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ss nucleus - summer 1999,  Differential Diagnosis 28

Differential Diagnosis 28

Luke 14:1-4.

Luke has a difficult task in determining the most likely diagnosis for the man who was healed on the Sabbath in the home of a prominent Pharisee. Although this example of healing is important to our understanding of the Lord’s day, we know very little about the person involved other than that he suffered from dropsy. This term is derived from the Greek, ‘hydrops’, from ‘hydro’ meaning water. The patient was described as being ‘full of water’ or oedematous. This can be due to localised tissue injury or secondary to pathological processes of the heart, liver, lungs or kidneys.

Tropical diseases can lead to both nephrotic syndrome and oedema secondary to ascites. Glomerulonephritis may be due to leprosy, schistosomiasis, malaria, filariasis or hepatitis B. Although ascites may be secondary to strongyloides, entamoeba or cryptococcus infections, the differential diagnosis of non-infective causes of oedema is much longer.

Luke favours a diagnosis of heart failure in this case, as this is associated with the impression of being overloaded with fluid. In 600 BC the Yellow Emperor’s text of Internal Medicine, regarding heart failure, stated ‘if the breathing is noisy, then the veins of the lungs are in disorder… the water disturbs the rest, and causes the troubled breathing’. We now know that the pathophysiology of pulmonary oedema is not just due to pulmonary venous congestion secondary to left ventricular failure.

Modern treatment of heart failure involves diuretics, vasodilators, ACE inhibitors and digoxin. This patient may have been housebound and we often forget the simple measure of bed rest. This can improve renal blood flow by reduced stimulation of the sympathetic and renin-angiotensin systems.

Though the diagnosis is not certain, we can be sure that Jesus did not deal with the symptoms alone but healed the underlying disorder.

Differential Diagnosis 29

1 Samuel 17

David’s killing of Goliath the giant in 1 Samuel 17: 1-51 was a mighty feat, but could the giant have had a medical condition that contributed to his demise?

Luke's opinion in next issue.

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