AUBF CEREBROSPINAL FLUID Flashcards
a clear, colorless fluid which is chiefly dialysate from the blood (a plasma ultra- filtrate).
csf
csf is similar to serum but..
differs in its concentration of the major constituents.
csf differs from plasma as..
many of the crystalloids in the CSF are of different concentrations.
high level csf crystalloids
sodium and chloride
low level csf crystalloids
potassium, bicarbonate, phosphate, sulphate and glucose
MAJOR CONSTITUENTS OF CSF
protein, glucose and chloride
major constituent of csf that is extremely low w/ no fibrinogen
protein
major constituent of csf that is approximately 2/3 of that blood sugar.
glucose
major constituent of csf that is about 25% higher than plasma chloride.
chloride
csf is formed in the..
highly vascular choroid plexuses
the tufts of capillary blood vessel in the ventricles of the brain.
vascular choroid plexuses
csf is formed by
filtration (secretion and diffusion) from the blood plasma.
location of csf
internal and external
internally…
fills the ventricles of the brain (ventricular fluid), the cisternae, cisternal fluid and the canal of the spinal cord.
externally…
fills the space between the pia and arachnoid membranes surrounding the brain and spinal cord (spinal fluid).
functions of csf
buffer or cushion
medium of exchange
equalizes pressure
excretory channel
collection of csf is..
collected by making a spinal puncture.
occurs if the needle inadvertently has entered an epidural vein during insertion or simply, may blood upon collection
traumatic tap
types of puncture
lumbar puncture
cisternal puncture
ventricular puncture
relatively safe and simple procedure/puncture
lumbar
puncture in lumbar is..
between the 3rd and 4th
vertebrae of the lumbar region.
diagnosis of lumbar puncture
- obtain spinal fluid for study.
- estimate intracranial pressure.
- test for spinal block.
- introduce air or a lipoidal substance.
therapeutic in lumbar puncyure
- introduce serum, penicillin, streptomycin, or anesthetic substance.
- remove blood or irritative exudates.
CONTRAINDICATIONS OF LUMBAR PUNCTURE
A. Subtentorial Tumors
B. Presence of generally increased intracranial pressure
more dangerous than a lumbar puncture
CISTERNAL PUNCTURE (cistera magna or suboccipital)
cisternal puncture is done under ff. conditions:
blocked spinal canal
deformity of the vertebrae
infections of the tissue of the back.
a csf puncture done for last resort.
ventricular puncture
ventricular puncture is done frequently on infants
frequently done in infants whose
fontanelles are still open.
ventricular puncture is rarely done in adults
rarely done in adults except in
connection with ventriculography.
amount of csf in cc per pound of body weight
1 cc
amount of csf in cc in everyday production
100-150 cc
increased amount in acute and chronic
congestion of the meninges is due to..
due to increased transudation of plasma and to increase permeability of the choroid plexus
increased amount in acute and chronic infections is due to..
due to production of inflammatory exudate and to increase permeability of capillaries
csf pressure (position)
horizontal position
csf pressure (water)
between 70 and
200 mm of water
csf pressure (mercury)
0-8 mm. of mercury
csf pressure (average)
average of 100-150 mm.
normal color of csf
clear and colorless as distilled water
fresh red colored csf is due to
due to fresh blood (punctured while inserting needle)
dull red or brown is due to
(depends on lesion’s age) may be due to hemorrhage.
yellow colored csf is due to
due to blood pigments from disintegration of RBC within the subarachnoid space
another word for yellow color
xanthochromic
greenish or grayish colored csf is due to
due to pus cells in severe inflammatory reactions and in acute meningitis.
normal transparency of csf
clear
cloudy transparency of csf is due to
due to fewer than 200
white cells/cu.mm
hazy transparency of csf is due to
due to 200-500 white
cells/cu.mm
turbid transparency of csf is due to
due to over 500 white
cells/cu.mm
in acute meningitis fluid may exhibit
cloudiness/cloudy
in less acute stage of epidemic
meningitis and n tuberculosis and
syphilitic meningitis, tubes,
poliomyelitis, and encephalitis the liquid is
clear
csf coagulation
normally doesn’t coagulate.
fluid clots
increase in proteins including
fibrinogen
numerous small clots (coagulate)
occurs in paresis
“cobweb” / pine tree / “weblike” clot
occurs which may be due to TB meningitis.
where large clot is seen.
