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ANCILLARY PROCEDURES

ANCILLARY PROCEDURES. Done in the patient. CBC Na, K Creatinine SGOT, SGPT 12-L ECG. CBC. Complete Blood Count. broad screening test to check for such disorders as anemia, infection, and many other diseases Red blood cell (RBC) count

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ANCILLARY PROCEDURES

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  1. ANCILLARY PROCEDURES

  2. Done in the patient • CBC • Na, K • Creatinine • SGOT, SGPT • 12-L ECG

  3. CBC

  4. Complete Blood Count • broad screening test to check for such disorders as anemia, infection, and many other diseases • Red blood cell (RBC) count • count of the actual number of red blood cells per volume of blood • Hemoglobin • measures the amount of oxygen-carrying protein in the blood • Hematocrit • measures the percentage of red blood cells in a given volume of whole blood

  5. Complete Blood Count • Mean corpuscular volume (MCV) • measurement of the average size of RBCs • Elevated: macrocytic • ex.: vitamin B12 deficiency • Decreased: microcytic • ex.: iron deficiency anemia or thalassemias • Mean corpuscular hemoglobin (MCH) • average amount of O2-carrying hemoglobin inside a red blood cell • Macrocytic RBCs have a higher MCH, while microcytic red cells have a lower value

  6. Complete Blood Count • Mean corpuscular hemoglobin concentration (MCHC) • calculation of the average concentration of hemoglobin inside a red cell • Decreased: hemoglobin is abnormally diluted inside the red cells • ex.: iron deficiency anemia and thalassemia. • Increased: (hyperchromia); hemoglobin is abnormally concentrated inside the red cells • ex.: burn patients and hereditary spherocytosis

  7. Complete Blood Count • Red cell distribution width (RDW) • calculation of the variation in the size of your RBCs • Platelet count • number of platelets in a given volume of blood

  8. Complete Blood Count

  9. Anemia • Low RBC, Hgb, Hct • Due to insufficient production of EPO by the diseased kidneys (CKD stage 3)

  10. Thrombocytosis • Occurs as an acute phase response to infection

  11. Complete Blood Count • White blood cell (WBC) count • count of the actual number of white blood cells per volume of blood • White blood cell differential • looks at the types of white blood cells present • five different types of white blood cells: neutrophils, lymphocytes, monocytes, eosinophils, and basophils

  12. Complete Blood Count

  13. Leukocytosis • With predominance of neutrophils connotes active bacterial infection

  14. Blood Chemistry

  15. Biochemical Blood Tests • Liver Function test • AST/ ALT • Kidney Profile test • Creatinine • Electrolytes • ( Na, K, Ca, PO) • BUN • Uric Acid • Lipid Profile test • TG • Total Cholesterol • LDL, HDL, VLDL

  16. Biochemical Blood Tests • Liver Function test • AST/ ALT • Kidney Profile test • Creatinine • Electrolytes • ( Na, K, Ca, PO) • BUN • Uric Acid • Lipid Profile test • TG • Total Cholesterol • LDL, HDL, VLDL

  17. Biochemical Blood Tests • Liver Function test • AST/ ALT • Kidney Profile test • Creatinine • Electrolytes • ( Na, K, Ca, PO) • BUN • Uric Acid • Lipid Profile test • TG • Total Cholesterol • LDL, HDL, VLDL

  18. Biochemical Blood Tests • AST / ALT • Test associated with the cellular integrity of the Liver, indicates hepatocellular injury and necrosis

  19. Biochemical Blood Tests • AST / ALT • Active liver insult probably drug induced (aspirin).

  20. Biochemical Blood Tests • Liver Function test • AST/ ALT • Kidney Profile test • Creatinine • Electrolytes • ( Na, K, Ca, PO) • BUN • Uric Acid • Lipid Profile test • TG • Total Cholesterol • LDL, HDL, VLDL

