 | This article consists almost entirely of a plot summary .(April 2018) |
| "All In" | |
|---|---|
| House episode | |
| Episode no. | Season 2 Episode 17 |
| Directed by | Fred Gerber |
| Written by | David Foster |
| Original air date | April 11, 2006 |
| Guest appearances | |
| |
"All In" is the seventeenth episode of the second season of House , which premiered on Fox on April 11, 2006. [1]
During a field trip in a museum exhibit about the human body, six-year-old Ian Alston is found to have bloody diarrhea. Meanwhile, at a charity casino night at Princeton-Plainsboro, House, Wilson, and Cuddy are engaged in a game of Texas hold 'em poker when Cuddy receives the news about her new patient. She dismisses it as dehydration and gastroenteritis, but House, recognizing the symptoms and thinking this could be more than what she suggested, decides to drop out of the game (folding a pair of aces to Cuddy's bluff) and take the case behind her back.
With his suspicion, House tests Ian's coordination by asking him to reach out and grab his cane, which takes Ian multiple grasps until he actually touches the cane. House concludes Ian has ataxia and begins to assume Ian has the same disease as a former patient from twelve years ago, 73-year-old Esther Doyle, who died under House's care and was never correctly diagnosed. House then drags Cameron, Foreman, and Chase out of the party to perform a differential diagnosis. Drawing up a list of all of Esther's symptoms, House is able to predict what will happen to Ian next, as well as how long it will take him to get there.
House first suspects it is Erdheim–Chester disease and orders a colonoscopy, but tests are negative. House, knowing the next symptom that will develop is kidney damage, orders a kidney biopsy, which turns out to be negative. The rest of the team, annoyed, tell House that all Ian has is a stomachache due to some bad food. But after discovering Ian's urine catheter bag full of brown urine, they realize that Ian's kidneys are indeed failing and that they are already far too damaged to be saved. The team is forced to do another differential diagnosis, however many of the diseases proposed, House already tested for twelve years ago.
Next the team postulates it is lymphoma and tries more tests. To keep Cuddy busy and off the case, House calls Wilson and has him stall her in the poker game. However, tests are negative for lymphoma. Unable to determine what disease afflicts the two people, House orders immediate treatment to protect Ian's liver, which was the next symptom Esther developed. His plan succeeds and Ian does not develop liver damage, but instead skips the next two symptoms and goes into respiratory distress.
Thinking it could be cancer, House includes Wilson in the differential. Wilson suggests Kawasaki disease, but before the team begins tests, they discover a mass in his heart. Postulating that Ian, being younger than Esther, has a stronger immune system and can last longer while under assault from this unknown disease, House orders a heart biopsy on Ian. Wilson, recognizing House's ongoing grapple with Esther's case, warns him not to become obsessed, using Moby Dick as an allusion.
During the biopsy, as House collects the sample from Ian's heart, the catheter induces cardiac arrest in Ian, prompting an enraged Cuddy to pull House off the case and ban him and his team from performing any more tests on Ian. However, House refuses to give up, stating that they still have the mass obtained from the biopsy and can perform the tests on that.
The team suggests seven likely diseases but only has enough tumor mass to perform three tests. First the team tests for histiocytosis, but it is negative. Next they test for tuberous sclerosis but that is negative also. Desperate and with only one remaining test, House wanders the hospital trying to think of his next move, when he hears from Wilson that he won the poker tournament. Wilson won only because he had kept his hole cards, two aces, hidden the entire game, prompting House to have an epiphany. He realizes that the disease also remained a secret until the end because they biopsied the colon before the disease had reached the Gastrointestinal tract.
House then orders his team to perform the final test on the first disease suggested: Erdheim–Chester disease. In dismay, the team pleads, telling him they cannot waste their sample on a test for a disease they know he's negative for. House explains his reasoning about the disease not reaching the GI tract and orders the test anyway. The once-skeptical team is pleased when the test turns out positive, Ian is saved, and House finally discovers what killed Esther. The episode ends with House and Wilson playing poker and joking as they did in the beginning of the episode.
Nephrology is a specialty for both adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function and kidney disease, the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy. The word "renal" is an adjective meaning "relating to the kidneys", and its roots are French or late Latin. Whereas according to some opinions, "renal" and "nephro" should be replaced with "kidney" in scientific writings such as "kidney medicine" or "kidney replacement therapy", other experts have advocated preserving the use of renal and nephro as appropriate including in "nephrology" and "renal replacement therapy", respectively.
Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test. Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney. But not all red urine is hematuria. Other substances such as certain medications and foods can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation can help determine the underlying cause.
Assessment of kidney function occurs in different ways, using the presence of symptoms and signs, as well as measurements using urine tests, blood tests, and medical imaging.
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Malakoplakia is a rare inflammatory condition which makes its presence known as a papule, plaque or ulceration that usually affects the genitourinary tract. However, it may also be associated with other bodily organs. It was initially described in the early 20th century as soft yellowish plaques found on the mucosa of the urinary bladder. Microscopically it is characterized by the presence of foamy histiocytes with basophilic inclusions called Michaelis–Gutmann bodies.
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Bacteriuria is the presence of bacteria in urine. Bacteriuria accompanied by symptoms is a urinary tract infection while that without is known as asymptomatic bacteriuria. Diagnosis is by urinalysis or urine culture. Escherichia coli is the most common bacterium found. People without symptoms should generally not be tested for the condition. Differential diagnosis include contamination.
Cholesterol embolism occurs when cholesterol is released, usually from an atherosclerotic plaque, and travels as an embolus in the bloodstream to lodge causing an obstruction in blood vessels further away. Most commonly this causes skin symptoms, gangrene of the extremities and sometimes kidney failure; problems with other organs may arise, depending on the site at which the cholesterol crystals enter the bloodstream. When the kidneys are involved, the disease is referred to as atheroembolic renal disease. The diagnosis usually involves biopsy from an affected organ. Cholesterol embolism is treated by removing the cause and giving supportive therapy; statin drugs have been found to improve the prognosis.
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Renal biopsy is a medical procedure in which a small piece of kidney is removed from the body for examination, usually under a microscope. Microscopic examination of the tissue can provide information needed to diagnose, monitor or treat problems of the kidney.
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Ultrasound of the urinary tract involves the use of an ultrasound probe to image parts of the urinary tract. The urinary tract is the path that urine follows after it is formed within the kidneys, and involves a left and right ureter, the bladder, and the urethra.
