2020年11月17日星期二

hemorrhoids rupture,The most comprehensive test sheet interpretation tutorial in history (1)

    The most comprehensive test sheet interpretation tutorial in history (1)

    Blood routine:

    The word "routine" in English is routing, often abbreviated as RT or Rt. Therefore, blood routine can also be written as: "blood RT", which is the most frequently done blood test, and is also called "blood picture" in the habit. Including 16-18 items such as red blood cell count, white blood cell count, white blood cell count, hemoglobin measurement, platelet count, etc. Although it is not a specific examination, the blood carries various information to convey a slight abnormality in various parts of the human body.

    (1) English abbreviation of red blood cell count: RBC (normal male: 4-5 million/μL, female: 3.5-5 million/μL, newborn: 6-7 million/μL)

    Increase: can be seen in polycythemia vera, pulmonary heart disease, emphysema, high altitude hypoxia, etc.

    Decrease: seen in various anemia, blood thinning, etc.

    (2) Determination of hemoglobin (also called hemoglobin) English abbreviation: Hb or HGB (120~160g/L for normal men, 110~150g/L for women, 170-200g/L for newborns.)

    Increase: ①Physiological increase: seen in plateau residents, fetuses and newborns, strenuous activities, fear, cold baths, etc.; ②Pathological increase: seen in severe congenital and acquired cardiopulmonary diseases, vascular malformations and abnormalities with low oxygen carrying capacity Hemoglobinopathy, etc.; also seen in certain tumors or kidney diseases.

    Decrease: ① Physiological decrease: The gradual decrease of bone marrow hematopoietic function in the elderly can lead to the decrease of red blood cell and hemoglobin content. ② Pathological reduction: bone marrow hematopoietic failure, such as aplastic anemia, anemia associated with myelofibrosis, such as iron deficiency anemia, megaloblastic anemia caused by folic acid and vitamin B12 deficiency; due to red cell membrane and enzyme inheritance Anemia caused by excessive red blood cell destruction caused by sexual defects or external factors, such as hereditary spherocytosis, thalassemia, paroxysmal sleepiness, hemoglobinuria, abnormal hemoglobinopathies, immune hemolytic anemia, extracorporeal heart Major circulatory surgery or hemolytic anemia caused by certain biochemical factors, anemia caused by acute or chronic blood loss.

    (3) English abbreviation of white blood cell count: WBC (4000~10000/μL for normal adults, 15000~20000/μL for newborns, 11000~12000/μL for infants from 6 months to 2 years old.)

    Increase: common in acute bacterial infections and purulent inflammation, severe tissue damage, acute bleeding, poisoning (such as diabetic acidosis, uremia), malignant tumors, leukemia, and after surgery.

    Decrease: common in certain infectious diseases (typhoid fever, malaria, viral infection, etc.), certain blood diseases, autoimmune diseases, anaphylactic shock, hypersplenism, cachexia, after radiotherapy or chemotherapy, and aplastic anemia.

    (4) English abbreviation of white blood cell classification count: DC detects the percentage of white blood cells of various types of white blood cells.

    White blood cells are divided into 5 categories: ① English abbreviation of neutrophils: N%. Normally 50% to 70%. Increase and decrease are the same as white blood cell count.

    ② Eosinophils English abbreviation: E% increase: common in allergic diseases (bronchial asthma, urticaria, angioedema, food allergy, neurorhinitis and pneumonia caused by Aspergillus spores, etc., parasitic diseases (acute Schistosomiasis, hookworm disease, tapeworm disease, trichinosis, paragonimiasis, etc.), certain skin diseases, certain malignancies (Hodgkin’s disease, malignant diseases of the lymphatic system, etc.).

    Decrease: It is common in the long-term application of adrenal cortex hormone therapy, and can also be seen in the early stages of major surgery and certain infectious diseases.

    ③Basophilic granulocytes English abbreviation: B% increase: common in chronic myelogenous leukemia, basophilic leukemia, bone marrow fibrosis and some metastatic cancers.

