WORK UP

LABORATORY AND IMAGING

Dr. Rodney Martinez 1

IMAGES AND LABORATORY WORK UP

1. Indications and Purposes

2. Pre-test Preparation

3. Post-test Management

2

WHY DO WE USE ADDITIONAL TEST?

Clinical history

Physical examination

Complementary exams (Work Up)

Laboratory medicine

Imaging

3

FACTORS AFFECTING MEASURABLE VARIABLES

• Age.

• Sex.

• Ethnicity.

• Altitude.

• Build.

• Physiological conditions (e.g. at rest, after exercise, standing, lying).

• Sampling methods (e.g. with or without using tourniquet).

• Storage and age of sample.

• Container used, e.g. for blood sample, as well as anticoagulant.

• Method of analysis

4

SENSITIVITY & SPECIFICITY

Sensitivity % of patients with the disease and in

whom the test is positive

Specificity % of people without the disease in whom

the test is negative

5

LABORATORY 6

ELECTROLYTES

SODIUM

-bsorbed from the small intestine and excreted in the urine in amounts dependents dependent on dietary intake

-ustains osmotic pressure and acid base balance

-s major extracellular cation

-ormal daily requirement is 15 mEq

A

S

I

N 7

ELECTROLYTES

POTASSIUM

-romote cellular water balance, electrical conduction in muscle cells, and acid base balance

-btains K through dietary ingestion and the kidneys preserve or excrete K

-o evaluate cardiac, renal, and gastrointestinal function

- major intracellular cation

O

P

T

A

8

ELECTROLYTES

CHLORIDE

-ighly abundant body anion in the extracellular fluid

-ounterbalance cations and buffer

-ets digestion and maintenance of osmotic pressure and water balance

H

C

L

9

ELECTROLYTES

MAGNESIUM

lotting mechanism ontrols neuromuscular

activity ofactor that modifies activity

of many enzymes alcium metabolism

C

C

C

C 10

ELECTROLYTES

CALCIUM

-one formation -n conversion of

prothrombin to thrombin -ransmission of nerve

impulse -n contraction ok skeletal

and myocardial muscles

B

U

T

O

11

COAGULATION STUDIES

ACTIVATED PARTIAL THROMBOPLASTIN

TIME (APTT)

-mount of time it takes in seconds for

recalcified plasma to clot after partial

thromboplastin is added

-erformed for patient receiving heparin

-est for deficiencies and inhibitors of clotting

factors

-ime: 20 to 36 seconds

A

P T

T 12

COAGULATION STUDIES PROTHROMBIN TIME (PT) and

INTERNATIONAL NORMALIZED RATIO (INR)

-rothrombin is a vitamin K dependent glycoprotein produced by the liver for fibrin clot formation

-o monitor response to warfarin sodium (Coumadin)

P

T

13

COAGULATION STUDIES PROTHROMBIN TIME (PT) and

INTERNATIONAL NORMALIZED RATIO

(INR)

Normal Values:

PT:

9.6 to 11.8 secs (male)

9.5 to 11.3 secs (female)

INR:

2.0 to 3.0 (standard warfarin tx)

3.0 to 4.5 (high dose warfarin tx)

14

COAGULATION STUDIES CLOTTING TIME

-lient should not receive heparin 3 hours before specimen collection

-ong on any anticoagulation therapy

-n thrombocytopenia

-ime: 8 to 15 minutes

C

L

O

T

15

COAGULATION STUDIES PLATELET COUNT

Plug formation

Clot retraction

Coagulation factor

activation

16

COAGULATION STUDIES PLATELET COUNT 150T – 400T

cells/mm3

<PLT – thrombocytopenia (risk for bleeding)

>PLT – thrombocytosis (risk for clot) – prophylaxis of Anicoagulant - Lovenox

17

FULL BLOOD COUNT (FBC)

• Called complete blood count (CBC) in the USA.

