Clinical Diagnostics

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Clinical Diagnostics

• Department of gastroenterology
• Ren-Ji hospital
• Shanghai Jiao Tong University, School of Medicine
• Ran Zhi Hua (???)

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What is Clinical Diagnostics?

• Fundamental theory
• ????/??
• Techniques of diagnosing disease
• ???????
• Mode of clinical thinking
• ???????

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What is Clinical Diagnostics?

• Instruct a concise logical approach to recognize
  
• the genius of the diseases
• ???????????????????
• ????
• A fundamental course of clinical medicine
• ?????????

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Fundamental elements of Diagnostics

• Diagnosis

Identification
Analysis
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Diagnosis(??)

• Derived from Greek words
• distinguish or discern
• ??/?? ??

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• English term
• Diagnostic
• The distinguishing sign and symptoms with which
  it gerenally begins, continues and goes offas it
  were, a history of the disease
• ???????????????
• In 18th century Nosography(???)
• ???????????????????

?
?
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• In modern usage
• Identification of a disease by investigation of
  its signs and symptoms
• Medical terminology
• Clinical diagnosis Laboratory diagnosis
• X-ray diagnosis Electrocardiographic
  diagnosis
• Gene diagnosis

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Identification (??)
Inquiry Physical examination
Laboratory tests/Special examination
Analysis (??)
Basic knowledge of medicine Overall
analysis Scientific way of clinical thinking
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Importance of Diagnostics
Essential (??) Bridge (??) Tools (??)
Basic courses
Clinical medicine
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Content of Clinical Diagnostics
Symptomatic diagnosis (????)
Physical diagnosis (????)
Laboratory tests or clinical ancillary tests
Medical record
Diagnostic processes and the way of clinical
thinking
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Symptomatic Diagnosis
History taking(???? )--- Interview (??)
Symptoms (??)--- patients complaints (??)
Symptomatic Diagnosis (????)
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Symptomatic Diagnosis
Symptom (??)
Subjective sensation that patient describes
Physiological functional
Pathological morphological
Fever
Cough
Rash
Mass
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Physical Diagnosis
Sign (??)
Abnormality observed by the physician
Physical examination (????)
Conducted with thoroughness, alertness to detect
even slight derivations from normal
Inspection (?)
Palpation (?)
Percussion (?)
Auscultation (?)
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Laboratory test or ancillary tests

• Serum, Urine, Stool tests
• X-ray film
• EKG
• Endoscopy
• Ultrasonic imaging
• CT
• MRI
• PET (Positron Emission Tomography)

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Medical record
Medical record is a systematized way of storing
the required data, information and other relevant
documents
Specific requirement in terms of format and
content
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Special terms in clinical diagnosis
Impression (????)
Tentative diagnosis (?????)
Differential diagnosis (????)
Evidence based medicine(????)
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Differential diagnosis

• Preliminary diagnosis/Tentative diagnosis
• ???? ?????
• Exclusion of other diseases (??????)
• Selecting a number of possibilities to explain
  the clinical and laboratory findings in the case
  in question
• The way of exclusion is called Differential
  diagnosis

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Evidence based medicine

• It is the conscientious(???), explicit (???)and
  judicious (????)use of current best evidence in
  making decisions about the care of the individual
  patient It means integrating individual
  clinical expertise (????)with the best available
  external clinical evidence from systematic
  research

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Evidence based medicine

• One need to
• Be conscientious it requires effort and
  thought.
• Be explicit decisions will need to be backed up
  by good evidence
• Relate to specific problems it is not about a
  hypothetical
• "average" case.
• Integrate individual clinical experience it
  does not denigrate
• clinical skills in history taking, examination
  and diagnosis.
• Look for current best evidence the perfect
  study may not yet have
• been published, written up or even commenced.
  We may have to
• settle for something less rigorous, but be on
  the look out for new
• research that will supersede older studies.

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Important aspects---interrogation

• To get the history in detail of a patients
  illness
• The history is taken at initial contact between
  
• physician and patient
• As some crucial points might be overlooked by
  the patients, one will
• ask many searching questions to make the
  history more informative
• and complete, who must at the same time avoid
  suggesting answers
• Occasionally to interrogate his family member

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Other important aspects

• The diagnostic process is very complex
• The number of facts that can be collected in a
  detailed medical history and in thorough physical
  examination are almost without limit
• The laboratory tests or specialized technical
  procedures that can employed are numerous and
  costly

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Other important aspects

• Questions for interrogation, maneuver in P.E.,
  laboratory test should be thoughtfully selected
  with the view to eliminate some of the possible
  diagnosis and guide the search expeditiously to a
  specific disease
• Method of approaching a diagnosis
• Analysis of symptoms (????)
• Recognition of the syndrome (?????)
• Consideration of disease mechanisms (??????)

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Important aspects

• Modern advanced ancillary techniques
• have their limitations.
• It cant reduced the importance of certain
  parts
• of the classic P. E
• It should be avoided to neglect fundamental
• methods
• Interrogation
• Physical examination
• Scientific clinical thinking

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Approaches

• Basic knowledge learning(???????)

Clinical practice (????)
Bedside activity
????
Standardized patient
?????
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Developmental History of clinical diagnostics

• Western Medicine from ancient to modern
• Traditional Chinese Medicine

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Contribution of ancient doctors---Western

• Hippocrates
• Born on the island of Cos,
• Greece (c. 460-377 BC)
• The Father of medicine
• Hippocratic oath
• ???????
• Hippocratic corpus(??)
• a collection of 70 works

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• Hippocratic oath

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Contribution of ancient doctors---Western

• Galen
• c.130-c.200
• His work in
• anatomy/physiology is notable
• Identified artery and vein
• Added greatly to knowledge of the
• brain, spinal cord and pulse

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Contribution of ancient doctors---Western

• Auenbrugger
• Born at the village of Graz, Austria (1722)
• Son of an innkeeper
• The working experiences helped him to find
• Percussion
• Author of ltInventum Novumgt(1761)
• translated as On Percussion of the chest in
  1936

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Contribution of ancient doctors---Western

• Laennec RTH
• A French physician
• Invented Auscultation and stethoscope

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Contribution of ancient doctors---Western

• Laennec RTH

1816
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Contribution of Western Physician

• 17th19th century
• Leenwenhock Microscopy (end of 17th
  century)
• Fahrenheit Thermometer (1724)(???)
• Ludwig Hematomanometer
  (1847)(???)
• Welcher Hematinometer (1854)
• (??????)
• 20th century
• X-ray film EKG
• Endoscopy CT PET

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Ultrasonic imaging
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CT imaging
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MRI
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PET
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Traditional Chinese Medicine
Wood Fire Earth Metal Water
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Contribution of ancient doctors---Chinese

• Inspection
• Interrogation
• Smell
• Pulse palpation
• ??

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Pay attention to

• Good medical ethics
• Attach importance to clinical practice
• Unit theory with practice

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Goals

• Inquiry
• Independent systemic inquiry
• Comprehensive understanding of patients
  chief
• complains, signs, symptoms and their
  interrelation
• Physical Examination
• Systemic/thorough
• Familiar with routine tests, EKG manipulation
  and figure
• analysis
• Good case writing and propose the primary
  diagnosis
• Scientific clinical thinking