    ④ English abbreviation of lymphocyte: L%. Normally 20%-40%. Increased: It is common in infectious diseases caused by certain viruses or bacteria (measles, rubella, chickenpox, mumps, viral hepatitis, tuberculosis, etc.) , Infectious lymphocytosis, certain chronic infections and tuberculosis recovery period, lymphocytic leukemia, leukemic lymphosarcoma, etc.

    Reduction: It is common in exposure to radiation, application of adrenal cortex hormones, anti-lymphocyte globulin therapy, lymphopenia, immunodeficiency, and gamma globulin deficiency.

    ⑤Monocyte English abbreviation: M%. Normally 3%~8%. Increased: common in certain infections (such as subacute bacterial endocarditis), the recovery period of acute infection, monocytic leukemia, active Tuberculosis, lymphoma and myelodysplastic syndrome.

    Reduce: No clinical significance.

    (5) English abbreviation of platelet count: PLT increased (greater than 400×109/liter): ① Myelodysplastic syndrome: seen in chronic myelogenous leukemia, polycythemia vera, etc. ②Acute reactions: acute infection, blood loss, hemolysis, etc. ③Other: After splenectomy.

    Decrease (less than 100×109/liter): ①Generation disorder: seen in aplastic anemia, acute leukemia, and acute radiation sickness. ② Excessive destruction: seen in primary thrombocytopenic purpura and hypersplenism. ③Excessive consumption: seen in diffuse intravascular coagulation (DIc). ④Familial thrombocytopenia: giant platelet syndrome.

    (6). Erythrocyte sedimentation rate: westergren method 0-15mm/h for men, 0-20mm/h for women; iahinhkob method 0-8mm/h for men, 0-12mm/h for women. Faster: acute inflammation, connective tissue disease, severe anemia, malignancy Tumor, tuberculosis.

    Slow down: polycythemia, dehydration.

    (7). Reticulocyte count: normal conditions: (00.5-1.5)% increased: hemolytic anemia, massive bleeding, iron deficiency anemia, pernicious anemia when vitamin B12 is used.

    Decrease: low bone marrow hematopoietic function, aplastic anemia, leukemia.

    Urine routine tests include urine color, transparency, pH, specific gravity, the presence or absence of protein and sugar, and urine sediment test.

    On a laboratory test form, if a "+" sign is written after some items, it is called a positive result in medicine; on the contrary, a "-" sign is called a negative result. A positive result is usually a sign of urinary system disease.

    NIT stands for nitrite in urine. The amount of nitrite is often related to the type of food. If it often exceeds normal, it may indicate urinary stones or urinary tract infection.

    PH stands for pH. The normal result is 6.0. Increased pH is common in frequent vomiting and respiratory alkalosis. Decreased pH is common in acidosis, diabetes, etc.

    GLU stands for urine sugar. The normal result is negative. Urine sugar can reach 2 to 3 plus signs when suffering from diabetes. Hyperthyroidism, acromegaly, brain tumors, etc. can all lead to increased urine sugar.

    PRO stands for urine protein. The normal result is negative or trace amount. Positive is seen in acute glomerulonephritis, renal arteriosclerosis, multiple myeloma and high fever.

    BLO stands for occult blood. Urine occult blood in normal people is negative.

    KET stands for ketone body. The normal result is negative. Urine ketones are negative in ketoacidosis, which is common in diabetic patients when they are hungry, vomiting, and diarrhea.

    BIL stands for bilirubin. If it is positive, it indicates jaundice and needs to be checked.

    WBC stands for white blood cells. Normal results are negative, and increased WBC in urine is seen in pyelonephritis, cystitis, urethritis and prostatitis.

    SG stands for specific gravity. Increased urine specific gravity is seen in dehydration, high fever, heart failure, etc.; decreased in chronic glomerulonephritis and pyelonephritis.

    URO stands for urinary bile yuan. The normal result is negative or weakly positive. Before the emergence of jaundice in the early stage of viral hepatitis, the urinary biliary element is increased, and hemolytic jaundice is positive or strongly positive.

