What
is the cold knowledge about the human body?
There is a gynecological disease with strange causes, but it is also a multiple gynecological disease, which plagues nearly 190 million women worldwide.
Let’s talk about a case. I was on duty in the emergency room
that night, and a couple came. The girl was 26 years old, and she was a doctor (I forgot to ask about her major).
The girl is a patient, accompanied by her boyfriend.
The patient told me that he coughed up blood after dinner, and his tissues were covered with blood. He thought he was dying and was very afraid.
Call her boyfriend to send her to the emergency room.
I took her blood pressure, which was basically normal, and her heart rate was not too fast, which comforted her.
She was incoherent, her lips were trembling, she was really nervous, and she kept asking me what was wrong and what was wrong.
I motioned to her not to worry. Now her vital signs are stable in all aspects. Let me know the situation first.
She told me that she had a cough more than three months ago, but it would be better if she coughed for a few days or took some medicine. This
is the worst tonight. After eating, I kept coughing. Suddenly, there was a smell of blood in my throat. Then I coughed up a mouthful of blood. Then there was a second and third mouthful. The paper towel used to wipe my mouth was full of blood.
Just to be safe, I told her to stay in the emergency room. There are all kinds of patients in
the emergency room, but they are all very serious. She can walk and move. She seems to be the mildest one in the emergency room.
But I’m not sure. I’m worried that the next second she will have another big hemoptysis or hematemesis, which will be troublesome.
She could be a time bomb. After
setting her up, I had to find out whether she was coughing up blood or vomiting blood.
If the blood is coughed up from the respiratory tract, such as the lungs, trachea and bronchus, it is called hemoptysis.
If the blood is vomited from the digestive tract, such as esophagus, stomach, duodenum, etc., it is called hematemesis.
I tell them, it’s not the same.
I must have hemoptysis.
“She said to me,” I coughed violently at first, and then I felt that I coughed up phlegm. I didn’t expect to see blood. I almost fainted at that time.
Are you sure there is no food residue in the blood you vomit?
I have repeatedly confirmed.
No.
If the blood coughed up does not contain food residues, it can basically be ruled out as hematemesis.
After all, the patient has just finished dinner, and if it is really hematemesis in the digestive tract, it will certainly be accompanied by food residue vomiting.
I also quickly confirmed the fact that she had no chronic abdominal pain, abdominal distension, acid reflux, belching and other symptoms in the past.
That means that she probably doesn’t have gastric ulcer, duodenal ulcer and other problems, so it seems that she really doesn’t vomit blood.
Then it’s really hemoptysis.
Blood is coming out of the respiratory tract.
I said you were lucky. It was just a small amount of blood.
The day before yesterday, a patient had hemoptysis and coughed up a washbasin, which was too late to rescue and suffocated.
I say this to let her know that this hemoptysis may be very dangerous and can not be underestimated.
But unexpectedly, this sentence was a bit too fierce, and her face changed greatly, her lips trembled even more, and she was frightened.
I hastened to say, your hemoptysis is very small, the problem is not serious, don’t worry.
I asked the nurse to open the venous channel for her. To put it more popularly, it is the kind of infusion that can be given at any time after an injection.
If she really has a big hemoptysis, we have no time to give her an injection. We must do it in advance in case of emergency. At the same time, we can draw blood for testing.
I gave her a careful auscultation of her heart and lungs, and I didn’t find much abnormality.
She stabilized a little and asked me what the problem might be.
I told her that the most common causes of hemoptysis are tuberculosis, lung cancer and bronchiectasis.
In addition, common pneumonia may also be hemoptysis, basically lung problems, but heart and some vascular diseases will also have hemoptysis. The cause of the disease is not clear in the
short term, so we have to check it.
Her boyfriend said that everything should be checked.
I asked Dr. Gui Pei to push her to do a chest CT to see the condition of her lungs.
At the same time, she told her boyfriend that if the patient had massive hemoptysis, he must pay attention to protecting the respiratory tract and not let her suffocate.
I can’t get away by myself, and there are emergency patients coming in one after another.
After a while, they came back from the CT.
Fortunately, everything went smoothly, and the film and report were immediately obtained.
Chest CT showed a slight ground-glass opacity in the left upper lung, which did not appear to be severe.
