Logic and structure of pathologoanatomical diagnosis The diagnosis - brief medical conclusion about essence of disease (trauma), a condition

of the patient, expressed in terms, providing and accepted by classifications and the nomenclature of diseases (ICD-10). Stages of the diagnostic process: 1. A stage of gathering of data about disease. 2. A stage of the analysis and differentiation of revealed symptoms. 3. A stage of integration and synthesis (formulating of the diagnosis). There are following type of diagnoses in medicine: 1. The clinical diagnosis 2. The pathoanatomical diagnosis 3. Forensic medical diagnosis 4. The epidemiological diagnosis Functions of the clinical diagnose: 1. successive complex treatment 2. timely conducting of the antiepidemic measures 3. medical rehabilitation 4. medical prognostication 5. expertise of work capacity, professional selection & medical control in sport 6. expertise of military capacity, judicial deed capacity 7. statistics of morbidity & mortality 8. learning to clinical thinking & its perfection 9. scientific analysis of questions of clinics, diagnostics, therapy and pathomorphosis of diseases Functions of pathoanatomical diagnose: 1. determination of the cause & mechanism of the death of the person 2. specification of the statistics of the mortality according with ICD-10 3. control of the quality of clinical diagnostics & treatment 4. timely conducting of antiepidemic measures 5. learning & perfection of the clinical thinking 6. scientific analysis of questions of etiology, pathogenesis, pathological anatomy, pathomorphosis of diseases Clinical diagnosis is dynamic diagnose, it maybe changed with time. But final clinical diagnose (postmortem) & pathoanatomical diagnose are static. Clinical diagnose reflexes functional changes, but it may use morphological data (data of biopsy), pathoanatomical diagnose is based on morphological aspects & it uses clinical data when morphological changes dont developed or they were liquidated due to the treatment.

Principles of the pathoanatomical diagnose: 1. nosological 2. accordance to ICD-10 3. intranosologic additional characteristics of clinico-anatomical variant (syndrome), type of current, degree of activity, stage, functional disorder 4. pathogenetical 5. structure with unificated rubrics 6. factical, logical validity & reliability 7. timeliness & dynamism 8. Non-divulgence of the diagnose The non-observance of any of above mentioned principles in formulating of diagnose lead to typical mistakes & defects. Pathologoanatomical diagnosis is medical conclusion about substance of disease, which reflects nosology, etiology, pathogenesis, morphofunctional features, which are expressed in terms according with ICD-10. Its a result of final stage of the diagnostic process, established after death of the patient on the basis of the clinico-morphological analysis. Nosology is studying about diseases. Nosologic unit is certain disease (clinicomorphological notion). Syndrome is clinical constellation, where clinical signs joined by common pathogenesis, which is typical for different diseases. There are 1 500 of syndromes, but nosological units are more then 20 000. So syndrome is a pathogenetical notion, but not nosological. In the structure of pathologoanatomical diagnosis 1st place is the nosological unit by IDC-10. On next place are all morphological features of this nosology in pathogenetic order. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization. (WHO). The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses. Using optional subclassifications, the codes can be expanded to over 16,000 codes. Using codes that are meant to be reported in a separate data field, the level of detail that is reported by ICD can be further increased, using a simplified multiaxial approach. Work on ICD-10 began in 1983 and was completed in 1992. Both clinical and pathologoanatomical diagnosis consists of 3 categories: main disease, its complications and concomitant disease. Main disease is disease, which itself or by its complications become the cause of hospitalization or cause of death. So cause of death and main disease are identical notions.

Monocuasal variant of lethal outcome is registered in 45-50 % of cases of autopsies, in 35-40 % of cases of autopsies the death is the result of the combination of 2 leading nosologies (bicausal genesis of daeth), in 10-15 % of autopsies the cause of death is combination of 3 & more nosologies (multicausal genesis of death). Structure of final clinical & pathoanatomical diagnoses Variant of the genesis of the disease & The part of the diagnose death A. Monocausal I. Main disease II. Complication III. Concomitant diseases B. Bicausal I. Combined main disease a) 2 competitive main diseases b) main disease & background disease c) 2 associated diseases II. Complications III. Concomitant diseases C. Multicausal I. Polypathias: a) several diseases or conditions, which are etiologically & pathogenetically connected b) casual combination of several diseases or conditions II. Complications III. Concomitant diseases Main diseases is nosological unit, which has most expressed appearance, threatening to the health & life of patient, by the reason of which the treatment is conducting. So, its condition, which itself or through its complications caused the death. Complication of main disease is pathological process, which etiologically or pathogenetically is connected with main disease & significantly aggravate its course and may became the cause of death. There are main complications, which maybe the cause of death, and secondary complications. In diagnose the complications must be written in pathogenetical sequence & reflect the dynamics of disease. Complications maybe determined as: - joining to disease the syndrome of disorder of the pathological process. - Discontinuity of the organ or its wall - Bleeding - Acute or chronic insufficiency of the organ or system of organs

Cause of death (leading factor of thanatogenesis) is structural & functional or metabolic damages in human organism, which caused the disorder of the homeostasis, causing the lethal outcome. Usually its a main complication of the main disease. Concomitant disease (nosology) is disease, which isnt etiologically & pathogenetically connected with main disease & its complications, doesnt influence on its course, doesnt cause the death. Combined main diseases reflects the combination at patient of 2 leading diseases. These diseases cause the new pathological condition, and by interacting between each other, they cause the death (bicausal genesis of disease & death). And these 2 nosologies maybe in different pathogenetic & thanatological relations. There are: competitive diseases 2 simultaneously existing pathology, every of each may separately cause the death; as rule its impossible to divide them because of commonness of clinico-morphological appearance & thanatogenesis; assotiated diseases 2 nosologies, casually coinciding in time & topics, every of each separately in this conditions couldnt cause the death, but together they became the cause of death. background disease plays significant role in appearance & development of main disease, although its etiology is different; interaction of basic nosology with background disease accelerate & aggravate the thanatogenesis.