    A large number of white blood cells (WBC++-+++) and epithelial cells were reported on the report form of the urine routine laboratory test report, which often indicates infection of the treatment system of urinary diseases. A large number of red blood cells in the urine (RBC+-+++) indicates that you have kidney stones, tumors, acute nephritis, cystitis and urinary diseases. If the urine test shows a positive cast, it means that the kidneys have been damaged, which are common in acute and chronic nephritis, pyelonephritis, and nephrotic syndrome. If the urine sugar test is positive, it is likely to be diabetes, because normal people have only a small amount of sugar in the urine, which is generally not detected by the test. When eating a lot of sugar or bolus glucose, there will be short urine sugar. Diabetes patients not only have positive urine glucose, but also have significantly higher blood sugar.

    The significance of the different combinations of "two-and-a-half" normal situation: HBsAg, HBsAb, HBeAg, HBeAb, HBcAb The five hepatitis B serum markers are all negative.

    Abnormality: HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb are often combined with five hepatitis B serum markers, which is called hepatitis B "two-and-a-half" test. Their combination mode is shown in the table.

    Common combination mode (1-8)

    Serum marker 1 2 3 4 5 6 7 8

    HBsAg +-

    HBsAb-+-

    HBeAg +-

    HBeAb-+-+-

    HBcAb + +-+-+

    Rare combination mode (9-20)

    Significance: 1. Infected with hepatitis B virus, the virus continues to replicate and is highly infectious. Referred to as "Sanyang".

    2. Virus replication is contagious; if it changes from the "three positives", it indicates that virus replication tends to stop and the contagion is small.

    3. Early stage of acute hepatitis B infection; hepatitis B virus carriers; change from the "three positives", suggesting that virus replication tends to stop, and the infectivity is small; the core part of the virus is integrated with the core part of human liver cells and is non-infectious.

    4. The virus replication stops, or has a certain degree of replication, non-infectious or relatively less infectious.

    5. After being infected with hepatitis B virus, the virus has been cleared, non-infectious, and immune; immunity has been obtained after hepatitis B vaccine injection.

    6.7.8 After being infected with hepatitis B virus, the virus has been cleared, so there is no replication and infectivity, and it has immunity.

    9. Hepatitis B virus infection is early and highly infectious.

    10. In the recovery period or chronic carriers of hepatitis B, the serum markers are easy to turn negative. 11. Viral infection tends to recover; chronic carriers.

    12. Different subtypes of hepatitis B virus secondary infection, atypical hepatitis B virus infection early.

    13.14.15. Early hepatitis B virus infection.

    16. Atypical acute infection (suggesting non-A non-B hepatitis)

    17.18. Atypical infection 19. Mid-stage acute hepatitis B infection.

    20. Infection recovery period.

    21. I have been infected with hepatitis B in the past, and I still have immunity. It is an atypical recovery period, or it may be an acute hepatitis B infection period.

    Lipid Test Sheet

    In addition to scientific research, the current clinical testing items commonly used mainly include: total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A, apolipoprotein B, etc. 6 items. Hospitals at all levels may not be able to check the above items due to different medical conditions.

    The most common problem encountered when looking at the laboratory test form is that I cannot understand some of the abbreviated English codes written on it. Here, we introduce some of the most commonly used symbols on the test sheet: TC: stands for total plasma cholesterol, and T-CHO stands for total plasma cholesterol.

    TG: stands for triglycerides: HDL-c stands for high-density lipoprotein cholesterol in plasma.

    LDL-C: stands for low-density lipoprotein cholesterol in plasma.

    ApoA1: represents the apolipoprotein A1 in the plasma. ApoB: represents the apolipoprotein B in the plasma. Another problem encountered when looking at the test sheet is what the normal values ​​of these indicators should be. The general situation is as follows: Total plasma cholesterol: 3.36~5.78mmol/L (130~200mg/dl).