But the nature is unknown, it is not easy to say what it is, it may be pneumonia, it may be tuberculosis, it may be lung cancer.
Are there so many possibilities?
Her boyfriend didn’t seem satisfied with what I told him. I have seen
this situation a lot, many patients and their families think that we can determine the condition as soon as we come up, at most one or two examinations will give an accurate answer.
Yes, most patients can do it because the condition is simple.
But in front of this female patient, not simple, CT report is ambiguous, I do not have much information, dare not draw a conclusion.
At this time, the blood test results also came back, the white blood cell count was a little higher, the rest were not abnormal, liver and kidney function, electrolytes and so on were normal.
I suggest that we should be hospitalized in the Department of Respiratory Medicine. We can consider doing an enhanced CT tomorrow to see more clearly, and even do a fiberoptic bronchoscopy.
Of course, it may also be common pneumonia, which may be cured with antibiotics for a few days, and there will be no hemoptysis.
Generally speaking, pneumonia does not cause hemoptysis, but if the pneumonia happens to affect the blood vessels, causing the blood vessels to be destroyed, it is not surprising that hemoptysis is possible.
Can I go home?
I feel much better.
The patient asked me.
That won’t do.
Hemoptysis can be large or small, so you can’t take risks.
I turned her down flat. She was scared to death
just now. Why did she want to go home this time.
Her boyfriend was more cautious and agreed to my suggestion to be hospitalized.
I gave her something to stop the bleeding, and I had the respiratory physician come down and see the patient.
He also said that the cause of hemoptysis was unknown and further hospitalization was needed.
Let’s do it, stay in the hospital.
I exhorted.
Later, I learned that the patient had hemoptysis again after he went to the respiratory medicine department.
And the amount of hemoptysis is not small, startled the doctor on duty, all kinds of hemostatic drugs together, it is not easy to stop hemoptysis.
The next day, the patient was given a chest CT enhanced scan to further understand whether there was lung cancer or not.
Our doctor has not yet determined the cause of the disease, but the patient and her boyfriend have been frightened.
They believe that the possibility of lung cancer is very high, although the patient is so young, but there are two daunting points: first, the patient’s aunt died of lung cancer; second, the patient has moved into a newly decorated house in the past two months, and she thinks there is too much formaldehyde.
Because the chest CT done last night was a plain scan, the tumor was not clear, so the enhanced scan was done again, and the contrast medium was injected.
Last night, I wanted to give the patient a direct CT enhancement, but it was not easy for the imaging department to do an enhanced scan at night.
One is a shortage of staff to give the patient a special injection for imaging, and the other is that the enhanced scan will take a little longer, which may be a potential threat to the patient.
Enhanced CT came back. It doesn’t look like lung cancer. High risk of
pneumonia or tuberculosis.
So the respiratory physician gave the patient a round of examination about tuberculosis, including PPD test, tuberculosis antibody, T-SPOT test, and multiple sputum tests for acid-fast bacilli, but the results were all negative.
This shows that the patient is basically impossible to be tuberculosis.
Generally speaking, typical tuberculosis can be diagnosed by imaging, but there are always atypical cases. The lung manifestations of this
female patient are not very typical, so no one dares to say that it must be tuberculosis. It turned
out that she really might not have tuberculosis.
In addition, her whole person is still fat, not often low fever, fatigue that kind of performance, nor like a typical tuberculosis patient.
Typical tuberculosis patients are thin and weak, just like Lin Daiyu.
Since it’s not lung cancer or tuberculosis, it’s a common pneumonia.
In fact, respiratory physicians have been treating pneumonia with antibiotics from the beginning to the end. It
‘s been like this for almost a week, and the situation is almost better.
The patient stopped coughing and hemoptysis.
Their director was not at ease, and reviewed a CT, and found that the lung lesions were significantly reduced.
That’s right.
This confirms once again that the patient is just a common bacterial pneumonia, not lung cancer, not bronchiectasis, not tuberculosis or other difficult and complicated diseases.
If it is lung cancer or tuberculosis, it is impossible for you to get better with antibiotics for a week, and even lung cancer will grow unscrupulously.
In addition, the chest CT of bronchiectasis is very typical, and it is not like it at all now. When
the patient heard that it was pneumonia, he was very happy and finally did not have to worry about it.
