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【ppt】診斷學(xué)總論（英文版）-仁濟(jì)臨床醫(yī)學(xué)院診斷學(xué)課件
Clinical Diagnostics
Department of gastroenterology
Ren-Ji hospital
Shanghai Jiao Tong University, School of Medicine
Ran Zhi Hua (冉志華）
What is Clinical Diagnostics?
Fundamental theory
基礎(chǔ)理論/知識
Techniques of diagnosing disease
診斷疾病的技術(shù)
Mode of clinical thinking
臨床思維的方式
What is Clinical Diagnostics?
Instruct a concise logical approach to recognize
the genius of the diseases
教會(huì)一種簡明而又合乎邏輯的步驟去識別疾
病的本質(zhì)
A fundamental course of clinical medicine
臨床醫(yī)學(xué)的基本課程
Fundamental elements of Diagnostics
Diagnosis
Diagnosis（診斷）
Derived from Greek words
distinguish or discern
識別/鑒別 認(rèn)識


English term
Diagnostic

The distinguishing sign and symptoms with which it gerenally begins, continues and goes off…as it were, a history of the disease
對疾病特征的識別及對疾病的診斷

In 18th century: Nosography（病情學(xué)）
通過疾病的表現(xiàn)來識別疾病內(nèi)在本質(zhì)或?qū)傩?br />
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

【ppt】診斷學(xué)總論（英文版）-仁濟(jì)臨床醫(yī)學(xué)院診斷學(xué)課件

Importance of Diagnostics
Content of Clinical Diagnostics
Symptomatic Diagnosis
Symptomatic Diagnosis
Physical Diagnosis
Laboratory test or ancillary tests
Serum, Urine, Stool tests
X-ray film
EKG
Endoscopy
Ultrasonic imaging
CT
MRI
PET (Positron Emission Tomography)
Medical record
Special terms in clinical diagnosis
Differential diagnosis
Preliminary diagnosis/Tentative diagnosis
初步診斷 可能性診斷
Exclusion of other diseases (排除其它疾病)

Selecting a number of possibilities to explain the clinical and laboratory findings in the case in question
【ppt】診斷學(xué)總論（英文版）-仁濟(jì)臨床醫(yī)學(xué)院診斷學(xué)課件
The way of exclusion is called Differential diagnosis
Evidence based medicine
It is the conscientious（謹(jǐn)慎的）, explicit （明確的）and judicious （有見解的）use of current best evidence in making decisions about the care of the individual patient It means integrating individual clinical expertise （臨床專長）with the best available external clinical evidence from systematic research
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.
Important aspects---interrogation
To get the history in detail of a patient’s illness
【ppt】診斷學(xué)總論（英文版）-仁濟(jì)臨床醫(yī)學(xué)院診斷學(xué)課件
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

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
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
【ppt】診斷學(xué)總論（英文版）-仁濟(jì)臨床醫(yī)學(xué)院診斷學(xué)課件
Method of approaching a diagnosis:
Analysis of symptoms (癥狀分析)
Recognition of the syndrome (綜合癥識別)
Consideration of disease mechanisms (考慮疾病機(jī)制)
Important aspects
Modern & advanced ancillary techniques:
have their limitations.
It can’t 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
Approaches
Basic knowledge learning（基礎(chǔ)知識的學(xué)習(xí)）
Developmental History of clinical diagnostics
Western Medicine: from ancient to modern
【ppt】診斷學(xué)總論（英文版）-仁濟(jì)臨床醫(yī)學(xué)院診斷學(xué)課件
Traditional Chinese Medicine
Contribution of ancient doctors---Western
Hippocrates

Born on the island of Cos,
Greece (c. 460-377 BC)

The Father of medicine
Hippocratic oath
希波克拉底宣言
Hippocratic corpus（文集）:
a collection of 70 works

Hippocratic oath
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,

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診斷學(xué)總論（英文版）-仁濟(jì)臨床醫(yī)學(xué)院診斷學(xué)課件.ppt