LECT APPROACH TO DIAGNOSIS & PATIENT`S_110709.ppt

7/29/2019 LECT APPROACH TO DIAGNOSIS & PATIENT`S_110709.ppt

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Please do not sign foryour friend(s) its acriminal Punishment: 6months schorsingautomatically non eligibleto promote to 2nd year in

this academic year.


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this academic year.

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APPROACH TO DIAGNOSIS

& PATIENT`S TREATMENT

R.MUCHTAN SUJATNO

NADJWA ZAMALEK D


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Human body

Consist of many systems System is : a set or series of

interconnected or interdependent parts orentities (organs), that function together in

a common purpose or produce resultsimpossible of achievement by one of themacting or operating alone.

System consist of many organs Organ consist of tissues Tissue consist of cells


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Respiratory system

Organs:

nose, throat, trachea, bronchus,

bronchioles, lung, etc.

Tissue:

muscle, connective

Cells: epithel


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Systems work properly healthy human

System(s) work improperly sick/ill :

Signs & symptoms (e.g fever/febris)

Asymptomatic (e.g increase of blood


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Diagnostic: of or constituting a diagnosis

Diagnosis

Definition: The act or process ofdeciding the nature of a disease

conditioned by examination of

symptoms.

Diagnose: to make a diagnosis


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Diagnosis approach to disease Physicians usually tackle clinical situations

by taking a history of disease (History taking

anamnesis)

Performing a physical examination Additional examination (supporting

diagnostic tools):

- General: Laboratory, Radiology

- Specific: Audiology, Ophthalmology

Formulating a diagnosis


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The synthesis of the history taking, physical

examination, radio-imaging or laboratory test

Clinical Data Base After reaching a diagnosis, a treatment

plasn is usually initiated, and thepatients is followed for clinical response.

Rational understanding of disease andplans for treatment are best acquired bylearning about the normal humanprocesses on a basic science level.


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Likewise, being aware of howdisease alters the normalphysiological processes is alsobest understood on a basicscience level.


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History taking Symptom

Definition :

any subjective evidence of diseaseor of patients condition.

Examples :

Fatigue, nausea


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Healthy people could become ill by

one or another reasons called

etiology.

Mechanism of diseases is called

pathophysiology/pathogenesis


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Physical examination

Sign

Definition :

An indication of the existence ofsomething

Any objective evidence of disease

such evidence as is perceptible to theexamining physician

Examples :

Anemic or icteric sclera


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Etiology

The study or theory of the factors

that cause disease and the method oftheir introduction to the host thecause of disease.


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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.


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Anyquestions

???


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Pathology

Branch of medicine which treats ofthe essential nature of disease,

especially of the structural andfunctional changes in tissues andorgans of the body which cause orare caused by disease.

Cellular and Clinical Pathology


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Cellular (anatomical)

Pathology

Regards the cells as a starting points

of the phenomena of disease andthat every cell descends from some

preexisting cell.


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Clinical Pathology

Pathology applied to the solution of

clinical problems, especially the useof laboratory methods in clinical

diagnosis.

Body fluid (incl.secretion,excretion)examination


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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


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Healthy

HumanSick

Pathophysiology

Etio logy

- Symptoms

- Signs

- Lab.evaluations


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Healthy Human Sick/illPathophysiology

Etiology

- Symptoms : fever, headache

- Signs : fever

- Lab.evaluations : leukopenia,

culture (+), Widal (+)

S.typhi

Endotoxin

Diagnosis : Typhoid fever


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Any

questions???


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The purpose and function of Clinical Pathology

1. Confirming or rejecting diagnosis

2. Providing guidelines in patient management

3. Establishing a prognosis

4. Detecting disease through case finding orscreening

5. Monitoring follow up therapy


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Confirming or rejecting diagnosis

Patient with fever

Differential diagnosis:

Dengue

Typhoid

Laboratory results:

Dengue (-)

Typhoid (+)

Final diagnosis:

Dengue reject

Typhoid confirm


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Providing guidelines in patient

management

Patients with Diabetes Mellitus

2HPP* Blood glucose levels :

Mr.A : still high (300 mg/dL) Mrs.B : normal (110 mg/dL)

Increase Oral Anti Diabeticdose

Maintain Oral Anti Diabeticdose

*2HPP : 2 hours post prandial (after meal)


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Establishing prognosis

Patients with acute viral hepatitis

Cellular liver enzymes : ALT* level

Mr.X : high (400 IU) Mrs.Y: very high (1400 IU)

Prognosis : good Prognosis : bad

*ALT : Alanine aminotransferase


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Detecting disease through

case finding or screening

Screening of the donors for

Hepatitis B Virus :

HBsAg :

HBsAg : (+)

HBsAg : (-)

Donors rejected (case findings)

Donors accepted (screening

healthy subjects)


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Monitoring follow up therapy

Patient with urinary tract infection

After finished 1 cured dosage of

certain antibiotic

Urine culture still (+)

Change antibiotic with

the sensitive one


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Types of Clinical laboratory

Examination

Screening Test:

Hb, leukocyte count, ALT, AST

Confirmatory Test: Culture, HCV, Blood glucose


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Point of Care Testing(POCT)

Bringslaboratory testing to the site of the patient ratherthan obtaining a specimen and sending it to thelaboratory.

Used in variety of settings :

Emergency departments

Operating suites Clinics

Home Monitoring

etc

Examples :

Hemoglobin level

Blood gas analysis Hormones

Blood glucose

etc


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THANK YOU FOR

YOUR ATTENTION

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LECT APPROACH TO DIAGNOSIS & PATIENT`S_110709.ppt