One hundred years ago, when there were no antibiotics, people could die from pneumonia.
But now, the vast majority of pneumonia can be handled easily.
The patient was eventually discharged.
However, before long, the accident appeared.
After almost a month, I had forgotten about the patient.
Soon I finished my rotation in the emergency department and went back to the ICU ward to continue moving bricks. I was on night duty
that night. The Department of
Respiratory Medicine called us and said that there was a patient with massive hemoptysis who was going into shock and was ready to be transferred to us for monitoring and treatment. Is there a bed.
When there was an empty bed, I asked the nurse to prepare to receive the patient and rushed to the respiratory medicine department without stopping.
The road has been thinking, such a serious hemoptysis, if more than live blood, put us here is just waiting for death ah.
Maybe we have to find a second-line doctor and ask her to come and help. Maybe we need to stop bleeding under fiberoptic bronchoscopy, so we need to intubate the trachea immediately.
To the respiratory medicine department, the scene was a mess. There was a pool of blood on the
patient’s bed, quilt and floor, and it was obvious that he had just had a big hemoptysis.
The patient’s breathing is a little bit fast, and the blood pressure on the ECG monitor is OK, high, the heart rate is fast, and the oxygen saturation is 98%, which is under the premise of oxygen inhalation with nasal cannula.
At first glance, it seems to be OK, better than I expected.
The lips are a little pale, the complexion is OK, hey, I am surprised to find that this is not last month, I saw the female doctor of hemoptysis in the emergency department. Didn’t you say it was cured
at that time? Why did you come back?
And it’s obviously much heavier than last time. The doctor on duty in the
respiratory medicine department told me that the patient’s last discharge diagnosis was pneumonia, but he had hemoptysis again at home tonight. After the
emergency doctor finished the chest CT, she was sent to the respiratory medicine department.
Just after the bed, the patient coughed violently, and then the floor and quilt were covered with blood. The patient coughed several mouthfuls of blood and almost gushed out.
It’s too scary. The second-line teacher of
respiratory medicine also came back and directed the rescue. In
this case, there are three key points.
First, stop the bleeding immediately, whether with drugs or fiberoptic bronchoscopy, find the hemoptysis point and extinguish it, although this is very difficult.
Second, immediate blood transfusion and fluid infusion to resist shock and stabilize the patient’s blood pressure.
Third, and the most easily overlooked, is to ensure that the patient’s respiratory tract is unobstructed, do not let the patient choke on blood clots, once suffocated, it is over.
The second-line teacher’s words are reasonable, and I deeply agree with them.
But it’s easier said than done, so we can only do our best.
The patient’s boyfriend was also there, panicking and urging him to go to ICU.
Last time we thought it was pneumonia, but now it seems that it may not be as simple as pneumonia. How can there be pneumonia with hemoptysis one after another?
No, I’ve been a doctor for 30 years, and I’ve never had this kind of pneumonia.
The second-tier teacher told us.
Therefore, the patient should still have hidden problems and no cause has been found.
I called the patient’s boyfriend out and communicated with him about the ICU.
I am very cautious, saying that I know it is hemoptysis at present, but the cause is still unknown, and ICU is an extra layer of protection.
We will also try our best to cure her and stop bleeding, but we can not guarantee that we will succeed, we can only say that we will go all out.
He didn’t recognize me. I was wearing a mask and a hat.
I don’t care.
“He said,” It’s your problem to save the patient. Last time you said it was pneumonia, and now you say it’s not. I don’t understand.
Now my wife’s life (actually not married, the patient is unmarried according to the medical record) is in your hands, and you must help me.
He is contradictory. He is both angry and helpless. He wants to blame us, but he has to ask us. After a
quick exchange of fees and other considerations, I consulted my superior physician and prepared to take the patient to the ICU.
Unexpectedly, the patient herself began to flinch. She still had blood on the corners of her mouth. She said she dared not go to ICU. It was terrible.
I told her bluntly that if serious hemoptysis happened again, it would be necessary to intubate the trachea and stop bleeding by fiberoptic bronchoscopy.
Only if you can do it in ICU, there is a chance.
Otherwise, in the event of a sudden situation, it will be a dead end. The doctor
on duty added.
This sentence played a role, the patient no longer resisted, cooperated with us, and was sent to ICU.
