Transcript Infectious Disease and Immunodiagnostic Blood Test

Biomedical
Sciences
Laboratory and
Diagnostic Tests
©2010 Jones and Bartlett Publishers
Blood Cell & Chemistry Test
©2010 Jones and Bartlett Publishers
Blood Components
• Eyrthrocytes
– Red blood cells
formed in red bone
marrow; 120 days life
span
– Carry oxygen
• Leukocytes
– Fight infection
– Granulocytes
(polymorphonuclear
leukocytes)
• Neutrophils,
eosinophils, or
basophils
-
Agranulocytes
– Mononuclear
leukocytes
– Lymphocytes or
monocytes
• Thrombocytes
– Platelets
– Coagulation
• Plasma
– Liquid component of
blood
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Blood collection procedures
• Skin (dermal)
–Collect capillary blood usually in fingertip or
heel or great toe for infants
• Venipuncture
–Withdrawn from vein through needle and
special collection tube or syringe
–Used for most diagnostic test
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Common Blood Test
• CBC
–Identifies number of red and white blood cells
per cubic millimeter (mm3) of blood
–Evaluates cellular component of blood
–Tests include white blood cell count, differential
white blood cell count, red blood cell indices,
man corpuscular volume, mean corpuscular
hemoglobin, mean corpuscular volume, mean
corpuscular hemoglobin concentration,
thrombocyte test or platelet count
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Common Blood Test (cont.)
• White blood cell count and differential white
blood cell count identify number and type of
white blood cell present in blood
• ↑ is called leukocytosis and is indicative of
infection, hemorrhage, trauma, malignancy,
general hematologic problems and leukemia
• ↓ is called leukopenia and is indicative of viral
infection, bone marrow disorders, spleen
disorders, immune problems, AIDS and
nutritional deficiencies
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RBC
• ↑ is called erythrocytosis (slight increase) or
erythremia (excessive increase) and is indicative of
overproduction of red blood cells, or a decrease in
the amount of blood plasma. Dehydration, severe
diarrhea, acute poisoning, chronic lung disease
can increase RBC
• ↓ is called anemia. Factors that cause anemia are
decreased red blood cell production, increase red
blood cell destruction and blood loss. Diseases
that cause anemia include Hodgkin’s disease,
leukemia, rheumatic fever and diseases that affect
bone marrow
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Hematocrit or Packed Cell Volume
(PCV)
• Determines percentage of red blood cells in
whole blood
• RBC/plasma = PVC
• ↑ indicative of erythrocytosis or polycynthemia
when increase is related to increase in actual
number of red blood cells
• ↓ indicative of anemia
• Interfering circumstances
–Age, pregnancy, gender, living in high altitudes
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Hemoglobin
• ↑ found in any situation that results in increased
number of healthy red blood cells. Found in
COPD, CHF
• ↓ indicative of anemia. Found in hyperthyroidism,
cirrhosis of liver, transfusion of incompatible
blood, Hodgkin’s disease, lymphoma, reactions
to various chemical and drugs
• Interfering circumstances include pregnancy,
altitude, age, gender, excessive fluid intake, and
medication usage
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Mean Corpuscular Volume (MCV)
• Describes average size of an individual red blood
cell
• ↑ means red blood cells are larger than normal.
Pernicious anemia is associated with macrocytic
red blood cells
• ↓ means red blood cells are smaller than normal.
Microcytic red blood cells seen in iron deficiency
anemia, lead poisoning and thalassemia
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Mean Corpuscular Hemoglobin
Concentration (MCHC)
• Measures the average concentration or
percentage of hemoglobin within each red blood
cell
• ↑ indicative of spherocytosis which is an increase
in the number of abnormal, spheric, red blood
cells called spherocytes
• ↓ indicates red blood cells contain less
hemoglobin than normal and classified as
hypochromic anemia which mean red blood cells
lack color. Iron deficiency anemia
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Erythrocyte Sedimentation Rate
(ESR, Sed rate)
• Rate at which red blood cells settle out of
unclotted blood in an hour. Used to determine
the progress of inflammatory diseases such as
rheumatoid arthritis, rheumatic fever and acute
MI
• ↑ due to inflammation or tissue injury. Infections,
malignancies, collagen vascular diseases
• ↓ associated with polycynthemia vera, sickle cell
anemia, and a deficiency in plasma protein
fibrinogen
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Platelet count
• ↑ called thrombocythemia or thrombocytosis and is
seen in malignancies, early stages of chronic
granulocytic leukemia, polycynthemia vera, TB,
chronic inflammatory diseases, chronic blood loss
• ↓ is called thrombocytopenia. Pernicious and
aplastic anemias, idiopathic thrombocytopenic