• Red series

• Total red blood cells (absolute number per liter)

• Hemoglobin concentration (grams per deciliter)

• Hematocrit (Pack Volume Concentration) %

• Red blood indices

• Mean Corpuscular Volume (MCV) (fembtolitres)

• Mean Corpuscular hemoglobin (MCH) (picograms)

• Mean Corpuscular Hemoglobin Concentration (MCHC )

• Red blood cells distribution (RDW)

18

ERYTHROCYTE STUDIES

ERYTHROCYTE SEDIMENTATION RATE

(ESR)- 0 to 30 mm/hr

ndirectly measures how much

inflammation is in the body.

pecial preparations not needed, but fatty

meal may cause plasma alterations

ate at which erythrocytes settle out of

anticoagulated blood in 1 hour

E

S

R

19

ERYTHROCYTE STUDIES

RED BLOOD CELLS

-esults in the delivery of oxygen to the body

tissues

-lood diseases diagnosis

-irculate for 120 days and are removed from

the blood via the liver, spleen, and bone

marrow

-pecial preparation not needed

R

B

C

S

20

ERYTHROCYTE STUDIES

RED BLOOD CELLS 4.5-5.5 million/mm3

<RBC – Anemia (Faitgue, SOB)

>RBC – Polycythemia (erythrocytosis) – management phlebotomy

21

ERYTHROCYTE STUDIES

HEMOGLOBIN and HEMATOCRIT

Hemoglobin is the main component of

erythrocytes and serves as the vehicle

for transporting O2 and CO2

Normal Values:

14 to 16.5 g/dl (male)

12 to 15 g/dl (female)

22

ERYTHROCYTE STUDIES

HEMOGLOBIN and HEMATOCRIT

Hematocrit represents red blood cell mass

and is an important measurement in the

identification of anemia or polycythemia

Normal Values:

42% to 52% (male)

35% to 47% (female)

23

WHITE BLOOD CELL COUNT

WHITE BLOOD CELL

Immune defense system of the body

WBC 5,000-10,000 cells/mm3 <WBC – leukopenia (risk for infection)

>WBC – leukocytosis (infection/inflammation)

>100,000 – incapable of phagocytosis (leukemia)

24

CARDIOLOGY

Cardiac enzimes

LDH

CK

TROPONIN

OTHERS

25

CARDIAC MARKERS

CREATINE KINASE (CK)

Found in:

CK-MB (Cardiac)--- 0% to 5%

CK-BB (Brain)--- 0%

CK-MM (Muscles)--- 95% to 100%

26

CARDIAC MARKERS

CREATINE KINASE (CK)

R: 6 hours

P: 18 hours

N: 2 to 3 days

27

CARDIAC MARKERS

LACTASE DEHYDROGENASE (LDH)

R: 24 hours

P: 48 to 72 hours

N: 7 to 14 days

28

CARDIAC MARKERS

TROPONIN

- and I

-egulatory protein found in striated muscle

-n bloodstream when an infarction causes damage to the myocardium

T

R

O

29

CARDIAC MARKERS

TROPONIN I

>1.5 ng/ml… MI

R: 3 hours

N: 7 to 10 days

30

CARDIAC MARKERS

TROPONIN T

>0.1 to 0.2 ng/ml… MI

R: 3 hours

N: 7 to 14 days

31

CARDIAC MARKERS

MYOGLOBIN

Oxygen-binding protein

found in striated muscle

that releases oxygen at

very low tensions

Injury to skeletal muscle will

cause a release of

myoglobin into the blood

32

CARDIAC MARKERS

MYOGLOBIN

>90 mcg/L… MI

R: 1 to 2 hours

P: 4 to 6 hours

N: 24 to 36 hours

33

SERUM LIPIDS

Total Cholesterol---

140 to 199 mg/dl

Low Density Lipoprotein (LDL)--- <130

mg/dl

High Density Lipoprotein (HDL)--- 30 to

70 mg/dl

Triglycerides---

< 200 mg/dl

34

URINE DIPSTICK TESTING

• Depending on the type of dipstick used, urine

can be tested for

• pH.

• Specific gravity.

• Haemoglobin.

• Leucocyte esterases and nitrites.

• Glucose.

• Ketones.

• Protein.

• Urobilinogen.