  21. Biochemical Blood Tests • Creatinine • used to measure GFR; indicator of renal function Increase in • Acute tubular necrosis, Dehydration, Diabetic nephropathy, Eclampsia, Glomerulonephritis, Kidney failure, Muscular dystrophy, Preeclampsia, Pyelonephritis, reduced kidney blood flow (shock, congestive heart failure), Rhabdomyolysis, Urinary tract obstruction

  22. Biochemical Blood Tests • Creatinine • Impaired Filtering Capacity of the kidneys due to CKD

  23. Biochemical Blood Tests • Liver Function test • AST/ ALT • Kidney Profile test • Creatinine • Electrolytes • ( Na, K, Ca, PO) • BUN • Uric Acid • Lipid Profile test • TG • Total Cholesterol • LDL, HDL, VLDL

  24. Biochemical Blood Tests • Sodium • major extracellular cation • maintains the proper acid-base equilibrium for the proper osmotic balance • osmotic regulation of extra-cellular fluid balance and acid balance, as well as renal, cardiac and adrenal functions

  25. Biochemical Blood Tests Sodium Increased in: Water deficit Water deficit exceeding sodium deficit Excessive intake of sodium Adrenal Cortex Hyper-function Diabetes Pyloric Obstruction Congestive Heart Failure Insufficient Anti-Diuretic Hormone production by the hypothalamic-pituitary complex Alcohol intake reduces the sodium lost in the urine

  26. Biochemical Blood Tests Sodium Decreased in: Pyloric Spasm Hyperglycemia and Diabetes mellitus lo Excess Perspiration leads to loss in the sweat Adrenal Cortex Hypo-function Diarrhea and metabolic alkalosis Excess progesterone blocks the action of aldosterone but insufficient progesterone results in greater loss of sodium in the urine Renal Dysfunction Syndrome of Inappropriate Anti-Diuretic Hormone

  27. Hyponatremia • Sodium • Most probably due to impaired kidney function

  28. Biochemical Blood Tests • Liver Function test • AST/ ALT • Kidney Profile test • Creatinine • Electrolytes • ( Na, K, Ca, PO) • BUN • Uric Acid • Lipid Profile test • TG • Total Cholesterol • LDL, HDL, VLDL

  29. Biochemical Blood Tests • Potassium • major intracellular cation • essential to heart and kidney function as well as to the maintenance of blood and urine pH • increased in: • Renal Dysfunction • Adrenal Cortex under function • Catabolic/Dysaerobic State • Metabolic Acidosis • Respiratory Dysfunction • Bradycardia • Massive Tissue Destruction • Diabetes without adequate insulin

  30. Biochemical Blood Tests Potassium Diets High in Refined Foods due to lack of potassium in the diet Hypertension Insulin use Anabolic/Anaerobic States Decreased in: • Diarrhea and/or vomiting • Adrenal Cortex over function • Several Types of Anemia • Metabolic Alkalosis • Diuretic Use • Familial Periodic Paralysis

  31. Hyperkalemia • Potassium • Most probably due to impaired kidney function

  32. Other ancillary Procedure

  33. ECG • Sinus rhythm • Left ventricular hypertrophy • pathological reaction to cardiovascular disease, or high blood pressure • increase afterload that the heart has to contract against • causes of increased afterload that can cause LVH include aortic stenosis, aortic insufficiency, and hypertension • Peak T-waves • Due to hyperkalemia

  34. Requested but not done • iCA • iPO4 • BUN • Uric acid • Lipid profile • ABG • Ultrasound of KUBP • Sputum GS, proceed to C/S if PMN >25/lpf and epithelial cells <10/lpf • Sputum AFB

  35. Biochemical Blood Tests • Ionized Calcium • is calcium that is freely flowing in blood and not bound to proteins • free calcium • test to monitor patients having kidney and parathyroid problem

  36. Biochemical Blood Tests Increased in: Decreased in: Hypoparathyroidism, malabsorption, osteomalacia, pancreatitis, renal failure rickets, vitamin D deficiency • Hyperparathyroidism, • immobilization, • idiopathic hypocalciuria, • metastatic bone tumor, • milk-alkali syndrome, • multiple myeloma, • paget's disease, • sarcoidosis, • too much vitamin D, • use of thiazide diuretics