purpura (ITP). Commonly seen in AIDS. Patients
with platelet deficits often show signs of petechiae,
bleeding from gums, nosebleeds, and
gastrointestinal bleeding
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Mean Platelet Volume (MPV)
• Shows size of platelets
• ↑ in diameter occurs in systemic lupus
erythematosus, idiopathic thrombocytopenic
purpura in remission, various anemias,
myeloproliferative disorders and a variety of
chronic disease processes
• ↓ in size associated with aplastic anemia,
megatoblastic anemia and hypersplenism
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Blood Chemistry Tests
• Enzymes
– Proteins produced by living cells that
influence the chemical reactions of the
organism
– Increases indicative of cell death or
destruction
– Linked to specific disease processes that
affect specific organs
• Acid phosphatase
– Enzyme present in various tissues
– Highest concentration known as prostatic acid
phosphatase (PAP)
– ↑ indicative of metastatic prostate cancer
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Blood Chemistry Tests
• Prostate specific antigen (PSA)
– Found in normal prostate cells
– ↑ in prostate cancer
• Alanine Aminotransferase (ALT)
– Also known as Serum Glutamic Pyruvic
Transaminase (SGPT)
– Found in liver with lower concentrations in
heart, muscle and kidney
– ↑ associated with liver dysfunction
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Blood Chemistry Tests
• Alkaline phosphatase (ALP)
– Found in liver, bone and epithelium of all bile
ducts
– Affected by age and gender
– ↑ associated with bone diseases: Paget’s
disease, osteomalacia, metastatic bone
cancer, rickets, sarcomas arising from bone,
healing fractures
• Asparate Aminotransferase (AST)
– Also known as Serum Glutamic-oxaloacetic
Transaminase (SGOT)
– ↑ associated with MI and various liver
diseases
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Blood Chemistry Tests
• Creatine Kinase (CK)
– Also known as Creatine Phosphokinase
(CPK)
– Found in heart and skeletal muscles and
lesser degree brain
– ↑ indicative of MI, skeletal muscle disease
and brain injury or trauma
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Blood Chemistry Tests
• Lactic acid dehydrogenase (LD, LDH)
– Found in heart, liver, kidneys, skeletal muscle,
brain and lungs
– ↑ associated MI
• Lipase
– Produced by pancreas and assists in
breakdown of triglycerides
– ↑ associated with acute and chronic
pancreatitis, pancreatic cancer
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Blood Chemistry Tests
• Hormone
– Specialized chemical substances that are
produced and secreted by endocrine cells and
tissue, circulate in blood, affect the metabolic
activity of specific target cells and organs
– ↑ or ↓ affect the function of the target cells
and organs
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Blood Chemistry Tests
• Antidiuretic Hormone (ADH)
– Manufactured by hypothalamus, secreted by
posterior lobe of pituitary gland and controls
amount of H2O reabsorbed by kidneys
– ↑ serum levels give rise to syndrome of
inappropriate ADH secretion (SIADH) conditions
marked by high levels of ADH
• Diseases associated include cancer of lung,
thymus, pancreas, urologic tract, lymphomas,
leukemia, pulmonary disease, brain tumors
• ↓ seen in diabetes insipidus
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Blood Chemistry Tests
• Human Chorionic Gonadotropin (HCG)
– Found in pregnant women as early as 10
days after conception
– ↑ ectopic pregnancy, hydatidiform mole of
uterus, uterine and testicular cancer
– ↓ seen threatened abortion, incomplete
abortion, intrauterine fetal death
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Blood Chemistry Tests
• Cortisol
– Most abundant glucocorticoid hormone secreted
by adrenal cortex which play role in maintaining
blood glucose levels, metabolizing food,
functioning as anti-inflammatory agent
– ↑ found in Cushing’s syndrome, hyperthyroidism,
adrenal adenoma, over production of
adreoncoticotropic hormone (ACTH)
– ↓ seen in Addison’s disease, hypopituitarism,
hypothyroidism, hepatitis, cirrhosis
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Blood Chemistry Tests
• Gastrin
– Produced and secreted by specialized cells of
stomach
– Aids in digestion and maintenance of stomach
pH
– ↑ indicate Zollinger-Ellison syndrome
(stomach produces excess hydrochloric acid),
gastrin producing pancreatic tumor,
hyperplasia of G-cells of stomach, gastric
cancer, pernicious anemia
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Blood Chemistry Tests
• Growth hormone (GH)
– Also known as somatotropin and somatotropic
hormone (STH) is released by anterior lobe of
pituitary gland and is essential for growth
– ↑ can lead to gigantism in children,
acromegaly in adults
– ↓ result in premature closure of epiphyseal
disks which leads to dwarfism
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Blood Chemistry Tests
• Testosterone
– Responsible for sperm production
