Laboratory Medicine

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Gross Pathology Handbook
Excerpt

INTRODUCTION Why this guide?

As medical professionals (Christopher Horn is a pathologists’ assistant, Christopher Naugler is a general pathologist and family physician), we have often wanted a resource with a comprehensive list of gross-descriptive terms and examples of gross specimens. We figured such a resource would help not only us, it would help other professionals as well: it could, for example, help standardize gross-descriptive terminology and make pathology reports more succinct.

We couldn’t find a resource like this, so we created this guide.

This guide pairs a comprehensive list of gross-dissection terms with photographic examples of gross-dissection specimens.

It aims to help pathology professionals—pathology residents, pathologists’ assistants, and medical laboratory technicians—describe surgical and autopsy specimens as they perform gross dissection.

The pathology gross room and autopsy suite are fascinating places that analyze specimens from the operating room. The specimens often involve a variety of disease processes, 1 or many organ systems, and—as a result—a multitude of gross appearances. Quite often, the same disease process appears different on similar specimen types, or different from patient to patient. As a pathology-lab professional, your job is to describe what you see, so that a pathologist or clinician can read the description and visualize the specimen. This can be a daunting task, given the variability and complexity of specimens—especially for new pathology staff at the beginning of their surgical gross-dissection training. A common question in the gross room is: “How would you describe this specimen?”

The flipside of this question, from a clinician’s point of view, is: “What does this specimen look like, based on this description?” This guide also aims to help clinicians and medical students navigate pathology reports.

How to use this guide

Look up terms, look up images

If you are a lab professional who is training to perform gross surgical dissection, you can use this guide, first, as a way to study specimens and the terms to describe them. Then, as you work in the surgical gross area, you can use it to identify appropriate terms by comparing your gross findings with the images. As your skills progress, you can use it to refresh and validate your gross-descriptive skills.

As a clinician or medical student, you can use this guide “in reverse” to help interpret pathology reports: to look up unfamiliar gross-descriptive terms and see examples of specimens they describe.

Combine terms for precise description

As a lab professional, you should combine the terms in this guide as necessary to arrive at the most precise descriptions possible.

For example, to describe the appearance of a fibroid uterus, you might combine the terms whorled and circumscribed: “white-whorled, well-circumscribed masses.” This description avoids words such as fibroid and leiomyoma, which are considered diagnostic terms.

Note the inclusion of some diagnostic terms

The grosser’s job is to describe and the pathologist’s job is to diagnose. So, gross descriptions should not, in general, employ diagnostic terminology.

We have found, however, that some diagnostic terms provide the best way to describe some gross findings, and that pathologists and clinicians often agree. This guide includes these terms.

It includes, for example, the term diverticulum. Although diverticulum is technically a diagnostic term, it is often preferred as a descriptor over the more traditional and wordy “out pouching of mucosa and intestinal wall into the surrounding pericolic fat.”

You may want to check with your pathologists before incorporating these diagnostic terms into your reports.

Apply the sample gross descriptions

We use each term in this guide in a unique gross-description phrase, usually based on the specimen in the accompanying image.

You can use these phrases as the foundation of your own reporting.

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Lab Literacy for Doctors

Lab Literacy for Doctors

A Guide to Ordering the Right Tests for Better Patient Care
edition:Paperback
More Info
Excerpt

 

Introduction: Why this guide?

 

 

Five years ago, new evidence about vitamin D alerted doctors to the impacts of vitamin D deficits on patient health. This drove a meteoric increase in vitamin D testing in labs across North America. At some clinics, vitamin D testing became one of the single biggest expenses in the budget for lab services.

For all those tests and all that money, you would expect that doctors were at least getting useful information from the results. But they weren’t.

Vitamin D levels are not good predictors of bone health—or other health outcomes for that matter. Patients have different underlying disease susceptibilities, and, depending on supplements, their serum vitamin D levels go up and down. So, knowing a patient’s current vitamin D level has dubious value.

Ample evidence, however, shows the benefits of vitamin D supplements for almost everyone, regardless of their baseline vitamin D level. Therefore, a strategy of “treat don’t test” makes eminent sense and saves valuable health-care resources for testing that actually has a clinical impact.

In the setting of finite health-care resources, tradeoffs such as this—between clinical utility and costs of testing—will become increasingly important.

As health practitioners, we share an ethical responsibility to provide good stewardship of limited health-care dollars and testing resources. Whether you are a primary-care physician or resident, a medical student, or a health professional in an allied field, you need to be lab literate: you need to know which tests have the highest yield for the clinical situations you typically encounter.

