Medical monitoring: tests available at central hospitals

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1 medial monitoring: tests available at central hospitals: 1 medical monitoring: tests available at central hospitals Medical monitoring: tests available at central hospitals

2 medial monitoring: tests available at central hospitals: 2 Slide 1 X-ray and ultrasound Provide images of diffferent parts of the body. Can investigate symptoms and help in diagnosis. tests available at central hospitals: 1 X-ray and ultrasound These tests can provide images of different parts of the body. They are commonly used in medicine to investigate many different symptoms. Two of the most common imaging tests used in HIV infection are the chest X-ray and ultrasound of the abdomen and pelvis. The chest X-ray is normally carried out when someone has symptoms of a cough, breathlessness, or chest pain. An ultrasound of the abdomen is useful for investigating abdominal pain, abnormal swellings, and persistent fever. Simple X-rays and ultrasounds are quick and usually do not involve any uncomfortable injections or procedures. An ultrasound simply involves a probe being moved across the surface of the abdomen, and a chest X-ray involves standing in front of a machine as the image is taken. The images can provide essential information on the structure and form of internal organs and can identify abnormal lumps, swellings and masses. A chest X-ray can also provide information on the presence and severity of pneumonia. If active tuberculosis is suspected, an X-ray can indicate of the need for more tests and the extent of any damage. However, an X-ray alone cannot confirm the presence of TB. Further tests are always necessary to diagnose this disease and distinguish it from other lung conditions.

3 medial monitoring: tests available at central hospitals: 3 Slide 2 Bronchoscopy Flexible tube inserted up nose, down throat into the lungs. Fibre optics allow doctor to visualise and take tissue sample. tests available at central hospitals: 2 Bronchoscopy A bronchoscopy can be used as part of the investigation into cough, breathlessness, or an abnormal chest X-ray. A bronchoscope is a flexible tube containing optical fibres. It allows the doctor to visualise and take tissue samples (biopsy) from the bronchial tree (breathing tubes) and lungs. Before starting the procedure, the patient is given a light sedative, an injection to dry up the bronchial secretions and a local anaesthetic. The bronchoscope is passed up through a nostril, down the back of the nose and throat, past the vocal chords and into the lungs. Fluid is washed through a section of the lungs (lavage) to obtain samples to assist in diagnosis of infections such as PCP and TB. After the procedure the patient might feel drowsy for 3-4 hours and be asked not to eat or drink during this time, because the throat and vocal cords will be numb from the local anaesthetic. Lung infections such as Pneumocystis carinii pneumonia (PCP), tuberculosis, or other bacterial infections, can be more easily diagnosed with a bronchoscopy and the correct treatment chosen. Kaposi s sarcoma, which may be the cause of a cough or breathlessness, can also be seen down a bronchoscope.

4 medial monitoring: tests available at central hospitals: 4 Slide 3 Endoscopy Used to detect problem in the gullet, stomach or first part of small bowel. Can detect Candida, Kaposi s Sarcoma, CMV (cytomegalovirus). tests available at central hospitals: 3 Endoscopy This is usually done when there are symptoms of a problem in either the oesophagus, the stomach or first part of the small bowel (duodenum). It might used to find out the cause of stomach pains, swallowing difficulty, suspected bleeding from the gut, nausea and vomiting, anorexia, malabsorption, and weight loss. An endoscope is a flexible tube containing optical fibres that allows the doctor to see inside as it passes down through the oesophagus and into the stomach. The patient does not need to be admitted to hospital for this. However, the patient must fast for 12 hours before the endosocopy to ensure that the stomach is empty and to prevent vomiting. An intravenous sedative is often given, so although the test sounds unpleasant, afterwards the individual has little memory of the procedure. If there are clinical symptoms, it can help to diagnose duodenal ulcers, Candida or CMV (cytomegalovirus) infection in the oesophagus, and Kaposi s sarcoma. It is also used to diagnose infections in the small bowel, such as Cryptosporidium, Microsporidium and MAI.

5 medial monitoring: tests available at central hospitals: 5 Slide 4 Lumbar puncture Needle inserted into spine to remove cerebrospinal fluid. Diagnoses meningitis and other neurological problems; CMV, herpes simplex virus, PML (progressive multifocal leukoencephalopathy). tests available at central hospitals: 4 Lumbar puncture A lumbar puncture is used out to help in diagnosing meningitis (usually Cryptococcus), or viral infections that can cause neurological problems. It is an essential part of the investigation into the reason for a persistent headache and fever, or other problems such as weakness and numbness in the legs. It is also helpful in assessing the severity of a tumour. A needle is inserted under local anaesthetic into the base of the spine and a small amount of cerebrospinal fluid (CSF) is removed. This is usually done in the ward or clinic. The patient is asked afterwards to lie flat for 4 to 24 hours to reduce the risk of a post-lumbar puncture headache. If swelling of the brain tissue is suspected clinically, then it is essential that a brain scan is carried out first to ensure that it is safe to do a lumbar puncture. Cryptococcus and other causes of meningitis, such as tuberculosis, can be readily diagnosed with a lumbar puncture, and appropriate treatment started. Some viruses which cause neurological problems can also be detected in samples of CSF. These include CMV, herpes simplex virus and JC virus. A lumbar puncture might sometimes be used to assess the response to treatment for cryptococcal meningitis, or to help confirm or exclude a clinical relapse.