– ↑ in men can be caused by adrenal
hyperplasia and adrenocortical or testicular
tumors
– ↓ in males associated with cryptorchidism,
hypogonadism, and Klinefelter’s syndrome
(XXY or XXY syndrome is a condition caused
by a chromosome aneuploidy {chromosome
problem} causing small testicles and reduced
fertility)
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Blood Chemistry Tests
• Thyroid stimulating hormone
– Secreted by anterior lobe of pituitary gland
– Stimulates thyroid to produce and secrete
thyroxine, triiodothyronine, and calcitonin
– Thyroxine (T4) ↑ associated with Grave’s
disease, Plummer’s disease, thyrotoxicosis
– Triiodothyronine (T3) ↑ associated with
hyperthyroidism, T3 thyrotoxicosis, thyroiditis,
and thyroid tumor
– Calcitonin ↑indicative of medullary cancer of
thyroid, oat cell cancer of lung, breast and
pancreatic cancer, pernicious anemia
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Blood Chemistry Tests
• Thyroid Stimulating Hormone (TSH)
– Secreted by anterior lobe of pituitary gland
and stimulates thyroid to produce and secrete
thyroxine (T4) and triiodothyronine (T3)
– ↑ indicative hypothyroidism, thyroiditis, lack of
thyroid growth or development
– ↓ associated with secondary hypothyroidism,
hyperthyroidism, and pituitary dysfunction
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Blood Chemistry Tests
• Ferritin
– Storage form of iron, formed in intestine,
stored in liver, spleen, and bone marrow
– ↑ megaloblastic, and hemolytic anemia,
alcoholism, breast cancer, Hodgkin’s disease
– ↓ iron deficiency anemia, severe protein
deficiency, patients undergoing hemodialysis
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Blood Chemistry Tests
• Transferrin Test; Total Iron Binding
Capacity (TIBC)
– Iron in blood is bound to transferrin, a protein
to transport iron
– ↑ and/or ↓ of TIBC, serum iron, and transferrin
saturation associated with various anemias,
– ↓ associated with iron deficiency anemia
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Coagulation Studies
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Platelets and Clotting
• Platelet aggregation
– Sticking of platelets to each other
– Identifies platelets’ ability to aggregate
• Clot retraction time
– Used to evaluate platelet function and
fibrinolysis
– Abnormality noted in thrombocytopenia, von
Willenbrand’s disease, increased red blood
cell mass, severe anemia,
hypofibrinogenemia, decrease in fibrinogen in
blood
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Prothrombin Time
• Pro time
• Used to diagnose coagulation problems
• ↑ indicative of deficiency in 1 of 5
coagulation factors
– Vitamin K deficiency, toxic levels of vitamin A,
prothrombin deficiency, hemorrhagic disease of
newborns, alcoholic hepatitis, biliary obstruction,
salicylate poisoning
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Activated Partial Thromboplastin Time
•
•
•
•
•
APTT
Measure efficacy of anticoagulant therapy
Measure coagulation factors 1,2,5,8,9,10,11,12
↑ in heparin therapy, bleeding disorder
↓ in extensive malignancies (excluding liver),
immediately after acute hemorrhage, early
stage of disseminated intravascular
coagulation (DIC) disease
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Thrombin Time
• Measures blood plasma level of fibrinogen
(precursor of fibrin)
• ↓ results in absence of clot formation;
indicative of multiple myeloma, and
congenital abnormalities of fibrinogen
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Fibrinogen Assay
• Measures concentration of fibrinogen in
the blood
• ↑ associated with hepatitis, TB,
septicemia, multiple myeloma, cancer,
nephrosis, rheumatic fever
• ↓ can demonstrate genetic disorders,
severe liver disease, DIC
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Factor Assay Test
• Measures plasma concentration of specific
coagulation factors
• Variations from normal indentified by
Factors
– Hemophilia, von Willebrand’s disease, hepatic
diseases, vitamin K deficiency, liver disease,
nephrotic syndrome, coronary artery disease,
myeloma, hypoglycemia
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Immunodiagnostic Blood Test
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Infectious Disease and
Immunodiagnostic Blood Test
• Agglutination
– Clumping of cells due to their reaction with
antibody
– Antigens on cells react
– Agglutination = positive test results
– Used to determine blood type, rheumatoid factor,
infectious mononucleosis, bacterial identification
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Infectious Disease and
Immunodiagnostic Blood Test
• Agglutination test
– Microhemaggluntination (MHA)
• Clumping of RBC
– Latex agglutination
• Uses latex component that allows agglutination
– Hemagglutination inhibition test
• RBC prevented from clumping
• Positive results indicates absence of
agglutination
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Infectious Disease and
Immunodiagnostic Blood Test
• Fluorescent immunoassay (FIA)