  37. Biochemical Blood Tests • Ionized Phosphate • charged particle (ion) that contains the mineral phosphorus • Helps to build and repair bones and teeth, help nerves function, and make muscles contract • amount of phosphate in the blood affects the level of calcium in the blood • Used to monitor kidney and bone disease

  38. Biochemical Blood Tests Increased in: Decreased in: Hyperparathyroidism Osteomalacia Lack and malbsorption of vitamin D severe burns kidney or liver diseases. Severe malnutrition or starvation. Alcohol dependence High calcium levels • Kidney disease • Hypoparathyroidism • acromegaly • Too much vitamin D in the body • decrease in magnesium levels. • Pregnancy

  39. Relationship of Blood Ca and PO

  40. Biochemical Blood Tests • BUN • measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function • Urea is a substance secreted by the liver, and removed from the blood by the kidneys • Normal value: 10–20 mg/dL or 3.6–7.1 mmol/L

  41. Biochemical Blood Tests • BUN • Increased in: • kidney injury or disease • Congestive heart failure • Excessive protein levels in the gastrointestinal tract • Gastrointestinal bleeding • Hypovolemia • Heart attack • Shock • Urinary tract obstruction • Decreased in: • Liver failure • Low protein diet • Malnutrition • Over-hydration

  42. Biochemical Blood Tests • BUA • Most of the uric acid is filtered out by the kidneys and passes out of the body in urine. • if too much uric acid is being produced or if the kidneys are not able to remove it from the blood normally, the level of uric acid in the blood increases • Normal value: 3.4-7.0 mg/dL (men)

  43. Biochemical Blood Tests • BUA • Increased in: • Kidney disease or kidney damage • leukemia, lymphoma, and multiple myeloma or cancer treatments, hemolytic anemia, sickle cell anemia, or heart failure • liver disease (cirrhosis), obesity • Starvation, malnutrition • Medicines: diuretics, vitamin C, lower doses of aspirin (75 to 100 mg daily), niacin, warfarin, cyclosporine, levodopa, tacrolimus, and some medicines used to treat leukemia, lymphoma, or tuberculosis • Foods that are very high in purines: organ meats

  44. Biochemical Blood Tests • BUA • Decreased in: • Severe liver disease, Wilson's disease, or some types of cancer • Syndrome of inappropriate antidiuretic hormone (SIADH), a condition that causes large amounts of fluid to build up in the body • Not eating enough protein • Sulfinpyrazone, large amounts of aspirin (1,500 mg or more daily), probenecid and allopurinol

  45. Lipid Profile • Assess risk of heart disease • Includes: • Total cholesterol: <200 mg/dL • Triglycerides: <150 mg/dL • LDL: <100 mg/dL • HDL: >60 mg/dL

  46. Arterial Blood Gas • used to determine the pH of the blood, the partial pressure of carbon dioxide and oxygen, and the bicarbonate level

  47. Arterial Blood Gas • Expected result: • Metabolic acidosis

  48. Ultrasound of KUBP • used to assess the size, location, and shape of the kidneys and related structures, such as the ureters bladder, and prostate • can detect cysts, tumors, abscesses, obstructions, fluid collection, and infection within or around the kidneys. • can also detect calculi (stones) of the kidneys and ureters

  49. Gram's Stain and Culture of Sputum • Help to identify certain pathogens by their characteristic appearance • To be adequate for culture, a sputum sample must have: • >25 neutrophils and <10 squamous epithelial cells per low-power field • Sensitivity and specificity of the sputum Gram's stain and culture are highly variable

  50. Sputum AFB • used to determine an active Mycobacterium tuberculosis infection or an infection due to another member of the Mycobacterium family, or TB-like symptoms due to another cause • Done in patients having history and symptoms that suggest pulmonary TB such as: • Positive exposure • chronic cough (at least 2weeks), significant weight loss, low grade fever • Positive result: presence of ACID FAST BACILLI

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