued, "Well, okay, this is the name of the disease to be considered for diagnosis. I also want to know why you feel uncomfortable and come to the hospital for treatment? Before you come, you Have you diagnosed this disease? Or have you seen it somewhere?"

"Well, before we came here, at the endocrinology department of our city hospital, the doctor suspected that it was this disease, so he asked us to come here with the examination materials."

"Then why did you feel uncomfortable and why did you go to your city hospital to see a doctor?"

"Well, I went to our city hospital for treatment because of recurring pain in both knee joints that never relieved, some constipation, and a lot of weight loss. It lasted about half a year. "

Liu Dong gradually asked about the patient's illness, as well as the past diagnosis and treatment process, and he quickly understood it clearly.

Wang Rong is 37 years old this year. She was hospitalized this time because of "hyperparathyroidism".

Hyperthyroidism is commonly encountered in clinical practice, but the incidence of hyperparathyroidism is much lower.Liu Dong was quite surprised to encounter such a disease this time.

Parathyroid glands are not the same organ as the thyroid gland.They are all very important endocrine glands in the human body. The main function of the parathyroid glands is to secrete parathyroid hormone, which is responsible for regulating the body's calcium and phosphorus metabolism.

A person usually has four parathyroid glands, each about the size of a soybean, distributed on the dorsal side of the left and right thyroid lobes.Of course, the location and number of minorities may vary.

If a person develops hyperparathyroidism, excessive amounts of parathyroid hormone will be secreted, causing abnormalities in the body's calcium and phosphorus metabolism.When this electrolyte abnormality occurs, corresponding disease manifestations will occur, such as bone pain, fractures, kidney or ureteral stones in many places throughout the body, and in rare cases, pancreatitis and gastrointestinal ulcers may occur.Hypercalcemia can lead to polyuria, thirst, constipation, anorexia, nausea, vomiting, muscle weakness and other physical discomforts.Under Liu Dong's careful questioning, Wang Rong gradually told her experiences in the past 10 years, which was a "history of misfortune."

In the past 10 years, she has had three fractures at different locations on and off, all of which have undergone surgeries. To this day, the steel plate from the last fracture has not been removed from her body.I also asked the doctor why she had more fractures at such a young age than an old woman.After examination, the doctor found that she had osteoporosis and suggested that she take some calcium tablets and get more sun.

In addition, in the past 10 years, every summer, I often found that I had kidney stones or ureteral stones. After some drug treatment, they were excreted by drinking water, but two or three times, they could not be excreted by themselves. , and was finally discharged through lithotripsy surgery.Therefore, she did not dare to take calcium tablets.

After "knee joint pain, weight loss and constipation" occurred this time, the orthopedics department considered that she might have rheumatoid arthritis and recommended that she go to the rheumatology department for treatment.

In the process of seeing a doctor in the rheumatology department, drug treatment is given first, but the effect after taking the drug is relatively poor.However, during the review and monitoring process, other problems were discovered: elevated blood calcium, reduced blood phosphorus, elevated parathyroid hormone, and the X-ray of the pelvis showed widespread osteoporosis—ilium, iliac, and There was generalized decalcification and cystic degeneration of the femur, and no urinary tract stones were found.Based on these, a qualitative diagnosis of "hyperparathyroidism" was considered.

We continued with the localization examination - parathyroid ultrasound examination of the neck. Sure enough, we saw a 3 cm × 2 cm solid slightly hypoechoic area at the position of the left lower pole parathyroid gland.Then a CT was done to verify the judgment again.

After Liu Dong sorted out the basis for diagnosis, he briefly summarized it and told Wang Rong.At the same time, he briefly described the principles and methods of treatment, and the arrangements after hospitalization, so that she knew what to expect.

The most difficult thing about this disease is to diagnose it. The symptoms are not very specific. You can verify it through examination after thinking about it. However, if you just "treat the head for a headache and the feet for a sore foot", it is easy to ignore it.

I don’t know whether parathyroid adenoma has occurred when I got those diseases in the past, but the diagnosis this time is clear and definite.And it can be expected that after treatment, the problem can basically be solved and this "nightmare misfortune" can be ended.

The preferred treatment for hyperparathyroidism caused by parathyroid adenoma is surgical removal of the diseased gland. About 90% are benign lesions of a single gland and rarely recur after surgical removal.However, some familial or hereditary hyperparathyroidism often manifests as lesions in multiple glands and may require multiple surgical treatments.A very small number of cases are pathologically diagnosed as parathyroid cancer. This is a malignant tumor that may recur or metastasize far after surgery and requires adjuvant radiotherapy and chemotherapy.

Of course, what is said above is clearly positioned.

In a few cases, the qualitative diagnosis is clear, but the location is not clear, or the physical condition is too poor to tolerate surgery, then the treatment plan is mainly to control hypercalcemia and reduce related complications through drugs.

Fortunately, after going round and round, the ending is not bad.

Complete the examination first to assess whether you can tolerate the surgery.

At the same time, the medicine adjusts blood calcium and blood phosphorus to normal ranges, and also controls other indicators to normal.

Once you are ready, you can schedule your surgery.

(End of this chapter)