– Direct fluorescent antibody (DFA)
• Antigen detection
– Indirect fluorescent antibody (IFA)
• Antigen or antibody detection
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Infectious Disease and
Immunodiagnostic Blood Test
• Enzyme immunoassay
– Enzyme immunoassay (EIA)
• Detect antibodies or antigens in viral or
parasitic diseases
– Enzyme-linked immunoassay (ELISA)
• Detect antibodies or antigens in viral or
parasitic diseases
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Infectious Disease and
Immunodiagnostic Blood Test
• Radioimmunoassay (RIA)
– Identify viral diseases
– RIA procedures are being replaced with
EIA procedures
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Infectious Disease and
Immunodiagnostic Blood Test
• Syphilis Detection Tests (Treponema
pallidum)
– Detects reagin
• Reagin
– Antibody like substance found in serum of
individuals with syphillis
• Venereal Disease Research Laboratory
(VDRL)
• Rapid plasma reagin (RPR)
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Infectious Disease and
Immunodiagnostic Blood Test
– Detects treponemal antibodies
• Fluorescent treponemal antibody absorption
(FTA-ABS)
• Microhemagglutination Treponema pallidum
antibody (MHA-TP)
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Infectious Disease and
Immunodiagnostic Blood Test
• Lyme disease (borrelia burgdorferi)
– Western blot assay
– IFA
– ELISA
– Polymerase chain reaction (PCR)
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Infectious Disease and
Immunodiagnostic Blood Test
• Legionnaires’ disease test
– AKA legionellosis, Legionnaires’ pneumonia
Legionella pneumonophila
– Acute airborne bacterial disease that attacks
respiratory system
– Dx
• IFA (test of choice)
• ELISA
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Infectious Disease and
Immunodiagnostic Blood Test
• Chlamydia antibody test
– Chlamydia infections (Chlamydia trachomatis)
most frequent sexually transmitted disease
and most frequent cause of sterility
– Acute airborne bacterial disease that attacks
respiratory system
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Infectious Disease and
Immunodiagnostic Blood Test
• Chlamydia antibody test Continued…
– Dx
• IFA
• PCR
• Complement fixation (CF) test
– Identifies viral antibodies (primarily) and
fungal antibodies
– Negative result indicates absence of
antibody being tested and positive indicate
antibody being tested is present
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Infectious Disease and
Immunodiagnostic Blood Test
• Streptococcal antibody test
– Antistreptolysin O titler (ASO)
• Detects antibodies to streptolysin O
• Dx
– Rheumatic fever, glomerulonephritis,
endocarditis, scarlet fever
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Infectious Disease and
Immunodiagnostic Blood Test
– Streptozyme
• Identifies antibodies to several enzymes
– AntiDNase B (ADB)
• Detects antibodies to DNase B
• Dx
– Streptococcal pyoderma, streptococcal
pharyngitis
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Infectious Disease and
Immunodiagnostic Blood Test
• Infectious mononucleosis test
– Acute viral infection caused by Epstein-Barr
virus (EBV)
– EBV causes an increase in heterophil
antibody formation which is diagnostic for
infectious mononucleosis
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Infectious Disease and
Immunodiagnostic Blood Test
• Rubella antibody test
– AKA German measles
– Dx
• Complement fixation
• ELISA
• Latex agglutination
• Hemagglutination inhibition test
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Infectious Disease and
Immunodiagnostic Blood Test
• Hepatitis A
– AKA infectious hepatitis transmitted via fecaloral route
– Dx via RIA and ELISA
– Acute hepatitis A
• Indentifies 2 separate antibodies; both must be
present
– IgM antibodies against hepatitis A virus (IgM
anti-HAV)
– Total antibody against hepatitis A virus (total
anti-HAV)
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Infectious Disease and
Immunodiagnostic Blood Test
– Chronic or convalescent stage of hepatitis
A
• IgG antibodies against hepatitis A virus
(IgG anti-HAV) which appears after
increase in IgM anti-HAV can be detected
for > 10 years
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Infectious Disease and
Immunodiagnostic Blood Test
• Hepatitis B
– AKA serum hepatitis caused by hepatitis B
virus (HBV) transmitted via saliva, blood and
serum, semen and vaginal fluids
– Associated with occupations in frequent
contact with blood and blood products
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Infectious Disease and
Immunodiagnostic Blood Test
– Dx via RIA and ELISA
• Three antigen antibody substances
– Hepatitis B surface antigen (HBsAg)
– Antibody to HBsAg (anti-HBc)
– Hepatitis B envelope antigen (HBeAG) and
antibody to HBeAg (anti-HBe)
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Infectious Disease and
Immunodiagnostic Blood Test
• Hepatitis C
– AKA non-A, non-B hepatitis
