AMNIOTIC, SEROUS, SYNOVIAL, GASTRIC Flashcards
Synovial Fluid Volume
< 3.5 mL
Synovial Fluid Color
Colorless to pale yellow
Synovial Fluid Clarity
Clear
Synovial Fluid Viscosity
Able to form a string 4 to 6 cm long
Synovial Fluid Leukocyte count
< 200 cells/uL
Synovial Fluid Neutrophils
< 25% of the differential
Synovial Fluid Crystals
None present
Synovial Fluid Glucose:plasma difference
< 10 mg/dL lower than the blood glucose level
Synovial Fluid Total protein
<3 g/dL
Synovial Fluid Uric acid
Equal to blood concentration
Synovial Fluid Increased volume
Severe joint involvement
Synovial Fluid Yellow and cloudy
Inflammatory process
Synovial Fluid Milky (white/cloudy)
Crystals
Synovial Fluid Red, brown, or xanthochromic
Hemorrhage
Synovial Fluid Greenish
Bacterial infection
Forms shorter strings or run out of the syringe and down the side of the test tube like water
Synovial Fluid Poor/low viscosity (<3cm strings)
Gastric Fluid Appearance
Translucent, pale gray, and slightly viscous, no food, blood, drugs, or bile pigment
Synovial Fluid Poor/low viscosity (<3cm strings)
Arthritis; Indicates inflammation
Gastric Fluid Volume
50-75mL
Gastric Fluid Odor
faintly pungent
Gastric Fluid pH
1.6-1.9 (1.5-3.5)
Gastric Fluid Mucus
separates in 3 layers on standing
mucus, opalescent fluid, sediments
Gastric Fluid Yellow to green
bile
Gastric Fluid Red
trauma during collection
Gastric Fluid Coffee ground/brownish-red
old blood; gastric bleeding
Gastric Fluid Fasting state
20 to 50 ml
Gastric Fluid After a test meal
20 to 80 ml
Gastric Fluid After chemical stimulation
45 to 150 ml (alcohol/histamine)
contained in the pericardium enclosing the
heart
contained in pleural cavity enclosing the
lungs
contained in the peritoneum enclosing the
abdominal organs
Pericardial Fluid NV:
<10mL
Pleural Fluid NV:
10 to 50 mL
Peritoneal Fluid NV:
≤ 100 mL
Pericardial Fluid Normal:
clear, pale yellow
Pericardial Fluid: Blood-streaked
infection, malignancy
Pericardial Fluid Grossly bloody:
accidental cardiac puncture, anticoagulant medications
Pericardial Fluid Milky:
chylous and pseudochylous sample
Pleural Fluid Normal:
clear or pale yellow
Pleural Fluid Turbid:
presence of WBCs (infection)
Pleural Fluid Viscous:
malignant mesothelioma (↑ hyaluronic acid; type of cancer that develops in the lining that covers the outer surface of some organs)
Pleural Fluid Milky:
chylous or pseudochylous effusions
Pleural Fluid Bloody:
malignancy, hemothorax
Pleural Fluid Brown:
amoebic liver abscess rupture
Pleural Fluid Black:
Aspergillosis
Peritoneal Fluid Normal:
Clear, pale yellow
Peritoneal Fluid Turbid:
Microbial infection
Peritoneal Fluid Green:
Bile, gallbladder, pancreatic disorders
Peritoneal Fluid Blood-streaked:
Trauma, infection, or malignancy
Peritoneal Fluid Milky:
Blood trauma injury (<100,000 RBC/mL)
From thoracic duct leakage
Chylous Effusion
Chronic inflammatory conditions
Pseudochylous Effusion
Extractable in ETHER
Chylous Effusion
NOT Extractable in ETHER
NOT Extractable in ETHER
Stained by Sudan III
Chylous Effusion
Stained by Sudan III
Stained by Sudan III
(-) Cholesterol crystals
Chylous Effusion
(+) Cholesterol crystals
(+) Cholesterol crystals
Predominant Lymphocytes
Chylous Effusion
Mixed Cells
Mixed Cells
> 110 mg/dL TAG
Chylous Effusion
< 50 mg/dL TAG
< 50 mg/dL TAG
Milky white
Chylous Effusion
Milky green
Milky green
– fluid accumulation between peritoneal membranes
Ascites
: Sensitive for the detection of intra-abdominal bleeding in blunt trauma cases
Peritoneal lavage
Peritoneal lavage RBC count
> 100,000/uL
Serum:Ascites Albumin gradient (SAAG)
: transudate
: exudate
≥ 1.1
< 1.1
Pericardial Fluid Increased Neutrophils
Bacterial endocarditis
Pericardial Fluid Malignant Cells
Metastatic carcinoma
Pericardial Fluid CEA
Metastatic carcinoma
Pericardial Fluid Gram stain and culture
Bacterial endocarditis
Pericardial Fluid Acid fast and adenosine deaminase
Tuberculosis effusion
Pleural Fluid Neutrophils
Pneumonia, pancreatitis, pulmonary infarction
Pleural Fluid Lymphocytes
Tuberculosis, viral infection, autoimmune disorders, malignancy
Pleural Fluid Mesothelial Cells
Normal and reactive forms have no clinical significance, decreased numbers in associated with tuberculosis
Pleural Fluid Plasma Cells
Tuberculosis
Pleural Fluid Malignant Cells
Primary adenocarcinoma and small-cell carcinoma, metastatic carcinoma
Peritoneal Fluid Cellular Examination
WBCs, mesothelial cells, and macrophages
Peritoneal Fluid WBC count:
– normal
– bacterial peritonitis and cirrhosis
<500 cells/uL
>500 cells/uL
Peritoneal Fluid Neutrophils
Pneumonia, pancreatitis, pulmonary infarction
Pericardial Fluid Cells
Pleural Fluid Cells
Peritoneal Fluid Cells
Synovial Fluid Cells
Vacuolated macrophages with ingested neutrophils