The second-line doctor told me that the lesions seen on the chest CT were not close to the main airway.
If there is really local bleeding, it may be difficult to stop bleeding under the mirror (fiberoptic bronchoscope).
I also saw the CT film, and it was really difficult.
Although it is difficult, if there is no other way, or if you are forced, you should try when you should try.
There is a consensus. After
arriving at ICU, he continued to use hemostatic drugs, and pituitrin was also used.
Pituitrin is a drug that reduces blood flow to the blood vessels in the lungs, thereby reducing bleeding.
I told the patient’s boyfriend that you are not a direct relative, nor a real husband and wife, it is better to find the patient’s parents or siblings, so that the signature will be better.
He told me that the patient’s family members were all in other provinces, and it was at least tomorrow before they came. He could decide what rescue measures needed to be taken now.
Her boyfriend said that if it hadn’t been for this, they would have planned to get married.
I consulted the superior doctor and the medical department. In that case, the patient’s boyfriend signed it temporarily.
When the immediate family members arrive, they will sign again. Continue with whatever diagnosis and treatment you
should do, and don’t delay.
The medical department said.
I told the patient’s boyfriend that the most critical issue now is to stop bleeding. If you can stop bleeding, your life will not be in danger.
The patient’s boyfriend is very anxious and restless at the moment, and I can understand him.
I told him it would take some time to determine the cause.
And told him that the last time I saw a female patient in the emergency department, it was also me.
I took off my mask.
He was stunned for a moment and finally recognized me.
I told him that the patient’s condition was somewhat complicated and we were trying to find out. The most important thing
tonight is to stop the bleeding as soon as possible.
If the patient has another massive hemoptysis, if she can’t cough out in time, it is likely to cause blood clots to block the respiratory tract and cause asphyxia, which will be life-threatening.
The patient’s boyfriend anxiously asked us what we should do now.
I said that two or three kinds of hemostatic drugs had been used, and at the same time, we began to give her blood transfusion and infusion. If we still can’t stop the bleeding, and there are still repeated hemoptysis, especially massive hemoptysis, we will give her a tracheal intubation. Take her down
with a sedative, and then insert a finger-thick tube from her mouth to the trachea.
Then we go down with a fiberoptic bronchoscope to see where the bleeding is and find a way to extinguish it.
At the same time, protect the side of the lung that is not bleeding, do not let the blood flow back in, so as not to cause asphyxia.
The patient’s boyfriend nodded vaguely and asked me, “Are you going to do this right away?”? You can
still wait and observe.
After all, tracheal intubation and fiberoptic bronchoscopy are also risky and may aggravate bleeding.
If she can stop the bleeding on her own, that’s for the best. Don’t take any chances.
I said. After signing all the informed consent forms
for him, I went back to the ward and stayed at the patient’s bed.
The patient looked flustered and asked me when I could get out of the ICU. I can’t stand a day
here. It’s too depressing.
She looked around and breathed a little.
Yes, ICU patients are very critical. Almost all patients are intubated and then ventilated.
There are blood purification machines, all kinds of machines are running, there are constantly sharp alarm sounds, doctors and nurses hurried voices and footsteps, for a young patient who is still conscious, here is really purgatory.
I comforted her and said that after two days of observation, if there was no bleeding, we would go back to the respiratory medicine department, and your boyfriend could accompany you. A young nurse
next to me asked me what pituitrin was and why it was given to this patient.
I said that pulmonary hemorrhage can be used. This medicine can contract some blood vessels and reduce the amount of blood flowing into the lungs, thus reducing hemoptysis and achieving the purpose of hemostasis.
I thought this medicine could only be used for obstetrics and gynecology patients. When I was practicing in obstetrics, I saw many patients with postpartum hemorrhage using this medicine. It turns out that pulmonary hemorrhage can also be used.
She said. The
patient menstruates now, can you use this medicine to bring about menstruation disorder, can menstruation not come?
She continued to ask me.
Well, it’s a little sister who loves to ask questions. She knocked me down.
Neither can I. I shook my head in embarrassment. The overlapping knowledge
of obstetrics and gynecology and endocrinology is more complicated, and I have only a smattering of knowledge.
The hemostatic drug was used up, and 2u of red blood cells and 400ml of plasma were transfused continuously. The patient’s condition seemed to be more stable, and there was no more hemoptysis.