– Caused by hepatitis C virus and transmitted
by percutaneous exposure to contaminated
blood and plasma derivatives
– Dx EIA
• Detects anti-HCV
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Infectious Disease and
Immunodiagnostic Blood Test
• Human Immunodeficiency Virus (HIV-1, HIV2); Acquired Immunodeficiency Syndrome
(AIDS)
– AIDS
• Late clinical stage HIV
• HIV1 most common in US
• HIV 2 predominantly in West Africa
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Infectious Disease and
Immunodiagnostic Blood Test
– Caused by hepatitis C virus and transmitted
by percutaneous exposure to contaminated
blood and plasma derivatives
– Dx
• EIA
• If ELISA + then Western blot performed
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Infectious Disease and
Immunodiagnostic Blood Test
• Herpes Simplex
– Herpes simplex 1 (HSV-1)
• Fever blisters, cold sores
– Herpes simplex 2 (HSV-2)
• Sexually transmitted disease of urogenital tract
– Dx
• EIA
• IFA
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Infectious Disease and
Immunodiagnostic Blood Test
• Cytomegalovirus (CMV) antibody test
– Human viral pathogen that belongs to herpes
virus
– IFA, ELISA and latex agglutination detects
CMV-specific IgM antibody
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Infectious Disease and
Immunodiagnostic Blood Test
• TORCH
– Pregnancy screening test for toxoplasmosis,
rubella, cytomegalovirus and herpes virus
• C-Reactive Protein (CRP) test
– CRP antibody detected to evaluate
inflammatory diseases and conditions that
involve tissue necrosis
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Infectious Disease and
Immunodiagnostic Blood Test
• Rheumatoid factor (RF) test
– Rheumatoid factor is an autoantibody often
found in serum of rheumatoid arthritis
– Also detected in patients with lupus, hepatitis,
scleroderma, subacute bacterial endocarditis,
TB
– Sheep cell agglutination or latex fixation test
usually performed to detect rheumatoid factor
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Infectious Disease and
Immunodiagnostic Blood Test
• Anti-nuclear antibody (ANA) test
– ANA antibody reacts against cellular nuclear
material
– Presence highly indicative systemic lupus
erythematosus
• Blood group
– ABO grouping
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Infectious Disease and
Immunodiagnostic Blood Test
• Rh grouping
– Detects presence of absence of Rh antigen
on red blood cell membrane
– Identifies blood as Rh – or + next to A and B
antigen blood grouping
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Culture and Sensitivity Test
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Culture & Sensitivity Tests
• Culture
– Lab test by which samples of body specimens
are cultivated in a special growth medium in
order to isolate the microorganism
• Sensitivity test
– Identifies antibiotics that may be effective
against the microorganism
• Septicemia
– Systemic infection in which pathogens are
present in circulating blood
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Culture & Sensitivity Tests
• Blood culture
– E. coli (food poison, gastroenteritis, urinary
tract infections, pneumonia, septicemia and
neonatal meningitis), Staphylococcus
epidermis (nosocomial bacteremia),
Staphylococcus aureus (MRSA), Listeria
monocytogenes (food poisoning), Neisseria
meningitidis, Salmonella and Klebsiella
(nosocomial wound infections, pneumonia)
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Culture & Sensitivity Tests
• Cerebrospinal fluid culture
–
E. coli, Staphylococcus aureus, Haemophilus
influenzae (bacteremia, pneumonia, and
acute bacterial meningitis), Pseudomonas
aeruginosa, pneumococcus, meningococcus,
streptococci
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Culture & Sensitivity Tests
• Genitalia and Anal cultures
– Chlamydia, Candida, Mycoplasma,
Gardnerella vaginalis, Neisseria gonorrhoeae,
Treponema pallidum, Trichomonas vaginalis
• Nose and Throat cultures
– Staphylococcus epidermis (nosocomial
bacteremia), Staphylococcus aureus (MRSA),
Propionibacterium acnes (acne),
Microsporum, Trichophyton, Epidermophyton
(ringworm, athlete’s foot)
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Culture & Sensitivity Tests
• Sputum culture
– Haemophilus influenzae, Klebsiella
pneumoniae, Micobacterium tuberculosis,
Candida, Aspergillus, Corynebacterium
diphtheriae, Bordetella pertusis
• Stool culture
– Salmonella (typhoid fever, paratyphoid fever,
food poisoning) Shigella (dysentery),
Campylobacter (food poisoning, diarrhea),
Yersinia, Staphylococcus, E. coli, Ascaris
(hookworm)
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Culture & Sensitivity Tests
• Wound culture
– Staphylococcus aureus, Klebsiella, Proteus,
Pseudomonas (peritonitis, endophthalmitis,
septicemia and bacteremia, pneumonia),
Mycobacterium (TB, leprosy)
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Amniotic Fluid and
Cerebrospinal Fluid Tests
and
Other Body Fluids