Many references help you interpret lab investigations, but they don’t tell you what investigations to do in the first place. This guide is about what lab investigations to do first. We outline the most efficient and cost-effective way for you to use laboratory investigations to support clinical diagnosis and management.

How to use this guide The main guide

The guide is organized the way clinicians think: by clinical presentation and by organ system. So, if you have a patient with a skin problem, go to the section on dermatology. If a patient presents with fatigue, go to the section on fatigue.

In addition to information on lab investigations, we provide, where useful, differential diagnoses, etiologies, and summaries of signs and symptoms. We also share some “pearls”—particular knowledge about lab investigations we have gathered as experts and clinicians in our fields.

Lab basics

Lab investigations are only as good as the specimens delivered for analysis, and lab results are only as useful as human slip-ups and margins of error allow.

Find advice and information here on lab errors, false positives and negatives, and blood and tissue collection.

Lab investigations index

This index describes the diagnostic purpose of the lab investigations discussed in the guide, plus other common lab tests.

If you need a quick check on what an investigation is for, look it up here.

What’s not in this guide

This guide focuses on laboratory investigations. It does not cover diagnostic imaging.

It covers typical disorders and clinical presentations. It does not cover every disorder and clinical presentation, and is not meant to replace sound clinical judgement.

A note about units

This guide gives laboratory values in both conventional units and SI units (the International System of Units). We give the conventional units first and the SI units second.

We did this to be thorough: US laboratories usually report test results in conventional units, but SI units are increasingly used in the United States.

For this reason, we felt it was important to provide laboratory values in both systems as a reference.

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Lab Literacy for Canadian Doctors

Lab Literacy for Canadian Doctors

A Guide to Ordering the Right Tests for Better Patient Care
edition:Paperback
More Info
Excerpt

Introduction: Why this guide?

Five years ago, new evidence about vitamin D alerted doctors to the impacts of vitamin D deficits on patient health. This drove a meteoric increase in vitamin D testing in labs across North America. At some clinics, vitamin D testing became one of the single biggest expenses in the budget for lab services.

For all those tests and all that money, you would expect that doctors were at least getting useful information from the results. But they weren’t.

Vitamin D levels are not good predictors of bone health—or other health outcomes for that matter. Patients have different underlying disease susceptibilities, and, depending on supplements, their serum vitamin D levels go up and down. So, knowing a patient’s current vitamin D level has dubious value.

Ample evidence, however, shows the benefits of vitamin D supplements for almost everyone, regardless of their baseline vitamin D level. Therefore, a strategy of “treat don’t test” makes eminent sense and saves valuable health-care resources for testing that actually has a clinical impact.

In the setting of finite health-care resources, tradeoffs such as this—between clinical utility and costs of testing—will become increasingly important.

As health practitioners, we share an ethical responsibility to provide good stewardship of limited health-care dollars and testing resources. Whether you are a primary-care physician or resident, a medical student, or a health professional in an allied field, you need to be lab literate: you need to know which tests have the highest yield for the clinical situations you typically encounter.

Many references help you interpret lab investigations, but they don’t tell you what investigations to do in the first place.

This guide is about what lab investigations to do first. We outline the most efficient and cost-effective way for you to use laboratory investigations to support clinical diagnosis and management.

How to use this guide The main guide

The guide is organized the way clinicians think: by clinical presentation and by organ system. So, if you have a patient with a skin problem, go to the section on dermatology. If a patient presents with fatigue, go to the section on fatigue.

In addition to information on lab investigations, we provide, where useful, differential diagnoses, etiologies, and summaries of signs and symptoms. We also share some “pearls”—particular knowledge about lab investigations we have gathered as experts and clinicians in our fields.

Lab basics

Lab investigations are only as good as the specimens delivered for analysis, and lab results are only as useful as human slip-ups and margins of error allow.

Find advice and information here on lab errors, false positives and negatives, and blood and tissue collection.

Lab investigations index

This index describes the diagnostic purpose of the lab investigations discussed in the guide, plus other common lab tests.

If you need a quick check on what an investigation is for, look it up here.

What’s not in this guide

This guide focuses on laboratory investigations. It does not cover diagnostic imaging.

It covers typical disorders and clinical presentations. It does not cover every disorder and clinical presentation, and is not meant to replace sound clinical judgement.

A note about units

This guide gives laboratory values in both SI units (the International System of Units) and conventional units. We give the SI units first and the conventional units second.

We did this because Canadian laboratories generally, but not always, report test results in SI units. In addition, Canadian laboratories refer some esoteric tests to the United States, and laboratories in the United States generally, but again not always, report results in conventional units.

For these reasons, we felt it was important to provide laboratory values in both systems as a reference.

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