in several diseases but is important as an indicator of bile duct obstruction, either from inflammation, stones, or malignancy. Prostatic acid phosphatase is secreted by certain cells in the prostate gland, and elevation may indicate disease of the prostate, while prostate specific antigen (PSA) may indicate cancer of the prostate gland.
There are hundreds of other laboratory tests that physicians order to help in the diagnosis of disease, and not only blood is used in these tests. We can obtain spinal fluid for infections and malignancies and other diseases of the brain and spinal cord; paracentesis fluid, fluid from the abdomen, to be analyzed for infection, malignancy or chronic diseases; pleural fluid, or thoracentesis fluid from inside the chest for the same type of determinations; and, finally, fluid, aspirated from cysts anywhere in the body for diagnosis, including breast cysts, sebaceous cysts, and ganglion cysts. There are many blood studies for rare metals such as magnesium, zinc, and mercury.
The term C&S refers to culture and sensitivity, when samples are taken of possibly infected areas. The culture part means that the bacteria are grown outside the body on a special plate called a Petri dish in a nutrient called Agar. When the bacterial colonies grow, special laboratory workers can identify the organism, such as staph or strep or T.B. The bacteria is then tested for sensitivity to certain drugs, and a report is then sent to the doctor, indicating the name of the bacteria and the antibiotics that will be most effective in eradicating it.
Other laboratory tests (you have heard about and their normal levels) are: cholesterol <200, serum proteins, albumin and globulin, and blood sugar, 60100. The laboratory can also measure blood and urine levels of many drugs, such as digitalis, chemotherapeutic agents, alcohol, and street drugs. Arterial blood gases (ABG's) measure the amount of oxygen in your blood, and pulmonary function tests measure how much air you can take in your lungs and can determine lung function problems caused by smoking, infection, or other diseases.
Now you have a brief overview of diagnostic laboratory tests—I hope it hasn't been too boring and that it has given you some insight into the adjunctive measures your doctor can use in making a diagnosis.
Chapter 26
RADIOLOGY AND DIAGNOSIS FOR THE SURGEON
I won't go so far as to offer an apology
That surgeons are in bed, so to say, with radiology.
But we are quite dependent on what they can show,
And we're often enamored with that which they know.
You see, to find answers and make diagnoses,
We often need xrays, from head down to toesies.
They get complex angiograms and CT Scans rolling,
Sometimes I'm not sure if they're coming or going.
The surgeon is often deeply indebted to the radiologist for assistance in making diagnoses and for therapeutic radiological procedures. You may think of the radiologist as the physician who just reads chest xrays, but you'd be quite mistaken. These physicians have a huge armamentarium of procedures, involving xray, nuclear medicine, ultrasound, computerized scanning, interventional angiography, inserting catheters into blood vessels for diagnosis, treatment, dilating narrowed areas, placing drains, doing xray guided needle biopsies of the lung, liver, or breast, and magnetic resonance imaging, to name just a few. They have a detailed knowledge of anatomy, pathology, surgery, and medicine and often discuss with the surgeon what studies should be undertaken to make a diagnosis.
I want to describe some of the studies listed above just so you will have a better idea what you're in for should you need their diagnostic and therapeutic acumen.
First, there are the contrast studies of the intestinal tract, such as the upper gastrointestinal and small bowel series, where you swallow a special liquid and the radiologist can examine your esophagus, stomach, duodenum or the first part of the small intestine where ulcers sometime occur, and the entire small intestines. A barium enema is an exam of the lower intestinal tract via the rectum. All these studies can identify benign and malignant pathology, sometimes in anticipation of surgical intervention.
Angiograms are studies of blood vessels using contrast or dye. The uses are extensive, from studying vessels in the brain, to those in the heart. The coronary arteries study is done by cardiologists and may include the aorta, the vessels in the arms and legs and any other organ, such as the kidneys, liver, as well as the veins in the body. When pathology is found, it may need surgical intervention, but in the last twenty years radiologists and other specialists have developed techniques for percutaneous angiography and angioplasty. Catheters are placed through the skin without a big surgical incision, opening up closed vessels, dilating narrowings, placing filters in veins (see Pulmonary Embolism chapter), and saving patients from large incisions in the operating room. These procedures are done in the radiology department under a local anesthetic and often with sedation.
The radiologist has access to special techniques for visualizing the inside of the body, and among these are computerized axial tomography, the CAT scan, and the magnetic resonance imaging, the MRI scan. This complex machinery can reproduce images of your body on a computer screen showing almost every part of your anatomy, and sometimes do it in an almost three-dimensional way. They can see pathology, such as tiny lung, brain or abdominal cancers, abscesses, bowel obstructions, and many other abnormalities. They can also tell when there isn't anything wrong, and that's important for the surgeon also. You may have all the signs and symptoms of appendicitis but, with negative radiological studies, the surgeon may decide to hold off on surgery, and the diagnosis actually may be as simple as food poisoning or gastroenteritis.
Another modality is nuclear medicine. In this field the patient is given radioisotope material, though not radioactive enough to cause any damage, which frequently localizes in a special organ or special tissue, and radiologists are thereby able to make specific diagnoses. Examples are special scans for pulmonary embolism, for thyroid and parathyroid disease, brain tumors, and infections, to name a few. These are painless studies which give the surgeon a lot of information. For example, when I first started in surgery, we often had to spend hours in surgery exploring the neck for a 3 millimeter parathyroid gland tumor. Now the parathyroid scan can often localize the tumor so that the surgeon can find it rapidly, saving the patient extra time under anesthesia and saving the surgeon from getting ulcers looking for a tumor, like a “needle in a haystack.”
Ultrasound is another modality used by the radiologist, where sound waves create an image on a screen. The trained technicians and radiologists can diagnose cysts in breasts, liver, pancreas, or anywhere else in the body, gallstones in the gallbladder and common bile duct (see Gallbladder), and hematomas, seromas, and abscesses. The radiologist can also insert tubes and drains in these cysts, if indicated, using ultrasound, CAT scan, or MRI scan. On numerous occasions, radiologists have inserted drains in intra-abdominal abscesses, saving the patient a complex and difficult operation.
The radiologists have been working hand in hand with the surgeons since the end of the nineteenth century, when Wilhelm Roentgen first discovered the x-ray, and each year new procedures evolve that will continue to aid in diagnosis and, hopefully, simplify procedures for the patient.
Chapter 27
ALCOHOLISM, DRUG, AND OTHER ADDICTIONS AND SURGERY
Yo mamma, would you like a hit?
You won't have to worry the least little bit.
A little vodka, some “bennies” or a “toot,”
'Cause the doc will fix ya up, room and board to boot!