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Amniotic Fluid and Cerebrospinal Fluid
Tests
• Amniotic fluid
– Amniocentesis
• Fetal sex determination
• Fetal chromosome analysis
– Down’s syndrome, hemophilia, cystic
fibrosis
• Alpha-fetoprotein and Acetylcholinesterase
levels
– Anencephaly, spina bifida, hydrocephalus
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Amniotic Fluid and Cerebrospinal Fluid
Tests
• Cerebrospinal fluid
– Meningitis
– Encephalitis
– Guillain-Barre syndrome
– neurosyphillis
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Other Body Fluid Tests
• Effusion tests
– Excessive accumulation of fluid in body
cavities lines with serous or synovial
membranes
– Named for their associated cavities
– Sample obtained via needle aspiration
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Other Body Fluid Tests
• Pericardial effusion
– Hemorrhagic pericarditis, met ca, anueurysm,
TB
• Peritoneal effusion
– Blocked thoracic lymph ducts, trauma, cirrhosis,
pancreatitis, tuberculosis peritonitis
• Pleural effusion
– Emphyema, pneumonia, pulmonary TB,
pulmonary infarction, ca, thoracic trauma
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Other Body Fluid Tests
• Synovial effusion
– Arthritis, gout, synovitis, osteoarthritis,
degenerative joint disease
• Gastric secretion analysis
– Aplastic, hyperchormic and pernicious
anemia, Zollinger-Ellison syndrome
• Semen fertility
–
indicates infertility
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Radiology Studies
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Radiology Studies
• Chest x-ray
– Pneumonia, emphysema, pericarditis, pleural
effusion, TB, fractures, diaphragmatic hernia,
scoliosis
• Mammography
– Breast cancer, fibrocystic breast disease,
acute suppurative mastitis, abscess, tumors,
cysts
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Radiology Studies
• KUB
– Malformations of organ, calculi, ascites
• Long bone & skull radiography
– Fracture, tumor, infection, congenitital
abnormalities
• Spinal radiography
– Fracture, tumor, spondylosis, arthritic changes
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Radiology Studies
• Angiography
– X-rays of vascular system by injecting a
contrast medium such as iodine can reveal
thrombi, emboli and aneurysms
• Cholcystography
– Gallstones, polyps, chronic cholecystitis
• T-tube cholangiography
– Common bile duct stones, structures, tumors,
bile duct cysts, anatomic variations
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Radiology Studies
• Barium swallow
– Hiatal hernia, varices, strictures, esophageal
reflux, peptic ulcer, diverticula, chalasia
• Upper GI
– Esophageal strictures, diverticula, varices,
hiatal hernia, gastric ulcers, tumors, gastritis,
inflammatory diseases
• Barium Enema
– Colon tumors, obstructions, perforations,
diverticula, polyps, hernias
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Radiology Studies
• Urinary system radiography
– Cystography, Intravenous Urography, IVP,
Retrograde Pyelography
– Kidneys, ureters, bladder
• Arthrography
– Joint derangement, rotator cuff rupture, joint
dislocation, arthritis, synovial abnormalities,
ligament tears, cartilage disease
• Myelography
– Ruptured or herniated disks, spinal cord
tumors, spinal canal obstruction
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Radiology Studies
• CAT scan
– Cerebral infactions, neoplasms, hematomas,
aneurysms, hemorrhages, hydrocephalus,
nodules, cysts, cirrhosis of liver, lymphoma,
pleural effusion, bone metastasis
• MRI
– Produces images through bone tissue and
fluid filled soft tissue and is able to scan
transverse, sagittal and coronal planes of
body
– Abnormalities of bones, joints, cartilage
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Nuclear Medicine Studies
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Nuclear Medicine Studies
• Radionuclides which are tracers (decayed
radioactive isotopes) are given to a patient
• Radiation detection equipment locates the
uptake in the tissue under study
• Equipment converts detection of uptake into
images
• Images may be two or three dimensional in color
or shades of black and white, moving or static
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Nuclear Medicine Studies
• Single-photon emission computed
tomography (SPECT)
– Three dimensional imaging
– Assist in evaluating organ function and
structure
• Positron emission tomography (PET)
– Three dimensional imaging color images
– Assist in evaluating anatomy, physiology and
biochemistry
– Most often used for heart and brain
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Nuclear Medicine Studies
• Brain scan
– Rupture aneurysms, abscesses, cysts,
tumors, hematomas, thrombosis,
hermorrhage
• Cerebrospinal fluid flow scan
(cisternography)
– Hydrocephalus, spinal lesions, subdural
hematoma, cysts
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Thyroid scans
– Assess function and health of thyroid
– Goiters, cancer, Grave’s disease, Plummer’s
