Today is an extraordinary day, and the director decided to make rounds in person and listen to the doctors' case reports. As an intern, I had the privilege of participating with the director and experiencing this feast of medical knowledge.
At the beginning of the round, we first went to the ward of a patient with a stomach ulcer. The patient, Mr. Li, appeared a little anxious, and he eagerly asked the director questions about his condition.
"Director, my stomach ulcer has been cured for a while, but it always comes and goes, and it doesn't get better. What the hell is going on? Mr. Li looked sad.
The director smiled and comforted Mr. Li: "Don't worry, let's listen to what your doctor has to say first." ”
Xiao Zhang, the doctor in charge of Mr. Li, began to report the case: "Mr. Li, 45 years old, has a history of stomach ulcer for half a year, during which he has used a variety of drugs, but the effect is not good. A recent gastroscopy showed active bleeding from the ulcer surface. ”
After hearing this, the director nodded, and then suddenly asked Xiao Zhang: "Xiao Zhang, what do you think we should choose in terms of gastric mucosal protector to better promote the healing of Mr. Li's ulcer surface?" ”
Xiao Zhang thought for a while and replied, "I think you can try aluminum magnesium carbonate, which can not only neutralize stomach acid, but also protect the gastric mucosa." ”
The director smiled and shook his head: "Yes, aluminum magnesium carbonate is indeed a common choice, but do you know? Among the new gastric mucosal protectors, teprenone and rebamipide also have good effects. They increase blood flow to the gastric mucosa and promote the repair of the gastric mucosa. Especially for patients like Mr. Li who have active bleeding from the ulcer surface, the use of tepredone may be more helpful. ”
After hearing this, Xiao Zhang suddenly realized, and quickly nodded and wrote it down.
At this time, Mr. Li interjected again: "Director, I heard that there is a medicine called misoprostol, which can also treat stomach ulcers, can I use it?" ”
"Misoprostol does treat gastric ulcers, but it is mainly used for gastric ulcers caused by the use of non-steroidal anti-inflammatory drugs (NSAIDs)," the director patiently explained. Considering that you are not taking these medications, misoprostol is not the best option for you. ”
Hearing this, I couldn't help but admire the director's expertise. He not only knows the mechanism of action of each gastric mucosal protector inside out, but also makes the most appropriate choice for the specific situation of the patient.
The rounds continued, and we came to another patient's room. This is a patient with chronic gastritis and a relatively mild condition. Xiao Wang, the doctor in charge of the patient, began to report the case.
"This patient, 30 years old, had a history of chronic gastritis for one year and the main symptoms were stomach pain and hyperacidity. Some gastric mucosal protectors have been used before, but the effect is not very obvious. Xiao Wang said.
After listening to this, the director asked Xiao Wang: "Xiao Wang, how do you think we should choose gastric mucosal protector for this patient?" ”
Xiao Wang thought for a while and replied, "I think you can try colloidal pectin bismuth, which can not only relieve stomach pain, but also protect the gastric mucosa." ”
The director nodded and agreed: "Yes, colloidal pectin bismuth is a good choice." It is able to form a protective layer on the gastric mucosa to prevent the erosion of the gastric mucosa by gastric acid and pepsin. At the same time, it can also stimulate the secretion of mucus by the epithelial cells of the gastric mucosa, increasing the protective effect on the gastric mucosa. But, you know what? Are there any precautions to be taken when using colloidal pectin bismuth? ”
Xiao Wang thought for a while and replied, "I know that after taking colloidal pectin bismuth, the feces may turn black-brown, but this is a normal reaction, and it will return to normal after stopping the drug." ”
The director nodded with satisfaction: "Very good, you remember it very clearly." Indeed, this is a common reaction of colloidal pectin bismuth. However, it is also important to note that colloidal pectin bismuth should not be taken at the same time as milk and antacids, otherwise its efficacy will be affected. It is also contraindicated in patients with severe renal insufficiency and in pregnant women. ”
Hearing this, I couldn't help but have a deeper understanding of the use of gastric mucosal protectors. It turns out that each drug has its specific mechanism of action and precautions, and only when it is selected and used correctly can the best therapeutic effect be exerted.
After the rounds, I followed the director back to the office. I couldn't help but ask the director: "Director, your understanding of gastric mucosal protectors is really comprehensive. Can you give me a summary of the classification, mechanism of action, and correct use of these drugs? ”
The director smiled and patiently explained to me: "Of course you can." Gastric mucosal protectors are mainly divided into two categories: traditional gastric mucosal protectors and new gastric mucosal protectors. Traditional gastric mucosal protectors include bismuth agents (e.g., bismuth potassium citrate, colloidal pectin bismuth), prostaglandins and their derivatives (e.g., misoprostol), and aluminum-magnesium agents (e.g., aluminium magnesium carbonate, sucralfate). New gastric mucosal protectors include tepredone, L-glutamine guellenate sodium, rebamipide and isoladine.
The mechanism of action of these drugs varies. For example, bismuth can form a protective layer on the gastric mucosa to prevent the erosion of gastric acid and pepsin; Prostaglandins and their derivatives can inhibit gastric acid secretion and increase blood flow to the gastric mucosa; Magnesium aluminium neutralizes gastric acid while protecting the gastric mucosa from damage. The new gastric mucosal protector mainly plays a role by increasing the blood flow of the gastric mucosa, promoting the repair of the gastric mucosa and increasing the defense ability of the gastric mucosa.
There are also a few things to keep in mind when using these medications. For example, some medications should not be taken with milk and antacids; Some medicines may cause the stool to turn black or smell ammonia after taking it; Other drugs are contraindicated in certain populations (eg, pregnant women, people with severe renal insufficiency). Therefore, when choosing and using gastric mucosal protectors, it is important to consider them comprehensively according to the specific situation of the patient and the characteristics of the drug. ”
After listening to the director's explanation, I couldn't help but sigh at the breadth and profundity of medical knowledge. It turns out that there is so much knowledge and attention hidden behind the small gastric mucosal protector. This ward round experience has benefited me a lot, and it has also strengthened my determination to study medicine.
Summary:
Through today's ward rounds, I deeply felt the importance of gastric mucosal protectors in clinical treatment. Different drugs have different mechanisms of action and scope of application, and only the right selection and use can bring the best treatment effect to patients. At the same time, I also learned a lot of professional knowledge about gastric mucosal protectors, including the classification of drugs, mechanism of action, correct use methods, and precautions. This knowledge not only has important guiding significance for my future clinical work, but also gives me a deeper understanding of the complexity and diversity of medicine.