CLINICAL PATHOLOGY LECTURE 1 – GENERALITIES – Dr.

Pascual
USTMED ’07 Sec C - AsM

BASIC SCIENCE MEDICAL PRACTICE

research diagnosis
education therapy
prognosis
quality assurance

Computational Science
Management techniques
industry

Schematic outline of activities in clinical labs

ADMINISTRATION

PATIENT CARE SERVICE

Indications and selection Technology and generation Interpretation and translation

Teaching

Research

BIOHAZARD - ORANGE

National fire protection rating system

FIRE flammability - red

red health hazard - blue
reactivity - yellow

HEALTH REACTIVITY
blue yellow

OTHER
white

Review BIOSTAT

Result of test Diseas not Total

e disease
+ a (TP) b (FP) a+b
- c (FN) d (TN) c+d
Total a+c b+d a + b + c +d

sensitivity = a x 100
a+c

specificity = d x 100
b+d

false positive = b x 100

b+d

false negative= c x100

a+c

sensitivity of the test (++)

- refers to the proportion of people with disease who have a positive test result for the disease

specificity of the test (--)

- refers to the proportion of people without the disease who have negative test result for the disease

false positivity of the test (-+)

- refers to the proportion of people without the disease but have positive test result for the disease

false negativity of the test (+-)

- refers to the proportion of people with the disease but have negative test result for the disease
Components of Accuracy
1. positive predictive value
- refers to the probability that the patient has the disease given a positive test result
2. negative predictive value
- refers to the probability that the patient does not have the disease given a negative test result

accuracy = a+d x 100

a+b+c+d

positive predictive value = a x 100

a+b

negative predictive value = d x 100

c+d

Process of test selection and interpretation of results

Test request interpretation

written order report

calculation

specimen specimen prep measurement

patient prep

turn around time - the sooner the better

Interpretation and decision making
- normal, abnormal

Indications or reasons for ordering lab measurements or examinations

1. to confirm clinical impression or establish diagnosis
2. to rule out diagnosis
3. to monitor therapy (management guide)
4. to establish prognosis
5. to screen for or detect disease

Role of Clinical Pathogenesis

1. Internal - Quality control
a. assess procedure of test
i. sensitivity and specificity
ii. duplicability
iii. turn around time
b. assess applicability of latest equipment with regards to
i. need of the hospital
ii. acceptability of equipment
iii. economical
2. External
a. active participation in various hospital committees
I. infectious control committees
1. antimicrobial and sensitivity pattern of the hospital
2. education of hospital personnel
3. safety procedure to be implemented in the hospital
ii. blood transfusion committees
1. SOP for transfusion
2. education
3. safety transfusion and proper use of blood and its components
iii. medical audit committee
1. proper use of laboratory requests
2. education of training residents

Illustration of pathogenic reasoning. Cause-effect reasoning for extrahepatic obstruction caused by a common bile duct stone

+AST
pain +ALT
+ Bili
distension + LP enzyme release
+GGTP

CBD stone obstruction cholestasis cell necrosis

stasis cholangitis

infection bacteria positive blood culture

fever leukocytosis
Case protocol
ECP is male, BS Bio student, UST, came in because ____________

CC - Jaundice

HPI - few days prior to admission, developed moderate grade fever, abdominal pain, anorexia; subsequently, patient noticed his
urine to be highly colored

PPE - conscious, coherent, cooperative fairly nourished, febrile skin rashes, yellowish discoloration of skin

PPH - stages in boarding house along university belt. takes meals on several eateries regularly. recently donated blood

Clinical impression _____________________________

basis
1.
2.
3.
Lab diagnosis
1. blood exam
2. urine
3. stool
4. serologic
5. radiology
6. histopathology

Final clinical diagnosis________________

therapy

mortality or mobidity - post mortem

FINAL anatomic diagnosis ______________________

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