disease, Hashimoto’s thyroiditis,
hyperthyroidism, hypothyroidism
• Iodine-131
– Determines if thyroid tissue is in abnormal
locations of the body, mets. of thyroid ca,
residual thyroid following gland removal
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Radioactive Iodine Uptake (RAIU) Test
– Evaluate thyroid function for via % of
radionuclide absorbed over period of time
– Hyperthyroidism ↑ absorption of radionuclide
– Hypothyroidism ↓ absorption rate
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Thyroid stimulating hormone (TSH) test
– Differentiates between primary and secondary
hypothyroidism
– Primary hypothyroidism ↓ uptake of
radioactive iodine
– Secondary hypothyroidism ↑ in uptake of
radioactive iodine
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Parathyroid scan
– Assess size, position, function and location of
parathyroid
– Differential diagnosis between hyperplasia
and adenoma
– Abnormal glands identified
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Heart scans
– Used to evaluate heart function and wall
motion without surgical intervention
• Thallium stress test
– Radionuclide scan of heart used to assess
coronary perfusion, patency (unblocked) of
bypass blood vessels, coronary artery
disease, effectives of meds and angioplasty
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Multigated acquisition (MUGA) scan
– Radionuclide study of heart in motion to
record images of heart contraction and
relaxation
– CHF, valvular heart disease, cardiomyopathy
and ventricular aneurysm
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Lung scans
– Pulmonary perfusion and ventilation scans
identify embolisms
– Tumors, COPD, pneumonia, atelectasis,
asthma, bronchitis, emphysema and TB best
found on chest x-ray
• Gallbladder and biliary system scan
– Chronic cholecystitis, obstruction of cystic and
common bile ducts caused by gallstones and
tumors
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Gastrointestinal reflux scan
– Gastric reflux and pulmonary aspiration,
esophageal spasms, achalasia, inability of
cardiac sphincter muscle of the stomach to
relax
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Kidney (renal) scans
– Evaluate renal structure, function, and blood
flow; renal excretory function; glomerular
filtration rates
– Renal infarction, infection, inflammatory
disease, glomerulonephritis, pyelonephritis,
abscesses, cysts, thrombosis or stenosis of
blood vessels, assessing kidney transplants,
congenital abnormalities, size and shape of
kidneys
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Liver scan
– Study size, shape and function of liver
– Liver and spleen scans done together
because the same radionuclide is used for
each study
– Hepatitis, cirrhosis, ascites, hepatomegaly,
benign tumors, abscesses, cystic lesions,
mets tumor
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Spleen scan
– Study size, shape and function of spleen
– Abnormalities, tumors, obstructions, cancer
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Scrotal (testicular) scans
– Study contents of scrotal sac including testes,
epididymus, spermatic cord
– Epididymus orchitis, hydrocele, varicocele,
testicular and spermatic cord torsion, tumors,
hematomas
• Bone scan
– Study the skeleton
– Osteomyelitis, Paget’s disease, Perthes’
disease, fractures, cysts, arthritis, mets
cancer
©2010 Jones and Bartlett Publishers
Nuclear Medicine Studies
• Gallium-67 scan
– Radionuclide studies of entire body
– Lymphomas, carcinomas of gastrointestinal
tract, kidneys, uterus, stomach, testicles, mets
and primary ca of brain, lung, liver, and bone
©2010 Jones and Bartlett Publishers
Ultrasound
©2010 Jones and Bartlett Publishers
Ultrasonography
• Safe noninvasive procedure that uses
sound waves to create images of soft
tissues
• Higher frequencies used to treat back pain
and pulverize kidney and gallstones
(Percutaneous ultrasonic lithotrips- PUL)
©2010 Jones and Bartlett Publishers
Ultrasonography
• Neonate head
– Hydrocephalus, cerebral hemorrhages
• Thyroid
– Goiters, tumors, cysts
• Ocular
– Grave’s disease, hemorrhages, detached
retina
©2010 Jones and Bartlett Publishers
Ultrasonography
• Breast
– Tumors, cysts
• Echocardiography
– Stenosis, prolapse, PE, thrombi, tetralogy of
Fallot
• Intravascular
– Indentify candidates for CABG, thrombi,
atherosclerotic lesions
©2010 Jones and Bartlett Publishers
Special Organ Studies
©2010 Jones and Bartlett Publishers
Special Organ Studies
• EKG
– Records electrical impulses that stimulate
heart to contract
– Arrythmias, Wolff-Parkinson-White syndrome,
pericarditis
• EEG
– Measures electrical activity of cerebral cortex
– Lesions, hemorrhages, infarction,
glioblastoma, abscesses, seizure disorders
©2010 Jones and Bartlett Publishers
Special Organ Studies
• EMG
– Invasive diagnostic test to detect muscular
disorders
– Muscular distrophy, myathenia gravis,
Guillain-Barre syndrome, diabetic neuropathy
©2010 Jones and Bartlett Publishers
Special Organ Studies