The blood routine examination showed that the hemoglobin had returned to 98 G & # x2F; L, which was almost the patient’s usual level, because she was slightly anemic.
Blood pressure is normal, and the heart rate is not so fast.
Before, the fast heart rate was estimated to be related to bleeding and tension. Now, after settling down, everyone is a little relaxed. After
walking around the patients, I’m going to have a rest, and my eyelids can’t stand it.
But I can’t sleep. This female patient with hemoptysis is a time bomb here. Although she doesn’t have hemoptysis now, none of us knows when the next hemoptysis will be and what kind of hemoptysis will be. This unknown feeling is really bad.
The second-tier doctor called and asked how the patient was.
I hastened to report the situation, but also expressed his concern, whether to be positive, directly to her tracheal intubation to do fiberoptic bronchoscopy to see.
The second-tier doctor told me to calm down and not be reckless.
The patient is still so sober, from the film, it is estimated that the lesion is not too big, can be observed again.
If possible, we can discuss it tomorrow.
That’s the only way.
Before long, the nurse rushed in and called me, saying that the patient was menstruating.
I know. Didn’t I know just now.
“I said,” I want to squint more and rest for a while.
You put two more clean dressings on her. They work better than sanitary napkins.
No, she said sanitary napkins.
The nurse told me firmly.
I tried to call her boyfriend, but the phone was turned off and no one answered. I couldn’t find anyone to send sanitary napkins. What should I do.
I couldn’t sleep either, so I just got up. Can
you do something about it?
For example, you girls, who have stock, give her one or two tablets.
The nurse gave me a white look and said that if we had the goods, we wouldn’t have to come to you.
I know the girls are very kind, and they are very distressed to see this young girl sick. Everyone wants to help her, and she will try her best to meet her any request.
We are all girls about the same age, so it is enough to help her find sanitary napkins.
In that case, let her make do with wound dressings. The raw materials of sanitary napkins are those wound dressings, which should be similar.
I’m going to convince her myself. Where to find her a sanitary napkin in the middle of
the night.
The only hope is that her boyfriend won’t answer the phone, so what can he do.
As a result, the patient told me that her boyfriend should be at the door.
It’s so late. I asked him to go back to rest. I guess his cell phone was out of power, so I didn’t get a call.
I said.
She still insisted that I go to the door and if her boyfriend was outside, she asked him to go back and bring some sanitary napkins.
I couldn’t do anything about her, and I didn’t want her to get too excited. If her blood pressure soared and she bled, it would be bad, so I promised her to go outside and have a look.
When I looked outside, I was really surprised.
Her boyfriend was really there, lying directly on the stool in the corridor, never leaving.
He was a little surprised to see me, and then nervous.
Not hemoptysis again?
He asked me.
I told him not to panic. It’s all right. I just want you to go home and get some sanitary napkins. Your girlfriend’s period is coming and the sanitary napkins are used up.
He breathed a sigh of relief and said, “That’s it, nothing else.”.
Also, you have to keep your cell phone open, and remember to charge it, in case something happens and you can’t be found.
I told him.
He scratched his head, a little embarrassed, and said that every time he was hospitalized, he asked me to go home and get sanitary napkins, which was also a coincidence.
Every time?
I wonder. The
last time I was in the hospital, I didn’t bring enough sanitary napkins, so I went out to buy them.
He said. Did you menstruate
last time?
I felt vaguely uneasy.
Yes. After
he left, I still stood where I was, my brain racing.
I think I found something. The
two hospitalizations were due to hemoptysis, and the two hospitalizations happened to be the menstrual period, so coincidentally?
When menstruation comes, it is vaginal bleeding, which is caused by the shedding of endometrium. What does it mean
if there’s also pulmonary bleeding? I was so
excited that I almost jumped.
This is endometriosis.
This is the disease of department of gynaecology, although rare, but not impossible. Endometriosis
refers to the endometrium that was originally only in the uterus, but now it may appear in other parts, most commonly in other organs of the pelvic cavity, and rarely in the gastrointestinal tract or respiratory tract, just like the patient in front of us.
If the gastrointestinal tract is ectopic, it will follow the menstrual cycle bleeding, abdominal pain, abdominal distension; if the lungs are ectopic, it will certainly follow the menstrual cycle with hemoptysis ah.
