Clinical Disorders of the Major Organs and Cancer

Module details

Title

Clinical Disorders of the Major Organs and Cancer

Type

Specialist

Module code

SLS121

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with detailed knowledge and understanding of the clinical disorders of major organ function, and the clinical and laboratory methods used in diagnosis and management. They will understand the aetiology and biochemical investigation of a range of malignancies. In the work-based module they will be expected to apply this knowledge as they learn to perform and assure a range of manual, semi-automated and automated methods used in the investigation of major organ function and cancer. They will gain extensive experience of the interpretation of patient results in a variety of clinical settings.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1,2	Competency Perform the analyses to laboratory standard operating procedures on patients with: fluid balance disorders acid base disorders fluid replacement therapy.	Action View
# 2	Learning outcome 1,3	Competency Perform the analyses to laboratory standard operating procedures on patients with disorders of: renal pathophysiology.	Action View
# 3	Learning outcome 1,4	Competency Perform the analyses to laboratory standard operating procedures on specimens for: liver function tests INR (international normalised ratio) tumour markers ferritin and iron saturation copper and caeruloplasmin.	Action View
# 4	Learning outcome 1,5	Competency Perform the analyses to laboratory standard operating procedures specimens for: cardiac biomarkers lipids metadrenalines renin and aldosterone.	Action View
# 5	Learning outcome 1,6	Competency Perform the analyses to laboratory standard operating procedures on: bone metabolism (calcium, phosphate, magnesium and alkaline phosphatase) vitamin D and its metabolites parathyroid hormone (PTH) markers of bone turnover.	Action View
# 6	Learning outcome 1,7	Competency Perform the analyses to laboratory standard operating procedures on: tumour markers.	Action View
# 7	Learning outcome 1,8	Competency Perform the analyses to laboratory standard operating procedures on: markers of inflammation immunoglobulins and paraproteins cryoglobulins alpha-1 antitrypsin deficiency.	Action View
# 8	Learning outcome 2,3,4,5,6,7,8	Competency Identify cases that require urgent intervention and offer clinical advice on the follow-up and/or further management of the patient.	Action View
# 9	Learning outcome 9	Competency Interpret biochemical data in light of the clinical details.	Action View
# 10	Learning outcome 9	Competency Draft written reports on results of investigations.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform tests to determine Acid Base disorders	DOPS
Perform any necessary maintenance and run Internal Quality Control for Glucose measurement on a point of care analyser	DOPS
Prepare a set of lyophilised Internal Quality Control Samples for assay	DOPS
Assess performance of a manual pipette	DOPS
Prepare appropriate dilutions of an elevated sample for reassay on an automated analyser	DOPS
Perform weekly maintenance on an analyser in the automated laboratory	DOPS
Perform a manual semiautomated technique in the local laboratory	DOPS
Perform tests to determine kidney function	DOPS
Perform tests to determine cardiac function and disease	DOPS
Review External Quality assessment Chemistry Analytes	DOPS
Prepare and analyse samples by HPLC	DOPS
Perform tests to determine liver function	DOPS
Perform tests to determine bone metabolsim	DOPS
Collect a sample for cryoglobulin analysis	DOPS
Attend a phlebotomy clinic or ward round and explain to a patient what will happen to their blood sample	OCE
Explain to a patient how to collect a 24 hour urine sample	OCE
Phone and discuss abnormal results with a healthcare professional	OCE
Explain to a patient healthcare professional the preparation required to take samples for renin and aldosterone	OCE

Learning outcomes

1. Perform the range of laboratory and point-of-care testing techniques used in the work-base to investigate major organ function.
2. Perform clinical and laboratory investigation of homeostatic mechanisms.
3. Perform clinical and laboratory investigation of kidney function and renal replacement therapy.
4. Perform clinical and laboratory investigation of liver function.
5. Perform clinical and laboratory investigation of cardiac function in acute and chronic conditions.
6. Perform clinical and laboratory investigation of bone metabolism.
7. Apply Clinical Biochemistry to the screening, diagnosis and treatment of common cancers.
8. Perform clinical and laboratory investigation of disorders associated with specific protein abnormalities.
9. Interpret and report clinical and laboratory investigation and analysis in the correct clinical context.

