phantom: ......
oga the person in my illustration is male.
secondly it presents mainly with pruritis.jaundice is uncommon.
of course there is a need for all those tests you mentioned.
but my point is that if a pregnant lady presents to me with intense itching and NO jaundice after 25wks,then ICP is my likely diagnosis which is made first ,THEN I SEND HER FOR LABWORK TO CONFIRM MY DIAGNOSIS.
so even before lab work,I have a working diagnosis.

Morotov1: Who says jaundice is uncommon in obstetrics cholestasis and that it occurs only after 25 weeks of gestation,it can occur anytime during pregnancy. Please update your textbooks. And even if your patient is either male or female, you will have a list of differential diagnosis that you have to rule out.
Not all jaundice with itching is post hepatic. WHAT ABOUT BRIC- benign recurrent intrahepatic cholestasis.

phantom: .........lab scientist........ itching in a patient with jaundice is most likely post hepatic. I don't need your bilurubin levels to distinguish......its not magic.its just my training.
if I don't see the bilirubin levels expected in post hepatic jaundice, then I will query your result.
dont make comments when you shouldn't.

Iwegbadu:

Do doctors know its fake isnt it pharmacist job to make original yall busy embezzling money

phantom: my brother I don't like arguing with someone who DELIBERATELY decides to MISS MY POINT...
look as a doctor, I don't rely on the lab work for my diagnoses. I already have one before I send for CONFIRMATORY lab work.
if I am in a rural area with out a lab or radiological center,I can go ahead and treat my patients based on clinical findings.
if you can't understand this then I can't help you.i dont have the time to draw pictures for you.no need going round and round in circles.

lexib:

Sharrap there! These r d type dat fail exams
anyhow... u don come for Nairaland dey ginger...
go n release all dat stuff in a wardround let's c
how much u know... Nonsense!

Morotov1: You don't want to get sued for that clinical findings, using it alone to diagnose. Rurall centres has limits. Do you know and read about Nigerian referral system?
Working without Lab work is an archaic way of practicing medicine, it has been revolutionarised to evidence based medicine.
Doctors who knows their onion don't practice like these, even rural populace has started requesting for test to find out what is wrong with them.

Samgreguc:
u said most likely meaning there is an atom of doubt.

Morotov1: Who says jaundice is uncommon in obstetrics cholestasis and that it occurs only after 25 weeks of gestation,it can occur anytime during pregnancy. Please update your textbooks. And even if your patient is either male or female, you will have a list of differential diagnosis that you have to rule out.
Not all jaundice with itching is post hepatic. WHAT ABOUT BRIC- benign recurrent intrahepatic cholestasis.

lexib:

Doctors never use terms like, "always", "never", etc. U most put in a certain level of suspicion... "Most likely" implies it is it until proven otherwise.

lexib:

u sound like lab tests z all n all... we hv very regular incidences whr lab result state resistance to a certain drug which may hv bin started empirically, yet d patient is getting fine... on some occasions patient may hv taken over the counter antibiotics whc will suppress pathogens below the limit of detection n lab test would say d patient is fine, but d doctor uses his clinical accumen n prescribe a more appropriate drug based on d presentation of the patient n d most probable causative organism... also, for enteric fever, definitive test is d culture in blood, urine or stool at abt d 2nd, 3rd n 4th wks respectively (not d spurious widal test), so wud u sit n wait till 2nd wk of d illness to do a blood culture, wen d patient is dying infront of u... or do u talk abt lab tests b4 intervening in a patient with a medical emergency? ...... I can give u 20 instances whr lab findings fall short of diagnostic value

U CAN'T JUST GO FINKING ITS ALL ABOUT LAB TESTS

Morotov1: No, I am not thinking that please, in the wworld of evidenced based medicine you can't say absolute without investigations. Then comes the physicians intellectual acumen to discern and sieve out the likely and possible diagnosis, which can't be done with only clinical findings even malaria as somebody wrote has been mimicked.

