Chapter 1818: with translation of chapter title

1755 Factitious hypoglycemia? (Alliance Leader Avera extra chapter 3)

Zheng Ren ignored Luan Yingjie, directly took the film from his hand.

The thin one is an upper gastrointestinal contrast film.

This examination used to be called upper gastrointestinal barium swallow many years ago, because the barium agent is hard to drink and viscous, making the examination not very effective; later they chose liquid pantopaque as the contrast agent.

The effect…… is just so-so, and not many diseases can be diagnosed with it. But in certain situations, this examination still has its use.

For example, now, Su Yun thinks that if an upper gastrointestinal contrast study shows a "bird beak sign" in the cardia segment, it can preliminarily diagnose cardia achalasia.

Zheng Ren pulled out the thin film and held it up to the light.

The esophagus was very smooth, with no image of a bird beak sign. Overall, the esophagus showed no cardia achalasia, nor diverticula or other conditions that could cause fainting after eating.

Zheng Ren and Su Yun both fell silent.

What disease is this? Eating causes dizziness, and the condition is progressing; now eating causes fainting.

They went to the hospital for examination, but nothing was found.

Really strange.

Could it really be a psychiatric disorder? That is, a relatively severe hysteria?

Zheng Ren did not want to diagnose it that way; any psychiatric diagnosis must be made with extreme caution, just like a tumor diagnosis.

Su Yun took out the PETCT films and quickly flipped through them.

No tumor, the old gentleman of the Luan family is in good health…… actually a complete mess.

Luan Yingjie saw Zheng Ren and Su Yun looking at the films, remained silent for a while, and gave a wry smile inside. Perhaps they also didn't know what the disease was; it's no wonder, after all they are too young.

Being young means steady hands, fast reaction speed, and good eyesight.

These are neither necessary nor sufficient conditions for a surgeon.

But being young also means having seen few patients and lacking rich experience. Experience is something that is honed over time.

Some geniuses, like Su Yun…… never mind thinking about that. The supposedly miraculous Zheng Lao Ban rumored in Pengcheng is nothing more than that.

But what about his own grandfather? He certainly wouldn't be sent to a psychiatric hospital for treatment, right? Luan Yingjie immediately began to worry.

"Boss, what do you think?" Su Yun asked Zheng Ren while Luan Yingjie was lost in thought.

"Eating causes dizziness; it might be a transient insulin secretion problem. However, the abdominal CT showed no issues, and the PETCT didn't reveal an insulinoma." Zheng Ren said, "But for now we cannot rule it out."

"Insulinoma or beta-cell hyperplasia causing excessive insulin secretion, leading to hypoglycemia, sounds somewhat like dizziness." Su Yun said, "As the condition progresses, it becomes more severe, to the point that fainting now occurs."

"Just a guess." Zheng Ren said, "Insulinoma often presents with the classic Whipple triad: hypoglycemic symptoms, fainting, and neuroglycopenic symptoms, which are prone to occur when fasting or after exertion."

"It only matches one or two points, so calling it an insulinoma is a stretch, and there's no sign on the images. Did you reconstruct it? I reconstructed it once and didn't see anything." Su Yun murmured softly while looking at the films.

Zheng Ren suddenly focused his gaze, looking toward Luan Yingjie.

With an honest expression and sharp eyes, Luan Yingjie startled a moment, then quickly smiled apologetically, saying: "Zheng Lao Ban, do you have any instructions?"

"Do you have insulin at home?" Zheng Ren suddenly asked.

"Insulin?" Luan Yingjie blinked.

"Factitious hypoglycemia?" Su Yun asked, "But is it necessary?"

"Elderly people want their children to come home to keep them company; what wouldn't they do? Sometimes elderly people with paranoid personality disorder are very likely to do such things." Zheng Ren said.

"Zheng Lao Ban, this..." Luan Yingjie expressed some dissatisfaction.

"Old Luan, you really shouldn't say that." Su Yun chuckled and said, "A few days ago…… Song Ying, do you know him?"

"Little Song, of course I know him. His business is huge, much stronger than mine." Luan Yingjie didn't know why he brought up Song Ying.

"Song Ying's brother, that Chu Huaian, has a problem and insists on having the boss perform the surgery."

Luan Yingjie's heart stirred; Chu Huaian and Song Ying are people he cannot hope to reach. Could it be that Zheng Lao Ban actually has genuine skill?

But his speculation sounds unreliable.

Although I really don't want to, a psychiatric diagnosis would still be better than blind guessing. Factitious hypoglycemia sounds especially unreliable……

"I went to see the patient; next to the special care ward there was an old man who spoke unpleasantly, saying something about his son and so on. Later, someone with intent organized his words, and upon investigation, they really found a problem."

"" Luan Yingjie was astonished; there really are fathers who scheme against their own sons?

Su Yun said it simply, something something, four characters containing countless speculations. People who do business, wandering in the gray zone, is also normal.

But usually it's business partners who screw you over, or sometimes a mistress. Being screwed over by one's own biological father is truly rare.

"Oh? There's also this? What happened then?" Zheng Ren asked.

"Afterwards the old gentleman was discharged from the hospital; I estimate he's now down on his luck." Su Yun said: "These things are hard to explain; supposedly they dragged in many big shots. Getting back to the point, factitious hypoglycemia could exist, Old Luan, say something."

"Um…… insulin, I've never seen it." Luan Yingjie quickly recalled, immediately denied, then said: "I'll ask the maid and search the whole house."

This attitude is very proper; Zheng Ren is fairly satisfied.

Factitious hypoglycemia, insulinoma—these are merely possibilities, but the likelihood is not high; even Zheng Ren cannot convince himself.

But encountering such a strange case, giving it a try can't hurt.

On the table, Lin Ge saw the two intently examining the films, smiled and said: "Zheng Lao Ban, you don't even rest while eating."

"Director Lin, they're always like that." Chang Yue said: "Many times they just eat while looking at patients."

"It's just like the Emergency Department." Lao He felt somewhat moved.

They were talking about something, but Zheng Ren didn't notice at all; at this moment he was quickly searching his memory for cases, diagnoses, and differential diagnoses according to the patient's condition.

The first impression is that this fainting is closely related to gastrointestinal diseases, including hiatal hernia, esophageal stenosis, cardia achalasia, and esophageal cancer.

However, the imaging data ruled out all of the above possibilities, so there's no need to think further.

Next is a heart problem.

Atrioventricular conduction block is the most common electrophysiological problem, followed by sinoatrial node dysfunction, including sinus bradycardia, sinus arrest, and cardiac arrest.

But the patient's ECG, echocardiogram, and coronary CT also ruled out these diagnoses.

Just as Su Yun complained earlier, at 72 years old, the echocardiogram shows not even a trace of tricuspid regurgitation—this old man's health is truly excellent.

But where exactly is the problem?