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Health care delivery involves many different disciplines and specialities diagnostic evaluation/services laboratory test.
Human body
Consist of many systems System is : a set or series of interconnected or interdependent parts or entities (organs), that function together in a common purpose or produce results impossible of achievement by one of them acting or operating alone.
System consist of many organs Organ consist of tissues Tissue consist of cells
E.g :
Neurobehaviour system Respiratory system Cardiovascular system Gastrointestinal system Genitourinary system Reproductive system Dermato musculoskeletal system etc
Respiratory system
Organs: nose, throat, trachea, bronchus, bronchioles, lung, etc. Tissues: muscle, connective Cells: epithel
Systems work properly healthy human System(s) work improperly unhealthy (sick/ill) : Signs & symptoms (e.g fever/febris) Asymptomatic (e.g increase of blood glucose level/Diabetes Mellitus).
4 aspects of disease
1. Causes (disease agent, etiology) 2. Mechanism of its development (pathogenesis, pathophysiology) 3. Morphologic changes 4. Clinical significance
Sign
Definition :
An indication of the existence of something Any objective evidence of disease such evidence as is perceptible to the examining physician
Examples :
Anemic conjunctiva or icteric sclera
Symptom
Definition : any subjective evidence of disease or of patients condition. Examples : Fatigue, nausea
Healthy people could become ill by one or another reasons called etiology. Mechanism of diseases is called pathophysiology/pathogenesis
Etiology
The study or theory of the factors that cause disease and the method of their introduction to the host the cause of disease.
Pathophysiology/pathogenesis
Pathophysiology : the physiology of disordered function. Pathogenesis : the development of morbid conditions or disease; more specifically, the cellular events and reactions and other pathologic mechanisms occurring in the development of disease.
Pathology
Branch of medicine which treats of the essential nature of disease, especially of the structural and functional changes in tissues and organs of the body which cause or are caused by disease. Cellular and Clinical Pathology
Cellular (Anatomical Pathology): Regards the cells as a starting points of the phenomena of disease and that every cell descends from some preexisting cell.
Clinical Pathology: Pathology applied to the solution of clinical problems, especially the use of laboratory methods in clinical diagnosis.
Clinical Pathology
Medical principles
-Reagents
-IT -Industry/Vendor
Disease : disruption of normal body function Anything which disrupts homeostasis may be viewed as a disease agent (etiology). Disease agents :
Infectious agents Physical and chemical agents Inherited genetic alterations Acquired mutation and cancer Malnutrition Inflammation and autoimmunity
Etiology
Healthy Human
Pathophysiology
Sick/ill
- Symptoms
- Signs
- Lab.evaluations
S.typhi
Etiology
Healthy Human
Pathophysiology
Endotoxin
Sick/ill
- Signs : fever
- Lab.evaluations : leukopenia,
culture (+), Widal (+)
Clinical Pathology
Clinical Hematology Clinical Chemistry
Samples :
Clinical Microbiology
Clinical Immunology
Stool
CSF Trans/Exudate etc blood
Clinical Hematology
Parameters to be evaluated : Hemoglobin Leucocyte count
Manually
Platelet count
Hematocrit etc
Automatically
Clinical Chemistry
Blood Parameters to be evaluated Glucose, protein, bilirubin, pregnancy test, etc Glucose, cholesterol, triglyceride, cardiac enzyme, etc
Urine
Clinical Microbiology
Swab
Clinical Immunology
Blood
Parameters to be evaluated
TORCH
HIV Dengue Typhoid etc
4. Establishing a prognosis
Screening
1. Mass screening:
Phenylketonuria in newborn Hepatitis V in blood transfusion donor
Symptomatic patients
1. Non-specific complaints 2. Specific problem already identified
Non-specific complaints
1. Battery of chemistry tests 2. Complete Blood Count (CBC) 3. Routine urinalysis Problem: positive test false positive results
HBsAg : (-)
Screening test to spare down differential diagnosis (high sensitivity for a disease)
Test negative disease excluded Test positive True positive False positive use test(s) with high specificity
Final diagnosis:
Dengue reject Typhoid confirm
Establishing prognosis
Patients with acute viral hepatitis
Prognosis : good
*ALT : Alanine aminotransferase
Prognosis : bad
Order of testing
From cheap to costly From less to more risky From simple to more complex
Within the constrains of time, risk, and cost, try to do the test or procedure with the most efficiency as soon as possible highest: sensitivity, specificity and predictive value
Perfect Test
1. 2. 3. 4. 5. 6. 7. Accurate (teliti) Precise (keterulangan tinggi) Discriminating ( kemampuan membedakan) Pain free (tidak menyakitkan) Risk free (risiko kecil) Inexpensive (murah) Useful (bermanfaat)
Reference intervals
A set of values of a certain type of quantity obtainable from a single individual or a group of individuals corresponding to a stated description (Dybkaer)
This description must be spelled out and available if others are to used the reference values
For each type of quantity, a series of reference group will be necessary, taking into consideration : age, sex, ras, menstruation, previous diet and exercise, posture etc.
Example : Hemoglobin level (new born baby, infant, children, female adult, male adult, elderly)
Doctor has to :
1. Explain abnormal lab.value (esp.those that do not seem correlate with one another. 2. Recommended/order lab.test that may lead to correct diagnosis. 3. Reveal the occurrence of laboratory error
Fundamental Principles in
Interpretation of Values
Never rely on a single (out of reference range) value to make a diagnosis. It is vital to establish a trend in values.
Example :
Single Sodium values of 30 mEq/L does not necessarily indicate hyponatremia. It maybe spurious and may reflect such factors as : - improper phlebotomy technique - laboratory variability
Oslers Rule
Especially if the patient is under the age of 60 years, try to attribute all abnormal lab.findings to a single cause. Only if there is no possible way to correlate all abnormal findings, should the possibility of multiple diagnosis be entertained.
Sequence of Tests
Depends on many situation: 1. Critical test with the highest yield is done, even though there maybe some risks. 2. Time-lower risk yield, less risky procedure done first
Margins of error
Ethics and the law Patients bill of right & respon
Cultural sensitivity