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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 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
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connective • Cells: • epithel 4 . bronchioles. etc. bronchus. lung. • Tissue: • muscle. throat.Respiratory system • Organs: • nose. trachea.

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g fever/febris) • Asymptomatic (e.• Systems work properly  healthy human • System(s) work improperly  sick/ill : • Signs & symptoms (e.g increase of blood 6 .

Normal Individual Disease agents Pathophysiology Sick/ill Individual Diagnosis Pharmacology How? Treatment 7 Non Pharmacology .

Diagnose: to make a diagnosis Diagnostic: of or constituting a diagnosis 8 .Diagnosis Definition: The act or process of deciding the nature of a disease conditioned by examination of symptoms.

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): . Ophthalmology Formulating a diagnosis 9 .General: Laboratory.Specific: Audiology. Radiology .

and the patients is followed for clinical response.The synthesis of the history taking. • Rational understanding of disease and plans for treatment are best acquired by learning about the normal human processes on a basic science level. radio-imaging or laboratory test  Clinical Data Base • After reaching a diagnosis. 10 . physical examination. a treatment plasn is usually initiated.

11 .Likewise. being aware of how disease alters the normal physiological processes is also best understood on a basic science level.

History taking  Symptom • Definition : any subjective evidence of disease or of patient’s condition. • Examples : Fatigue. nausea 12 .

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• Mechanism of diseases is called pathophysiology/pathogenesis 14 .• Healthy people could become ill by one or another reasons called etiology.

Physical examination  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 or icteric sclera 15 .

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Etiology The study or theory of the factors that cause disease and the method of their introduction to the host  the cause of disease. 18 .

more specifically. • Pathogenesis : the development of morbid conditions or disease.Pathophysiology/pathogenesis • Pathophysiology : the physiology of disordered function. the cellular events and reactions and other pathologic mechanisms occurring in the development of disease. 19 .

Any questions ??? 20 .

• Cellular and Clinical Pathology 21 .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 (anatomical) Pathology • Regards the cells as a starting points of the phenomena of disease and that every cell descends from some preexisting cell. 22 .

• Body fluid (incl.secretion. especially the use of laboratory methods in clinical diagnosis.excretion) examination 23 .Clinical Pathology • Pathology applied to the solution of clinical problems.

• 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 24 .

Signs .Lab.evaluations 25 .Etiology Healthy Human Pathophysiology - Sick Symptoms .

evaluations : leukopenia. headache .S.Symptoms : fever.Signs : fever .typhi Etiology Healthy Human Pathophysiology Endotoxin Sick/ill . culture (+).Lab. Widal (+) Diagnosis : Typhoid fever 26 .

Any questions ??? 27 .

3. 2. 4. Confirming or rejecting diagnosis Providing guidelines in patient management Establishing a prognosis Detecting disease through case finding or screening Monitoring follow up therapy 28 .The purpose and function of Clinical Pathology 1. 5.

Confirming or rejecting diagnosis Patient with fever Differential diagnosis: • Dengue • Typhoid Laboratory results: • Dengue (-) • Typhoid (+) Final diagnosis: • Dengue  reject • Typhoid  confirm 29 .

B : normal (110 mg/dL) Increase Oral Anti Diabetic dose Maintain Oral Anti Diabetic dose 30 *2HPP : 2 hours post prandial (after meal) .A : still high (300 mg/dL) Mrs.Providing guidelines in patient management Patients with Diabetes Mellitus 2HPP* Blood glucose levels : Mr.

Establishing prognosis Patients with acute viral hepatitis Cellular liver enzymes : ALT* level Mr.Y: very high (1400 IU) Prognosis : good *ALT : Alanine aminotransferase Prognosis : bad 31 .X : high (400 IU) Mrs.

Detecting disease through case finding or screening Screening of the donors for Hepatitis B Virus : HBsAg : HBsAg : (+) Donors rejected (case findings) HBsAg : (-) Donors accepted (screening healthy subjects) 32 .

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 33 .

AST • Confirmatory Test: • Culture. leukocyte count. Blood glucose 34 .Types of Clinical laboratory Examination • Screening Test: • Hb. HCV. ALT.

Point of Care Testing (POCT) Brings laboratory testing to the site of the patient rather than obtaining a specimen and sending it to the laboratory. Used in variety of settings : • Emergency departments • Operating suites Examples : • Hemoglobin level • Blood gas analysis • Clinics • Home Monitoring • etc • Hormones • Blood glucose • etc 35 .

THANK YOU FOR YOUR ATTENTION 36 .