No matter be in which place, should be the film of the uterus only, menstrual cycle it can fall off of haemorrhage.
Isn’t this hemoptysis? Is it
really endometriosis?
I can’t believe it. I’ve never seen this before.
Everything is just theoretical knowledge.
Back in the ward, I felt more comfortable when I saw that the patient’s vital signs were stable.
If it’s really endometriosis, the bleeding will definitely end with the end of the menstrual cycle, and my little heart hanging in my throat is finally put down.
I wanted to call the second-line doctor and ask her to come and evaluate it, but when I thought it was not urgent, there was no need to bother her. The second-line doctor had been busy all day, and the bones were probably loose.
Just that wave of bleeding, like menstruation, but the location is not in the reproductive tract, but in the respiratory tract, this is really a bandit thought ah.
Although I think this possibility is very high, I will not tell the patients and their families for the time being. After reporting to the superior doctor tomorrow, I will ask the gynecologist to consult and confirm that it is this thing before communicating.
Soon, the patient’s boyfriend came over with a sanitary napkin.
The patient also got rid of a worry.
I even have a fantastic idea, will this serious endometrial bleeding, the ectopic tissue on the other side of the lung will not bleed?
I hope so.
Whether the guess is reasonable or not, the patient did not have any more hemoptysis in the second half of the night.
Everyone had a good night.
The next day I reported the situation to the superior doctor, especially when we heard that the two hemoptysis occurred in the menstrual cycle, we were amazed, saying that nine times out of ten it was endometriosis.
But no one dares to be careless, and we still have to be ready to rescue massive hemoptysis at any time.
We found respiratory physicians and gynecologists, and carefully compared the chest CT films of patients before and after several times, all of which were lesions in almost the same location.
Ground-glass shadow, enhanced chest CT scan ruled out lung cancer and bronchiectasis, and other examinations ruled out pulmonary tuberculosis and lung lesions caused by some autoimmune diseases.
The gynecologist said that judging from the patient’s hemoptysis process, it is indeed in line with endometriosis.
I asked the patient carefully, and the patient carefully recalled that the two hemoptysis were indeed in the menstrual cycle, but the patient himself did not realize that the hemoptysis was related to menstruation, so he did not deliberately tell the doctor.
Respiratory physicians were somewhat annoyed, saying that when they were hospitalized for the first time, the medical history was not detailed enough, and they did not ask about the patient’s menstruation, so that they missed it.
Everyone comforted him, saying that this was a very rare situation. Common endometriosis was ectopic to the ovaries, uterosacral ligaments, pelvic cavity, and other places. It was the first time for everyone to see ectopic to the lungs.
Even if asked about menstruation, it is estimated that there will be no way to connect them for a while. It is very simple
to diagnose endometriosis. In a few days, when the patient’s menstruation is clean, let’s pull it out and do a chest CT to compare it. If the lesion disappears, it will be a stone hammer.
This lesion is not an ordinary inflammation. You have no effect on antibiotics. It disappears by itself. It falls off and is discharged in the form of hemoptysis.
The gynecologist’s words are very reasonable, and everyone agrees.
Remembering the scene of massive hemoptysis last night, the respiratory physician and I still have lingering palpitations.
In fact, when the patient was hospitalized for the first time, he thought it was bacterial pneumonia and used antibiotics. Later, the symptoms improved, and the chest CT lesions improved significantly. At that time, he thought it was pneumonia. Looking back
now, it may also be the situation mentioned by the gynecologist, that is, the menstruation is clean, the focus naturally disappears, and it has nothing to do with our medicine.
Before the nurse reminded me that the patient was menstruating, because I had no relevant experience, I never thought that the patient’s hemoptysis might be related to menstruation. If I
had a similar experience, I would not be foolish enough to talk to nurses about the efficacy of pituitrin.
This is really an eye-opener.
After careful evaluation and the patient’s strong request, we moved the patient out on the same day and returned to the respiratory medicine ward.
I thought it would be more appropriate to go to the gynecology department, but in case the patient still has hemoptysis, the gynecologist may not be able to cope with it, which is not their strong point, so it is more appropriate to go back to the respiratory medicine department.
Gynecologists told patients and their families that this was hemoptysis caused by endometriosis.