“Purulent meningitis”
heavy coagulation and sediment
occur in acute suppurative meningitis.
complete coagulation with xanthochromia w/o hemmorage
occurs in Froin’s Syndrome (spinal subarachnoid block)
test for fibrinogen
- Add 1/3 volume of NaOH to a few cc. of spinal fluid and shake,
- observe for fine fibrin flocculation (condenses on surface)
sediment in fibrinogen test
Normally no sediment (often present in meningitis)
pH in fibrinogen test
Normal reaction is slightly alkaline (7.30 to 7.45 pH level)
SG in fibrinogen test
Normal SG is 1.006-1.008.
A test to confirm the presence of any subarachnoid block.
QUECKENSTEDT TEST
when both jugular is compressed in queckenstedt test it. results to
rise of CSF pressure (rapidly over 300 mm) but returns to normal when compression ceases.
where subarachnoid block at the foramen magnum
sinus thrombosis
a mass lesion at the spinal canal
foramen magnum
in sinus thrombosis the subarachnoid block at the foramen magnum (a mass lesion at the spinal canal)
the rise of CSF may be decreased or delayed.
queckenstedt test positive result
delayed or decreased rise of CSF pressure.
The protein of chief interest
globulin
Globulin test value ____ when applied to
fluid containing blood.
less
Globulin is increased in
meningitis and
latent syphilis.
DIFFERENT TESTS UNDER PROTEIN-GLOBULIN
A. Nonne-Apelt Test for Globulin
B. Ross-Jones Test
C. Pandy’s Test
D. Noguchi’s Test (Qualitative Detection of Protein)
must be performed within 1⁄2 hour after
fluid withdrawal
sugar test
glucose ____ on standing
gradually
decomposes
glucose in spinal fluid is normally ___ of that in the blood.
60%
Qualitative Test for Sugar
Benedict’s Test
Quantitative Test for Sugar.
Nelson-Somogyi Test
chlorides in spinal fluid is normally ___
higher than that in the blood.
25%
a quantitative test which procedure the same as in the chemistry procedure.
Schales and Schales Test
READING AND INTERPRETATION (SCORE OF TUBES BY THE APPEARANCE OF FLUIDE IN TUBE)
Unchanged Deep Red = 0 Red to Blue = 1
Lilac to Purple = 2
Deep Blue = 3
Pale Blue (partial precipitate) = 4 Colorless (complete) = 5
10 tubes results 0 (unchanged in color)
Normal Reaction
highest numbers on the first 3 tubes
Zone 1 or Paretic Curve
Zone 1 or Paretic Curve is related to
related to being insane or multiple myeloma
highest number on the middle tubes
Zone 2 or Tabetic Curve
Zone 2 or Tabetic Curve is related to
syphilis/syphilitic
highest numbers on the last 3 tubes
Zone 3 or Meningitic Zone
Zone 3 or Meningitic Zone is related to
TB meningitis
A TRACED OF BLOOD IN CSF MAY GIVE RISE TO
meningitis curve
BACTERIAL CONTAMINATION MAKES THE RESULT
unreliable
diluting fluid for WBC count which is composed of 1% glacial acetic acid, 99% distilled water.
tuerk’s fluid
a stain used to make the cell darker and easily counted
gentian violet
normal volume of pericardial fluid
10 to 50 mL
presence of excess
blood within the pericardial sac.
Pericardial effusion
pericardial fluid is produced during
inflammatory process,
malignant process, and hemorrhage process.
common causes of pericardial fluid
- Infection – such as bacterial pericarditis, TB,
fungal pericarditis, and AIDS related. - Neoplasm – such as metastatic CA and lymphoma.
- Hemorrhage – such as trauma, anticoagulant therapy and leakage of aortic aneurism.
- Metabolic – such as uremia, myxedema.
- Rheumatoid
- MI (myocardial infarction)
- SLE (systemic lupus erythematosus)
pericardial fluid method of collection
- Pericardiotomy
- Pericardiocentesis
