Case Analysis!! Pathophysiology!! Female 53 year old farmer Diagnosis mechanism of sudden disease! 1

The diagnosis is right.

Hepatitis B or hepatitis C virus infects the liver for a long time, and if it is not timely, it will lead to the destruction of liver tissue, gradual hardening, blocking the portal vein access pathway, causing blood stasis, ascites and splenomegaly.

There should be a compensatory response, i.e., a compensatory increase in heart rate.

The normal heart rate ranged from 60 to 100 minutes, and the patient's heart rate was 130 minutes, which was significantly higher than the normal range, indicating that the patient's heart rate was compensated.

Since cardiac output = stroke volume heart rate, within a certain range, under the condition that the stroke volume remains unchanged, the increase of heart rate can increase cardiac output, and can promote coronary blood perfusion by increasing diastolic blood pressure, and to a certain extent, the body can achieve self-protection.

Diagnosis: acute glomerulonephritis; Basis for diagnosis: 1. Upper respiratory tract infection more than 1 to 4 weeks before the onset of the disease.

History of tonsillitis infection; 2. Edema; 3. Oliguria and hematuria; 5. In severe cases, acute renal failure may occur. 6. Laboratory examination: urine routine to red blood cells.

predominantly, there may be mild or moderate protein or granular casts; Blood urea nitrogen may be temporarily elevated during oliguria; Esr.

increased in the acute phase; Elevated serum creatinine.

**：1.Bed rest is usually required for 2 to 3 weeks in the acute phase, and indoor activity can be gradually increased after gross hematuria disappears, blood pressure recovers, and edema decreases. For residual mild proteinuria.

and hematuria, follow-up observation should be strengthened without prolonging the period of bed rest, and if urine changes and weight gain, bed rest should be required again. It is advisable to avoid strenuous physical activity for 3 months. After 2 months, if there are no clinical symptoms and the urine is usually normal, you can start half-day schooling and gradually participate in full-time study.

2.Diet and intake In order to prevent further retention of water and sodium and the severity of circulatory overload, it is necessary to reduce the burden on the kidneys, and limit salt, water, and protein intake in the acute stage. For those with edema, high blood pressure.

Use a salt-free or low-salt diet. Patients with severe edema and oligouria have water restriction. Limit protein intake in people with azotemia.

The use of high-quality protein in the short term in children can be calculated. Be careful to provide calories with sugars, etc. 3.

Penicillin should be given to patients who still have pharynx,** foci of infection.

or other allergies **7 to 10 days. 4.Application of diuretics The main pathophysiological changes in acute nephritis are water and sodium retention and expansion of extracellular effluent, so the application of diuretics not only achieves diuretic and swelling reduction, but also helps to prevent and treat complications.

Diuretics should be given to those who have low urine, edema, and high blood pressure despite water and salt control. When thiazides are ineffective, strong loop diuretics such as furosemide and diuretic acid may be used. Mercury diuretics are generally contraindicated.

5.Use of antihypertensive drugs Antihypertensive drugs should be given to patients whose blood pressure remains high after rest, water and salt restriction, and diuresis. 6.

Other** Adrenocorticosteroids are generally not used. Severe oliguria or anuria, high circulating congestion, acute glomerulonephritis blood state and uncontrolled hypertension that are ineffective in internal medicine.

Dialysis is available**.

Consider systemic lupus erythematosus a high possibility!

Diagnosis is based on facial erythema, multi-joint swelling and pain, bilateral elbow, wrist, and knee involvement, with the right side evident. In the course of the disease, there is hair loss, mild concave edema of both lower limbs, and swelling of both knee joints; Complete blood count:

PLT80*1 min HB110G L, urinalysis, proteinuria (++ana(+)1:1000, anti-DS-DNA(-)1:10, anti-SSA(+)

**Medications: 1Cyclophosphamide. , intravenously or orally, or 200 mg every other day2

Anti-lymphocyte globulin (ALG) or anti-thymocyte globulin (ATG) 20-30 mg kg d, diluted in 250 500 ml of normal saline, slowly intravenous infusion, for 5 to 7 days.

3.Levamisole enhances a lower-than-normal immune response and may be helpful in patients with SLE who are co-infected. The dosage is 50 mg daily for three days with 11 days of rest. It is a decrease in gastric sodium and a decrease in white blood cells.

Well, in fact, I have almost forgotten the terminology of the pathophysiological process, and I habitually use diagnostic terms, I don't know if it is useful to you, how much should I say, and then organize it myself.

Diagnosis was: intestinal obstruction, shock, dehydration; hypokalemia, metabolic alkalosis, paradoxical aciduria;

The whole process is as follows: the child will have abdominal pain and vomiting due to intestinal obstruction;

The change of intestinal obstruction is the increase of intestinal endocrine into the intestinal lumen, a large amount of exudation from the intestinal lumen, accompanied by frequent vomiting, and the course of the disease has been 3 days, indicating that excessive fluid loss will occur, and dehydration and blood volume will decrease;

Dehydration will cause dehydration, lack of energy, and drowsiness;

In order to maintain cardiac output, the heart rate is compensated for an increase (120), systolic blood pressure is normal or high, diastolic blood pressure is increased, and pulse pressure difference (28) is reduced, which is the early manifestation of shock;

Normal blood potassium concentration is, the main place of potassium absorption is the intestine, intestinal lumen exudation, at the same time potassium ions will also seep into the intestinal lumen, so there will be a decrease in blood potassium (a certain concentration of blood potassium can dilate blood vessels, and can maintain muscle cell membrane excitability, low potassium can cause skeletal muscle cell membrane super, so there will be muscle weakness and intestinal paralysis, intestinal paralysis will have abdominal distention, which is a kind of dynamic intestinal obstruction;

On the one hand, the H-K pump is activated, and more intracellular potassium ions are transported to the extracellular fluid, and on the other hand, due to the increase in intracellular hydrogen ion concentration (acidosis), the secretion of hydrogen ions by renal tubular epithelial cells increases, K-Na exchange is weakened, H-Na exchange is enhanced, and renal potassium excretion is reduced. The excretion of hydrogen ions increases, so there will be abnormal acidic urine, and the urine pH is;

After surgery, due to fasting, gastrointestinal decompression, potassium ion intake is reduced, gastrointestinal decompression will drain out part of the digestive juice, but also cause the child's water loss and water, electricity, acid-base balance disorder, postoperative heart rate is high, part of it is stress, the other part is due to the loss of body fluids, if the fluid is insufficient and unscientific, it will aggravate the disorder of body fluid balance.

It's so professional.

It is recommended to consult a doctor with an acquaintance in another hospital.