Patients and their families could not believe it until they went online and learned that there was such a disease, they believed the gynecologist’s words. After the end
of menstruation, a review of chest CT showed that the lesions almost disappeared.
Get to the bottom of it.
So how to deal with it?
Can’t you vomit blood as soon as menstruation comes?
The patient frowned and asked the gynecologist.
There are two ways, one is to do surgery, open the chest, and cut off all the endometrial tissue in the lungs.
But it may not be clean, and there may be bleeding after the operation. I won’t consider
opening my chest. It’s too scary.
The patient said.
The 2nd method takes prophylactic namely, do not let menstruation come OK.
Birth control pills include estrogen and progesterone in them, and menstruation will not come during the medication, so there will be no bleeding.
This method works very well.
Then I can’t use contraception all the time. I’m already planning to get married and have a baby.
The patient was distressed.
Gynecologist smiled, said not always eat, is to eat a year or so, when the time comes can stop, stop may not bleed again, if the time also bleeding, may have to change other drugs, or consider surgery. When
I went to the respiratory ward to see the patient, she had stopped hemoptysis and began to take contraceptives. Before I
left, I told her boyfriend that thanks to you, you saved your wife.
In fact, what I mean is that he let me know that the patient’s two hospitalizations were related to menstruation, but he probably thought I was talking about his meticulous care for her, saying that he should take care of his wife, and the rest depends on you.
I wasn’t going to tell him. It was because of his inadvertent reminder that we made the correct diagnosis.
Otherwise, it seems that we have no level. Haha, in fact, we really have no experience in this disease.
Later, I heard the gynecologist say that the patient had no hemoptysis in the first month after using contraceptives, and no hemoptysis in the second month, which lasted for a year. There was still no hemoptysis one year after
stopping the drug.
And then she had a baby.
Up to now, almost 3 years, I heard that the patient still did not have hemoptysis in the menstrual cycle.
It seems that birth control pills really starve the endometrial tissue in the lungs.
Bless her.
Popular Science Class: What is Endometriosis? What disease
is endometriosis?
What are the typical symptoms? Endometriosis
is a gynecological disease, only women will have, men will certainly not have (this is still to be emphasized).
Because as the name implies, this disease is the position of the endometrium has changed, normally speaking, only the uterus will have endometrium, if other organs also have endometrium, that is endometriosis.
Why does endometriosis occur?
At present, it is not very clear, some people think that it is related to menstrual blood reflux, others think that it may be related to some gynecological operations that cause endometrium to enter the incision by mistake and cause implantation.
Anyway, I don’t understand the reason.
Because many organs have the possibility of endometriosis, the symptoms caused by different organs are different. Generally speaking, there will be lower abdominal pain, dysmenorrhea, abnormal menstruation and other possibilities. If the rectum and uterus are depressed, it will lead to discomfort during sexual intercourse, and even infertility.
Intestinal ectopia will have abdominal pain, abdominal distension, diarrhea and constipation; urinary tract ectopia will have frequent urination and urgent urination.
Like the patient in our article, if the respiratory tract is ectopic, there will be cough, hemoptysis and so on.
How to check endometriosis? How
to treat it?
Examination is mainly ultrasound examination, ultrasound examination can see ovarian ectopic cysts and bladder, rectum and other parts of the ectopic situation.
Laparoscopy is internationally recognized as the best diagnostic method. If the lesion can be seen by laparoscopy, biopsy can be performed immediately.
In addition, blood tests can be taken, and serum CA125 levels may be elevated in endometriosis (elevated does not necessarily mean endometriosis). The
treatment of endometriosis is more complex, which must be carried out under the guidance of gynecologists. Medical treatment or surgical treatment
can be chosen.
Drugs mainly inhibit ovarian function and prevent the development of endometriosis.
For example, non-steroidal anti-inflammatory drugs, oral contraceptives, progesterone and so on.
Surgery is mainly to remove the lesion, which is suitable for the situation that the effect of drug treatment is not good.
At present, laparoscopic diagnosis, surgery and drug treatment are considered to be the gold standard. Can endometriosis
affect fertility?
It’s possible. Studies show that about 40% of patients become infertile.
Patients with endometriosis, if they are infertile, should be the first choice for surgery.
. Focus on not getting lost ~