35

POISONING & OVERDOSE

• Amphetamines & derivatives (MDMA (ecstasy),

MDEA (eve), MDA (adam)

• Anticonvulsants

• Benzodiazepines

• Carbon monoxide

• Cocaine

• Cyanide

• Digoxin

36

ENDOCRINE INVESTIGATION

Fasting plasma

glucose

A1C

GH

TSH, T3 & T4

Norepinephrine and

epinephrine

Cortisol testing

37

RENAL MEDICINE

Serum creatinine

Serum urea

24hrs creatinine clearence

Anion gap

Urine culture

Urine microscopy

38

RHEUMATOLOGY

Rheumatoid factor

Antinuclear antibody (ANA)

Anticentromere antibodies

Anti-DNA

39

IMAGING 40

CHEST X-RAY

A-natomy

A-ppearance 41

CHEST X-RAY PREPROCEDURE:

emove all jewelry and other metal objects from the chest area

ssess the client’s ability to inhale and hold his or her breath

ou question women regarding pregnancy or possibility of pregnancy

R

A

Y 42

CHEST X-RAY

POSTPROCEDURE:

Control the technique

43

ULTRASOUND

44

USES

Main imaging study in OBGYN

Study blood vessels like

Vena cava

Aorta

Study solid organs like

Heart

Liver

Gallbladder

Kidneys

45

PROPERTIES

Advantages

Unexpensive

Shows the organs and structures around it

No side effects

Disadvantages

It cannot penetrate bone structures

Is operator deppendent

46

CT SCAN

Scans the following in

successive layers by a

narrow beam of x-rays:

ngiogram

elly and Pelvic

hest

’ heart

xtremities

A

B

C

D

E

47

CT SCAN

48

CT SCAN PRETEST:

ssess allergies to iodine and seafoods

e sure to obtain informed consent

onscious sedation for claustrophobia

o remove jewelries and hair pins

xplain hot flushed sensation and metallic taste in

the mouth when dye is injected

luids and hydration

ive instruction to lie supine with small pillow under

the head

old if pregnant

t takes 20 minutes

A

B

C

D

E

F

G

H

I 49

CT SCAN

POSTTEST:

llergic reaction check

e sure to replace fluid

VS

istal pulse check

xtremity color check

ind bleeding and hematoma

A

B

C

D

E

F 50

MRI

-RI is nonivasive

-eveals types of tissue, tumors and vscular abnormalities

-s similar to CT scan

M

R

I

51

MRI

52

MRI PRETEST

-etal objects must be removed

-ssess for ineligibility and contraindications

-ive instruction to lie supine with small pillow under the head

-ormal audible humming, thumbing, grating, or knocking sounds

-ncourage conscious sedation for claustrophobia

-akes 45 to 60 minutes

-nformed consent

-ompletely enclosed in scanner

M A

G

N

E

T

I

C 53

MRI POSTTEST

Resume normal activities

Fluids and hydration

54

MRI Ineligible to undergo MRI: Automatic Internal Defibrillator

Cerebral Aneurysm Clip

Cochlear Implant

Hip Replacement

Knee Replacement

Non-removable dental prosthesis

Pacemaker

Prosthetic Valve Replacement

Soldiers

55

EEG

56

EEG • graphic recording of electrical

activity of the brain by several small electrodes placed on the scalp

To diagnose:

bnormal firing of electrical activity

rain tumors

ertain psychiatric disorders

egenerative disorders

nflammation of brain and spinal cord

A

B

C

D

E

57

EEG PRETEST

ash the client’s hair

ssure that electrodes will not cause electric shock

timulants and depressants avoided for 24 to 48 hours

ypoglycemia prevention, do not omit breastfeeding

W

A

S

H

58

EEG POSTTEST

Wash the client’s hair

Maintain side rails and

safety precaution, if the

client was sedated

59

EEG

Sleep Deprivation EEG 60

SKULL X-RAY

Radiographs of the skull:

ize

hape

uture separation

ome calcification

hows erosion and fracture

S

S

S

S

S 61

SKULL X-RAY

62

SPINAL X-RAY

Spinal radiographs:

bnormal spine and dislocation

one degeneration

ompression

eformed curvature

rosion

racture

A

B

C

D

E

F 63

SPINAL X-RAY

64

SKULL AND SPINAL X-RAY

-clude metal items from

body parts

-eassure nursing support

-ccurate documentation if

with thick and heavy

hair

-ou immobilize

X

R

A

Y 65