Learning outcomes

1. Explain the clinical investigation of hydrogen, water and electrolyte homeostasis, and blood gases, and discuss the causes and consequences of abnormal results.
2. Describe and evaluate the function of the kidney in a range of pathological conditions and the monitoring of biochemical parameters controlled by renal replacement therapy.
3. Explain the use of liver function tests to differentiate the cause of liver disease, assess the degree of liver damage and/or remaining function in a range of pathological conditions.
4. Describe and differentiate the causes of abnormal cardiac function, assess the degree of damage to cardiac tissue and monitor treatment.
5. Explain the process of normal bone modelling/remodelling in health and disease and the investigation of normal and abnormal bone metabolism and calcium homeostasis.
6. Discuss the role clinical biochemistry plays in the screening, diagnosis and treatment of common cancers and the contribution to patient care.
7. Explain the properties and functions of a range of specific proteins in health and disease.
8. Discuss the partnership of clinical biochemistry with other clinical specialisms in the investigation of major organ function and cancer and patient care.

Indicative content

• Water and electrolytes: distribution of fluid and electrolytes; renin angiotensin aldosterone system, antidiuretic hormone, natriuretic peptides, hyper- and hypovolaemia; hyper- and hyponatraemia; hyper- and hypokalaemia; metabolic effects of trauma/stress/surgery; principles of IV fluid replacement therapy
• Renal function: assessment of glomerular function; salt and water homeostasis; hydrogen ion homeostasis; uraemia; definition and assessment of acute kidney injury; definition and assessment of chronic renal failure; renal replacement therapy; renal transplantation; renal tubular acidosis; renal stones
• Liver function: formation of bilirubin; enterohepatic circulation and bile salts; jaundice; hepatitis; cirrhosis; haemochromatosis; alcohol/drug hepatotoxicity; fatty liver disease; Wilson’s disease; cholestasis; biliary obstruction; gallstones; hepatoma; liver transplantation
• Cardiac function: apolipoproteins and cholesterol metabolism; hyperlipidaemia; atheroma; acute coronary syndromes; chronic heart failure; hypertension; cardiovascular risk stratification; primary and secondary cardiovascular disease prevention
• Lung function: respiratory and renal mechanisms in acid–base balance; acidosis; alkalosis; tissue oxygenation; acute and chronic respiratory disease
• Bone function: structure and function of bone; calcium and magnesium homeostasis; vitamin D; hyper- and hypocalcaemia; disorders of phosphate; disorders of magnesium; rickets and osteomalacia; osteoporosis; Paget’s disease; renal osteodystrophy
• Cancer: causes of malignancy; tumour growth and metastasis; molecular basis of malignancy; blood and urinary tumour markers of breast, lung, prostate, ovarian, testicular, pancreatic, GI tract, bladder and thyroid cancer; tissue-based tumour markers; tumour-related effects of malignancy; NHS bowel cancer screening programme
• Proteins: properties and functions of albumin, transport proteins, protease inhibitors; ceruloplasmin, immunoglobulins, CRP, cytokines; hyper- and hypoalbuminaemia; paraproteinaemia; cryoglobulinaemia; alpha-1 anti-trypsin deficiency; plasmapheresis

Activities

• Participate in multidisciplinary review meetings at which biochemical results of major organ function and malignancies are presented as part of the clinical record and prepare reports. Reflect on your experience in terms of the role of multidisciplinary working and its benefits for patients.
• Attend ward rounds and clinics at which patients are being investigated for disorders of major organ function and malignancies and prepare reports. Select, with permission, one patient and follow their investigative and diagnostic experience. Reflect and report on the results with regard to service delivery and patient care.
• Visit a GP centre and review/reflect on its use of the clinical biochemistry service and the role of GPs, nurses and other staff in the patient pathway. Suggest possible improvements to this service.
• Attend a phlebotomy clinic to observe patients undergoing venepuncture.
• Become familiar with the laboratory quality management system and perform examination and other audits as part of the laboratory accreditation process (applies to all specialist modules).