Clinical methods

Ass.Prof.Aleksandar Mitevski
Faculty of medical sciences, UGD sthip
ReMedika general hospital Skopje
• 1. appetite
• 2. thirst
• 3. swallowing
• 4. nausea, vomiting, dyspeptic sy
• 5. pain, location , type
• 6. symptoms connected to food ingestion , seasonal
• 8. Perianal symptoms – pain , bleeding , discharge, connected or not to stool
• 9. regularity of the stool
• 10. consistence of the stool
Symptoms connected to urogenital system

• 11. voiding/ regularity, timing

• 12. urethral discharge

In female patients questions for menstrual cycle

• 13. regularity and intensity of the bleeding

• 14. other symptoms during the cycle , pregnancies , births …

• 15. vaginal discharge

Oesophagus
• dysphagia
• odynophagya
• pirosis
• regurgitatio
stomach
• Appetite disorders anorexia
• polyfagia, polydipsia
• nausea/ vomiting
• (aerogastria, dyspepsio, aerophagia)
• pain
Small bowel
• Meteorismus
• Pain / colic
• diarrhea
Large bowel and rectum
• Pain/ tenesmus
• Diarrhea
• Constipation
• Bleeding , discharge
Liver
• Clinical symptomes in late
faze/ dull pain, malease ,
loss of apetite
• Jaundice/ icterus
• Acholic stool
• Dry skin, loss of hair ,
ginecomasty
• Caput medusae / spider
nevus
• Digestive tract bleeding(
varices )
• Ascites
Pancreas
• pain
• Malabsorbtion disorder/ steatorhhea
• Biliary obstruction
Spleen
• Part of hematology disorders / symptoms
• pain
• poliuria > 2 L/24часа
• oliguria < 500 ml/24ч • pneumaturia
• anuria <100ml/24ч • piuria
• nicturia • incontinentio
• pollakisuria • stres incontinentio
• dysuria • retentio urinae
• alguria • ischiuria paradoxa
• haematuria • enuresis nocturna
Pain
• Renal/ dull
• Ureteral / colicky
• Bladder/ prostate
• testicular
inspection
• Patient position
• Level to the torax
• Respiratory excursion
• Skin marks
auscultation
• 3min
• 15-20 sec./ 2-5sec.
Palpation
Muscular defense
Percussion
Fluctuation phenomena
• Inspection and palpation of
anus and rectum
Labaratory examinations
• Complete blood count
Labaratory examinations
Labaratory examinations
Labaratory examinations
• The blood urea nitrogen (BUN) test measures how much urea
nitrogen is in your blood. It helps a healthcare provider
determine if your kidneys are working as they should
• Creatinine is a chemical waste product of creatine. Creatine
is a chemical made by the body and is used to supply energy
mainly to muscles. This test is done to see how well your
kidneys work. Creatinine is removed from the body entirely
by the kidneys.
Labaratory examinations
• Bilirubin is a yellowish pigment that is made during the
breakdown of red blood cells. Bilirubin passes through the
liver and is eventually excreted out of the body. Higher than
usual levels of bilirubin may indicate different types of liver
or bile duct problems.
• AST-aspartate aminotransferase и ALT-alanin
aminotransferase
• LDH (Lactate dehydrogenase)
• ALP (Alkaline phosphatase) и GGT (gamma-glutamyl-
transpepdidase)
Labaratory examinations
• Amylase is an enzyme, or special protein, that helps you digest
carbohydrates. Most of the amylase in your body is made by your
pancreas and salivary glands
• Lipase is an enzyme the body uses to break down fats in food so
they can be absorbed in the intestines. Lipase is produced in the
pancreas, mouth, and stomach
• Na, K, Ca и Cl
• Hundreds of proteins are dissolved in the plasma. By measuring
the concentration of these proteins, the clinician can obtain
information regarding disease states in different organ systems.
The measurement of protein is done on serum, which is the fluid
that remains after plasma has clotted
Labaratory examinations
• CEA (carcinoembryonic antigen), CA19-9 (cancer antigene,
carbohydrate antigene), CA72-4 , CA125, AFP (alpha
fetoprotein), PSA (prostate specific antigen), Beta-hCG (beta
human chorionic gonadotropin)
Labaratory examinations
• A fecal occult blood test (FOBT) looks at a sample of your stool (poop) to check for blood. Occult
blood means that you can't see it with the naked eye. And fecal means that it is in your stool.

• Blood in your stool means there is bleeding in the digestive tract. The bleeding may be caused by
a variety of conditions, including:

• Polyps, abnormal growths on the lining of the colon or rectum

• Hemorrhoids, swollen veins in your anus or rectum

• Diverticulosis, a condition with small pouches in the inside wall of the colon

• Ulcers, sores in the lining of the digestive tract

• Colitis, a type of inflammatory bowel disease

• Colorectal cancer, a type of cancer that starts in the colon or rectum

• FIT fecal immunochemical test ( FIT-DNA test)

Labaratory examinations
• Urinalysis - macroscopic examination
-microscopically
-reagent-impregnated strips ( pH, proteins, Ketone bodies,
glucose , bilirubin…)
-microbiology
Labaratory examinations

• biopsy / cells, tissue or fluid for examination

• Healthcare providers do biopsies when they identify areas of
concern or if you have symptoms or signs of certain
conditions. There are different types of biopsy procedures.
• Cytology is the exam of a single cell type, often found in fluid
specimens
Imaging

Medical Imaging are series of techniques that are using

different methods for visual representation of tissue and organs
of the body for clinical diagnostics and interventions. Also they
are used for interpretation of organ function and structure.
Imaging
Imaging
Endoscopy
• Gastroscopy, colonoscopy
• ERCP (endoscopic retrograde cholangiopancreatography)
• Laparoscopy, cystoscopy, renoscopy,
БЛАГОДАРАМ