    Plasma triglycerides: 0.45-1.81mmol/L (40-160mg/dl) for men; 0.23-1.22mmol/L (20-108mg/dL) for women; low-density lipoprotein cholesterol in plasma: 0.9- —2.19mmol/L (35—85mg/dL); Apolipoprotein A1: 110—160mg/dL. Low-density lipoprotein cholesterol in plasma: <3.12mmol/L (120mg/dL); Apolipoprotein A1: 110~160mg/dl; Apolipoprotein B: 69~99mg/dl; When the above values ​​on the blood lipid test sheet are found to be outside the normal range, first check whether the blood sample was taken under an empty stomach. Generally, patients are required to start fasting at 10 o'clock in the evening before blood collection, and to take venous blood from 9 to 10 o'clock the next morning. Secondly, attention should be paid to the drinking situation of subjects, because drinking can significantly increase the concentration of lipoproteins and high-density lipoproteins rich in triglycerides in plasma. Third, when analyzing the results, it should be considered that the lipid and lipoprotein levels themselves have large biological fluctuations, which are partly caused by seasonal changes, menstrual cycles, and accompanying diseases. Finally, we need to find the reason from a clinical perspective. The following focuses on the clinical significance of total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, and apolipoprotein.

    Clinical significance of total cholesterol: increase seen in biliary obstruction, nephrotic syndrome, chronic glomerulonephritis, amyloidosis, atherosclerosis, hypertension, diabetes, hypothyroidism, infectious hepatitis, portal cirrhosis, certain Some chronic pancreatitis, spontaneous hypercholesterolemia, familial hyperlipoproteinemia, senile cataracts and psoriasis. Reduces seen in severe anemia, acute infection, hyperthyroidism, steatorrhea, tuberculosis, congenital serum lipoprotein deficiency and malnutrition.

    The clinical significance of triglycerides: increased levels are seen in hyperlipidemia, atherosclerosis, coronary heart disease, diabetes, nephrotic syndrome, biliary obstruction, hypothyroidism, acute pancreatitis, glycogen accumulation, and primary triglycerides Hyperplasia. The clinical significance of the reduction of high-density lipoprotein cholesterol: suggesting the risk of coronary heart disease.

    The clinical significance of increased low-density lipoprotein cholesterol: It suggests that they are susceptible to coronary heart disease and cerebrovascular disease caused by atherosclerosis.

    Clinical significance of apolipoprotein: ApoA, ApoA, and ApoB can be used to estimate the risk of cardiovascular and cerebrovascular. High-density lipoprotein ApoA; decrease and increase of ApoB are most obvious in cardiovascular and cerebrovascular diseases, and are also seen in hyperlipoproteinemia and other abnormalities Lipoproteinemia.

    Finally, it needs to be explained that due to differences in the methods used and experimental conditions in various medical units, the normal values ​​of various indicators may not be completely the same. Under normal circumstances, the normal reference values ​​are marked on the test sheets, and the measured indicators can be compared whether they exceed the normal range.

    How to look at routine stool test sheets? Routine stool tests include checking the presence of red blood cells and white blood cells in the stool, bacterial sensitivity test, occult blood test (OB), and inspection of eggs.

    The stool of a normal person is generally yellow, without blood and mucus, without red blood cells, white blood cells, eggs and protozoa. If the color of the stool is clay or off-white. It may be a biliary obstruction; if the stool is tarry black, there may be bleeding in the upper gastrointestinal tract, or drugs such as activated charcoal or iron have been taken; if the stool is red, it may be gastrointestinal bleeding, especially in the colon, rectum or anus. Sick people sometimes have red stools.

    If red blood cells and white blood cells are detected in the stool above "+—— + +", it can be considered as bacillary dysentery; only white blood cells are found, indicating enteritis; only red blood cells are found, most of which are suffering from colitis, tumors, polyps, and tuberculosis And bleeding from hemorrhoids. Egg inspection can detect roundworm eggs or tapeworm eggs from the stool.

    Gynecological gynecological diseases threaten the health of women, putting women's body and mind under tremendous pressure. If you have a gynecological disease, you should go to the hospital for regular gynecological examinations, so how do you understand these checklists? The result of a laboratory test or report is often expressed by (+) and (-). The (+) and (-) here are not the signs of addition and subtraction in mathematical calculations, but are used to indicate the positive and negative results. Some people don’t understand (+) and (-), positive and negative. Actually, I can’t figure out what it means. Below we will teach you a few tricks.