If defensive medicine is being practice where you reside ,where every of your activities is scrutinized by attorneys then you will know the importance of Lab and other investigations.

lexib: A doctor shd be d CMD... can't imagine a nurse
or lab scientist heading doctors in a hospital...
the hospital is the primary place of work for
Doctors and Nurses... other professionals are
ancilliary or support staffs... the primary place of
work for a Lab. Scientist is a Medical Research
laboratory best within in a University whr dey shd
make reagents n improve on available analytical
procedures, serve as a control for hospital-based
routine labs, carry out researches dat advance medical practice (dats why dey r scientists)... d govt shd look into dat, dey r to
head such places n not fight for headship with
doctors in hospitals, or call demsefs "scientists" wen all dey do is feed samples into auto-analysers (machines) and read out d results...

the primary place of work for pharmacists shd be
in Pharmaceutical companies... if d govt dsnt own
any, it means d country has bin importing drugs
or using those produced by private firms or
both... d pharmacist shd head here, dia job in d
hospital z supportive n not frontline as in these
companies... in hospitals, dey stock n dispense drugs, n r involved in patient drug counselling... dey dnt nid to review patient drug mgt for wen physicians are in doubt, dey invite the Therapeutic n toxicology team of Physicians for a review... Consultant pharmacists in foriegn climes are not hospital-based staffs...

the physiotherapist shd run a Rehabilitation
Home... etc.
the frontline hospital staffs are Doctors and
Nurses n only these two can talk about
headship... buh Nurses take oaths within which
they say "With loyalty, I shall ASSIST the
PHYSICIAN in the performance of HIS job"...
Nightangle pledge. I dnt fink Nurses insist on also
bcoming CMD, most importantly, Doctors shd
respect dem n carry them along.
SO, WHERE IS ALL THIS JOHESU THING COMING
FROM

lexib:

U r obviously not interested in logical reasoning... I wnt want to argue illogically wif u cos u'll flaw me in dat realm...

Oduduwaboy:
Wannabe !

Oduduwaboy:
Wannabe !

allycat: Please educate me, which lab test do I need to diagnose Otitis media with effusion, Ca Larynx, Tonsillities, Sensorineural hearing loss, Tinnitus or epistaxis. These are a few conditions I see everyday and I make my diagnosis based on clinical findings alone. I then investigate my patients to rule out contributing factors but these investigations do not in anyway make my diagnosis for me.

GentleMimi:
If he already knows what he is expecting,why proceed with the request? If u query a lab result showing malaria,it indicates u do not really know what u are doing. Don't u know many Nigerians are asymptomatic parasite carriers? Using QBC to investigate for MP,u'll find it in virtually 70% of Nigerians,with only half being sypmtomatic.
Sending a request for Serum bilirubin to investigate jaundice will not only tell u if it is a jaundiced patient,but will also point out if its hepatic,prehapatic or post hepatic. Now,why the hell will u get a malaria test result when u requested for jaundice test(SB,urobilinogen)? It only means u got confused at a certain point.
Query indeed. You prolly work in a clinic that employed the services of technicians and SLTs whom u pay peanuts. That is when u can come out to tell us u can ''query'' a result.

YourHealthlabs:

Guess you've never heard of ear swab investigation and Antibiogram sensitivity in otitis media.
Of course you know everything a Scientist knows.
I applaude you.

lexib:

Mr. "Scientist"... What research hv u carried out b4... changing name from technician to scientist is not just enough... be an actual scientist.

phantom: I give up. trying to make you see my point is akin to fetching water with a basket.
best regards.

dakotchic:

Ignorance exposed again! Who told you an ear swab is done for otitis media with effusion? Or that it is treated with antibiotics? I reiterate, if we all understood the meaning of these terms we are fighting for then there won't be any fight ab initio by either party

Morotov1: Who says jaundice is uncommon in obstetrics cholestasis and that it occurs only after 25 weeks of gestation,it can occur anytime during pregnancy. Please update your textbooks. And even if your patient is either male or female, you will have a list of differential diagnosis that you have to rule out.
Not all jaundice with itching is post hepatic. WHAT ABOUT BRIC- benign recurrent intrahepatic cholestasis.

Morotov1: No, I am not thinking that please, in the wworld of evidenced based medicine you can't say absolute without investigations. Then comes the physicians intellectual acumen to discern and sieve out the likely and possible diagnosis, which can't be done with only clinical findings even malaria as somebody wrote has been mimicked.

If defensive medicine is being practice where you reside ,where every of your activities is scrutinized by attorneys then you will know the importance of Lab and other investigations .

phantom: ........it so obvious why you are a lab scientist and not a doctor.please let's not take this discussion further.best regards.

lexib:

Mr. "Scientist"... What research hv u carried out b4... changing name from technician to scientist is not just enough... be an actual scientist.