Reiter cells
Seen in Reiter’s syndrome and non-specific inflammation
Reiter cells
Neutrophils with small, dark, cytoplasmic granules of precipitated rheumatoid factor
RA cells/Ragocytes
Seen in rheumatoid arthritis and immunologic inflammation
RA cells/Ragocytes
Neutrophil containing a characteristic ingested round body
LE cell
Seen in systemic lupus erythematosus
LE cell
Monocytes that contain an engulfed nuclear material
Tart cell
May be mistaken as an LE cell
Tart cell
Similar to macrophage, but may be multinucleated
Synovial lining cell
Also resembles mesothelial cells
Synovial lining cell
Normally seen in synovial fluid
Synovial lining cell
Large, multinucleated cell
Cartilage cell
Seen in osteoarthritis
Cartilage cell
Macroscopically resemble polished rice
Rice bodies
Microscopically show collagen fibers and fibrin strands
Rice bodies
Seen in tuberculosis, sepsis and rheumatoid arthritis
Rice bodies
Refractile intracellular and extracellular globules
Fat droplets
Seen in traumatic injury
Fat droplets
Inclusions within clusters of synovial cells
Hemosiderin
Seen in pigmented villonodular synovitis
Hemosiderin
Debris from metal and plastic joint prosthesis
Ochronotic shards
Look like ground pepper
Ochronotic shards
No significant diagnostic value
Ochronotic shards
Seen in bacterial sepsis and crystal-induced inflammation
Neutrophil
Seen in non-septic inflammation
Lymphocyte
Seen in acute rheumatoid arthritis, parasitism and Lyme disease
Eosinophil
May contain vacuolations
Macrophage and Monocyte
Normally seen in synovial fluid, but may also indicate viral infection
Macrophage and Monocyte
Normally seen in synovial fluid, but may also indicate viral infection
unresponsive pneumonia and esophageal rupture
↓pH
rheumatoid inflammation and purulent infection
↓Glucose
pancreatitis, esophageal rupture, malignancy
↑Pleural Fluid Amylase
chylous infection
↑Pleural Fluid Triglycerides
tubercular peritonitis and malignancy
↓Peritoneal Fluid Glucose
pancreatitis, gastrointestinal perforations
↑ Peritoneal Fluid Amylase
malignancy of gastrointestinal origin
Peritoneal Fluid CEA
Peritoneal Fluid CA 125
malignancy of the ovaries, fallopian tubes or endometrium
Carcinoembryonic antigen
CEA
assayed in ruptured bladder or accidental puncture of the bladder during paracentesis
Peritoneal Fluid BUN and creatinine
Metastatic uterine cancer
CA 125
Breast cancer
CA 15.3 and CA 549
Lung cancer
CYFRA 21-1
Degenerative joint disorders
Noninflammatory
osteoarthritis
Noninflammatory
Immunologic disorders
Inflammatory
rheumatoid arthritis
Inflammatory
lupus erythematosus
Inflammatory
scleroderma
Inflammatory
polymyositis
Inflammatory
ankylosing spondylitis
Inflammatory
rheumatic fever
Inflammatory
Lyme arthritis
Inflammatory
Crystal-induced gout and pseudogout
Inflammatory
Microbial infection
Septic
Traumatic injury
Hemorrhagic
tumors
Hemorrhagic
hemophilia
Hemorrhagic
other coagulation disorders
Hemorrhagic
anticoagulant overdose
Hemorrhagic
Clear, yellow fluid
Noninflammatory
Inflammatory
Good viscosity
Noninflammatory
WBCs < 1000uL
Noninflammatory
Neutrophils < 30%
Noninflammatory
Normal glucose (similar to blood glucose)
Noninflammatory
Hemorrhagic
Poor viscosity
Inflammatory
WBCs: 2000 to 75,000 uL
Inflammatory
Neutrophils > 50%
Inflammatory
Decreased glucose level
Inflammatory
Possible autoantibodies present
Inflammatory
Cloudy or milky fluid
Inflammatory
Low viscosity
Inflammatory
Hemorrhagic
WBCs up to 100,000uL
Inflammatory
Neutrophils < 70%
Inflammatory
Decreased glucose level
Inflammatory
Septic
Crystals present
Inflammatory
Cloudy, yellow-green fluid
Septic
Variable viscosity
Septic
WBCs 50,000 to 100,000 uL
Septic
Neutrophils > 75%
Septic
Positive culture and Gram stain
Septic
Cloudy, red fluid
Hemorrhagic
WBCs equal to blood
Hemorrhagic
Neutrophils equal to blood
Hemorrhagic
SEROUS FLUID: for cell counts, morphology and differential count
EDTA
SEROUS FLUID: for chemistry tests
Heparinized or Clotted blood
SEROUS FLUID: for microbiology and cytology
Sterile heparinized
SEROUS FLUID: specimens for pH
Anaerobically on ice
SYNOVIAL FLUIDS Chemistry
Non-anticoagulated NaF
SYNOVIAL FLUIDS Glucose analysis
Heparin
SYNOVIAL FLUIDS Microscopic examination: Cell counts
Liquid EDTA
SYNOVIAL FLUIDS Microbiology: Gram stain and culture
Sterile heparinized tube SPS tube
—via mouth; for washing and emptying stomach in case of poisoning
—via mouth; for the collection of gastric and duodenal contents
—for gastric collection
—for gastric collection
—via nose, for gastric collection
—via mouth; for washing and emptying stomach in case of poisoning
—via mouth; for the collection of gastric and duodenal contents
—for gastric collection
—for gastric collection
—via nose, for gastric collection