    The routine cleanliness of leucorrhea of ​​BV and cervical scrapings is normally Ⅰ~Ⅱ degree. If it is above Ⅲ degree, it may indicate vaginitis or cervicitis. It needs to be judged in conjunction with other items. If it is positive for “trichomoniasis”, it is “trichomoniasis vaginitis”, if it is “mould” positive, it is “candidal urethritis”. All need systematic and standardized treatment, including sexual Regular treatment of the partner.

    BV (baceerialvaginosis), called "bacterial vaginosis", is also common. It refers to a mixed infection caused by the imbalance of the normal flora in the vagina, in which anaerobic bacteria are the majority, which is completely different from vaginitis.

    Cervical scraping is an important method for screening early cervical cancer. Therefore, it is also called "anti-cancer smear". The report form is mainly divided into two types: graded diagnosis and descriptive diagnosis. At present, most hospitals in China still use graded diagnosis. The clinically commonly used Pap classification method: Pap grade Ⅰ: normal; Pap grade Ⅱ: inflammation, which refers to individual cells with obvious nuclear heterogeneity, but does not support malignancy, and the rest are ⅡA; Pap Grade III: suspicious cancer; Pap grade IV: severe suspicious cancer; Pap grade IV: cancer.

    Since the Pap 5-level classification has many subjective factors and there are no strict objective standards between levels, it is gradually being replaced by the TBS classification, and the latter needs to be readable by professional doctors. Therefore, at present, many domestic hospitals often use the function of electronic colposcopy to magnify the area of ​​10-40 times to stain suspicious parts of the cervix, so as to focus on collecting materials to improve the detection rate of lesions.

    Leucorrhea test Single leucorrhea is a mixture of vaginal mucosal exudates, cervical canal and endometrial gland secretions, and its formation is related to the effect of estrogen. The general leucorrhea routine laboratory test sheet has the following 6 test items: pH After puberty, due to the stimulation of ovarian sex hormones, the mucosal epithelial cells are rich in animal starch, which is decomposed by vaginal bacilli and turns into lactic acid, resulting in weak vaginal secretions. Acidity can prevent pathogenic bacteria from multiplying in the vagina, which is the self-purification effect of the vagina. The pH value is often used in laboratory tests to indicate the pH value. Normally, the pH value is 4.5. When suffering from trichomonas or bacterial vaginitis, the pH value of leucorrhea increases, which can be greater than 5-6. Vaginal cleanliness can be divided into 4 levels: Ⅰ degree: A large number of vaginal epithelial cells and a large number of vaginal bacilli were seen under the microscope.

    Degree Ⅱ: There are vaginal epithelial cells, a small amount of white blood cells, some vaginal bacilli, and a few bacteria or pus cells under the microscope.

    Degree III: There are a small amount of vaginal bacilli, a large number of pus cells and other bacteria under the microscope.

    Degree IV: No vaginal bacilli were seen under the microscope, except for a few epithelial cells, mainly pus cells and miscellaneous bacteria.

    Degrees I to II are normal, and degrees III to IV are abnormal leucorrhea, indicating vaginal inflammation.

    Mold and Trichomonas: After the leucorrhea has been processed, it can be found under the microscope whether there are trichomoniasis or mold according to its morphology. If there is trichomoniasis or mold, no matter how much it is, it is indicated by "+", and the symbol "+" is only for illustration The woman was infected with trichomoniasis or mold, which does not indicate the severity of her infection.

    Amine test: Leucorrhea suffering from bacterial vaginosis can emit a fishy smell, which is caused by the volatilization of amines present in the vaginal discharge after being alkalized by potassium hydroxide.

    Clue cells: Clue cells are clue cells that have many bacilli gathered on the edge of vaginal epithelial cells in patients with bacterial vaginosis. In hanging drop smears, the edges of vaginal epithelial cells are seen as granular or stippled, which are clue cells. It is the most sensitive and specific sign of bacterial vaginosis. Clinicians can make the diagnosis of bacterial vaginosis based on the positive amine test and the cells with clues.

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