6 medial monitoring: tests available at central hospitals: 6 Slide 5 Lung function test Determines reasons for shortness of breath. Helps to identify PCP (Pneumocystic carnii pneumonia) tests available at central hospitals: 5 Lung function test Lung (pulmonary) function tests indicate how efficiently a person is breathing. A clip is placed on the patient s nose so that all breathing takes place through the mouth. The patient breathes into a mouthpiece attached to a machine that measures how much air is breathed in and out. Lung function tests are used to help determine the cause of shortness of breath and other breathing difficulties. They can help to differentiate between different forms of respiratory disease, such as obstructive conditions like asthma, or problems due to infections such as PCP. Different tests may be required for different reasons. For example, to measure Forced Vital Capacity (FVC), the patient will be asked to take as deep a breath as possible then exhale as fully as possible; or the patient may be asked to breathe in and out rapidly for a period. Sometimes the patient may be asked to first breathe in a drug spray, to expand the airways in the lungs, or asked to breathe in a special mix of oxygen and carbon dioxide to see how well the lungs are absorbing the oxygen and excreting the carbon dioxide.

7 medial monitoring: tests available at central hospitals: 7 Slide 6 Pap smear HIV-negative women should have cervical smear every two years. HIV-positive women require more frequent monitoring. Speculum inserted into vagina. Cervical cells swabbed and examined under microscope. Can detect abnormal or cancerous cells. Anal Pap smears can detect and prevent anal cancer. tests available at central hospitals: 6 Pap (Papanicolau) smear It is routine for a women in the UK to have a cervical smear (a Pap smear) every two years in the UK to screen for abnormal or cancerous cells. It is also done if the cervix looks abnormal on examination, or if there has been abnormal bleeding from the vagina. In women with HIV infection it may be advisable to have this test more frequently. Women with HIV have higher rates of sexually transmitted diseases, fungal infections (such as thrush), and menstrual disorders compared with HIV-negative women. A cervical smear should be a part of a regular gynaecologic check-up for all HIV-infected women. Regular Pap smears allow early detection and treatment of abnormalities in the cervix or the anus, such as cancer or pre-cancerous cells. In HIV there is some evidence that these changes may be more common, especially if there is co-infection with the human papilloma virus (HPV). If abnormalities of the cervix are detected on a smear, then a colposcopy may then be carried out to remove abnormal cells. A speculum is inserted into the vagina and then, using a wooden spatula, a sample containing cells from the surface of the cervix is smeared onto a glass slide. After staining, the slide is examined under the microscope to look for abnormal or cancerous cells. HIV-positive men and women who engage in receptive anal intercourse are also at increased risk of anal cancer. An anal Pap smear every second year can help in detecting pre-cancerous cells, and preventing anal cancer.

8 medial monitoring: tests available at central hospitals: 8 Slide 7 Serology Blood tests to detect antibodies to certain infections such as: CMV, hepatitis, Toxoplasma. tests available at central hospitals: 7 Serology A serology test is a test on a sample of blood. It is used to detect the presence of specific antibodies in the blood that are the result of previous exposure to specific infections. Serology tests for Toxoplasma, CMV, syphilis and hepatitis might be done during routine monitoring of HIV infection, or to help the doctor reach a diagnosis. The presence of antibodies to an infection indicates that the individual has previously been infected. People who have severe damage to their immune system are at risk of reactivation of some infections. Knowledge of this risk allows treatment to be started that can prevent or reduce this risk (prophylaxis).

9 medial monitoring: tests available at central hospitals: 9 Slide 8 Sigmoidoscopy and rectal biopsy Detects cause of persistant diarrhoea or abnormal bleeding. Sigmoidscope inserted into bowel. Can detect Kaposi s Sarcoma, CMV colitis, Cryptosporidium and MAI (Mycobacterium avium intracellulare) tests available at central hospitals: 8 Sigmoidoscopy and rectal biopsy A sigmoidoscopy can help in finding out the cause of persistent diarrhoea or abnormal bleeding from the lower bowel. It is usually done when the stool cultures have not been able to identify the cause of diarrhoea. A rigid sigmoidoscope is usually used for rectal biopsy. It can only pass about 15 cm into the bowel and allows the rectum to be seen. Sometimes, a flexible sigmoidoscope (or colonoscope) is used; which is a flexible tube containing optical fibres. A laxative is given prior to the procedure to empty the bowel so that it can be seen clearly (a bowel wash-out is usually not required). It should be possible to see if there is any inflammation or ulceration of the rectum or colon, or lesions which might be the cause of bleeding, such as Kaposi s sarcoma. Small pieces of tissue (biopsies) are taken from abnormal areas of the bowel and are sent to the laboratory for microscopic examination.these will help diagnose the cause of diarrhoea, which might be CMV colitis, Cryptosporidium, MAI infection or Microsporidium.

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