• Holter monitor
– Continuously record electrical activity of heart
over an extended time
– Arrhythmias, bradycardia, tachycardia, a-fib,
a-flutter
©2010 Jones and Bartlett Publishers
Special Organ Studies
• Somatosensory Evoked Response (SER)
– Neurological and sensory pathways
associated with pain and touch
– Multiple sceloris, Guillain-Barre syndrome,
spinal cord injuries
• Electrophysiology Study (EPS)
– Invasive study to identify heart defects and
arrythmias
©2010 Jones and Bartlett Publishers
Special Organ Studies
• Spirometry
– Lung capacity
• Pulmonary perfusion
– Blood flow through pulmonary vessels
• Pulmonary diffusion
– O2 CO2 exchange
• Pulmonary ventilation
– Air exchange with atmosphere
©2010 Jones and Bartlett Publishers
Urine and Fecal Studies
©2010 Jones and Bartlett Publishers
Urine Analysis
• Physical Analysis
– Exam clarity, color, odor, specific gravity
• Abnormalities Indicative of
– Renal or metabolic disorders, infections, or
obstructions as well as other conditions
©2010 Jones and Bartlett Publishers
Chemical Analysis of Urine
• Bilirubin
– Liver or bile ducts condition
• Blood
– Infection, trauma, bleeding in kidneys
• Glucose
– Diabetes mellitus, Cushing’s syndrome,
pituitary disorder, malfunction glucose
reabsorption by kidneys
• Keytone
– Diabetes, anorexia, diet low in carbs high in
fat, starvation, fasting, excessive vomiting
©2010 Jones and Bartlett Publishers
Chemical Analysis of Urine
• Nitrites
– UTI, E. Coli
• pH
– UTI, chronic renal failure, hyperventilation,
respiratory disease
• Protien
– Nephrosis, glomerulonephritis, pyelonephritis,
polycystic kidney disease, UTI, diabetes,
lupus erythematosus
©2010 Jones and Bartlett Publishers
Chemical Analysis of Urine
• Urobilinogen
– Cirrhosis of liver, acute hepatitis, pernicious
and hemolytic anemia, hemorrhage
©2010 Jones and Bartlett Publishers
Urine Studies
• Pregnancy test
– Checks for presence of human chorionic
gonadotropin
– Trophoblastic disease (malignant neoplastic
disease of uterus), breast and ovarian cancer
may give positive results
• Phenylketouria (PKU) Urine Test
– Routine test on newborns to test for PKU
which can cause brain damage
©2010 Jones and Bartlett Publishers
Fecal Studies
• Physical exam of feces
– Color, consistency, order, shape
– Gastrointestinal bleeding, ulcerative colitis,
diverticulitis
• Occult blood analysis
– Bright red
• Colorectal cancer, hemorrhoids, ulcerative
colitis
– Black and tarry
• Upper gastrointestinal bleeding consist with
ulcers and varices
©2010 Jones and Bartlett Publishers
Fecal Studies
• Leukocyte test
– Leukocytes in stool with diarrhea may be
bacterial diarrhea
– Ulcerative colitis
• Fat test
– Pancreatic enzyme deficiency
©2010 Jones and Bartlett Publishers
Fecal Studies
• Parasite tests
– Protozoa infestations = dysentery =
perforation and peritonitis
– Hookworm = anemia
– Pinworm = itching of skin around anus
– Tapeworm = diarrhea, epigastric pain, weight
loss
©2010 Jones and Bartlett Publishers
Endoscopy Studies
©2010 Jones and Bartlett Publishers
Endoscopy Studies
• Bronchoscopy
– Abscesses, tumors, blockages, foreign
bodies, inflammation
• Mediastinoscropy
– TB, Hodgkin’s disease, lymphoma,
sarcoidosis, histoplasmosis
©2010 Jones and Bartlett Publishers
Endoscopy Studies
• Thoracoscopy
– Plural effusion, infection, inflammation
• Transesophageal Echocardiography
– Aortic dissection, cardiac tumors, cardiac
emboli, cardiomyopathy, myocardial ischemia,
infarction, septal defects, valvular heart
disease
©2010 Jones and Bartlett Publishers
Endoscopy Studies
• Laparoscopy
– Pancreatitis, cirrhosis of liver, gallstones,
pancreatic cancer
• Endoscopic retrograde
cholangiopancreatography
– Gallstones, pancreatic stones, cholangitis,
pancreatitis, tumors, cysts, strictures of biliary
and pancreatic ducts
©2010 Jones and Bartlett Publishers
Endoscopy Studies
• Proctoscopy, sigmoidoscopy,
protosigmoidoscopy
– Hemorrhoids, rectal prolapse, abscesses,
fissures, polyps, tumors
©2010 Jones and Bartlett Publishers
Endoscopy Studies
• Colonoscopy
– Colon cancer, Crohn’s disease, infectious
colitis
• Cystoscopy
– Cancer of bladder, polyps, stones, prostatic
hypertrophy and prostatitis
• Urodynamic studies
– Sensory or motor abnormalities that alter
normal muscular functioning of lower urinary
tract
©2010 Jones and Bartlett Publishers
Endoscopy Studies
• Pelviscopy, gynecologic laparoscopy
– Endometriosis, PID, ovarian cysts, tumors,
fibroids
• Colposcopy
– Tumors, condylomata and HPV
• Culdoscopy
– Ectopic pregnancy, abnormal fallopian tubes,
pelvic masses
©2010 Jones and Bartlett Publishers
Endoscopy Studies
• Arthroscopy
– Joint fractures, torn ligaments or cartilage,
arthritis, synovitis
• Amnioscopy
– Amniotic fluid that contains meconium
staining may be indicative of fetal hypoxia
• Fetoscopy
– Abnormal physical defects in fetus such as
neural tube defects, blood disorders such as
sickle cell anemia or hemophilia and skin
disorders
©2010 Jones and Bartlett Publishers