AUBF-Lec-Sputum&BAL Flashcards by vnlla babe

Sputum is from the?

From upper and lower respiratory tract

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Tracheobronchial secretions are a misture of?

mixture of plasma, electrolytes, mucin and water
added with:
-cellular exfoliations
-nasal and salivary gland secretions
-normal oral flora

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Sputum normal flora reference range

<10 SEC/LPF and >25 WBC/LPF

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Sputum preservative:

Ref or 10% formalin

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Sputum Collection (5)

First morning sputum
24-hour
Throat Swab
Sputum induction
Tracheal Aspiration

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Sputum Collection: Most preferred

First Morning Sputum

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Sputum Collection: For volume measurement

24-hour

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Sputum Collection: For pediatric patients

Throat swab

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Sputum Collection: For non-cooperative patients

Sputum induction

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Sputum Collection: For debilitated patients (unconscious patients)

Tracheal Aspiration

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Macroscopic Examination of sputum includes?

VOLUME
ODOR
COLOR
CONSISTENCY

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Decrease sputum volume is associated with conditions such as

Bronchial asthma
acute bronchitis
early pneumonia
stage of healing

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Increase sputum volume is associated with conditions such as?

Bronchiectasis
lung abscess
edema
gangrene
tuberculosis
pulmonary hemorrhage

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Normal odor of sputum

Odorless

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Sputum odor when is Lung gangrene, advanced necrotizing tumors present

Foul or putrid

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Sputum odor when Bronchiectasis, tuberculosis is present

Sweetish

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Sputum odor when Necrosis, tumors, empyema is present

Cheesy

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Sputum odor when Liver abscess, enteric Gram-negative bacterial infection is present

Fecal

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Causes of Colorless or translucent sputum color

Made up of mucus only

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Causes of White or yellow sputum color

Increase PUS (TB, bronchitis, jaundice, pneumonia)

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Causes of Gray sputum color

Increase PUS and epithelial cells

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Causes of Bright green or greenish sputum color

Increase Bile, P. aeruginosa infection, lung abscess

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Causes of Red or Bright Red sputum color

Fresh blood or hemorrhage, TB, bronchiectasis

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Causes of Anchovy sauce or rusty brown sputum color

Old blood, pneumonia, gangrene

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Causes of Prune juice sputum color

Pneumonia, chronic lung cancer

Causes of Olive green or grass green sputum color

Cancer

Causes of Black sputum color

Inhalation of dust or dirt, carbon, charcoal, smoking, anthracosis

Causes of Rusty (with PUS) sputum color

Lobar pneumonia

Causes of Rusty (without PUS) sputum color

Congestive heart failure

Causes of Currant, jelly-like sputum color

Klebsiella pneumoniae infection

Consistencies of sputum

Mucoid Serous or frothy Mucopurulent

Mucoid Consistency of sputum is associated with

asthma, bronchitis

Serous or frothy Consistency of sputum is associated with

lung edema

Mucopurulent Consistency of sputum is associated with

bronchiectasis, tuberculosis with cavities

Macroscopic Examination of sputum: Yellow or gray material, size of pinhead Foul odor when crushed

Dittrich’s plugs

Macroscopic Examination of sputum: Hard concretion in bronchus Yellow or white calcified TB structures or foreign materials

Lung stones (Pneumoliths or Broncholiths)

Macroscopic Examination of sputum: Branching tree-like casts of the bronchi

Bronchial casts

Macroscopic Examination of sputum: 3 layers: 1st (top) = frothy mucus 2nd (middle)= opaque, water material 3rd (bottom) = pus, bacteria, tissues

Layer formation

Macroscopic Examination of sputum: Bronchial calculi (calcium carbonate & phosphate) Asbestos bodies, silica particles

Foreign bodies

Layer formation of sputum 3 layers

1st (top) = frothy mucus 2nd (middle)= opaque, water material 3rd (bottom) = pus, bacteria, tissues

Clinical Significance of Dittrich’s plugs

Bronchitis, bronchiectasis, Bronchial asthma

Clinical Significance of Lung stones (Pneumoliths or Broncholiths)

Histoplasmosis (most common) Chronic tuberculosis

Clinical Significance of Bronchial casts

Lobar pneumonia, bronchitis, diphtheria

Clinical Significance of Layer formation of sputum

Bronchiectasis, lung abscess gangrene

Clinical Significance of Foreign bodies

Pneumoconiosis

Microscopic Structures that may be found in sputum: Slender fibrils w/ double contour & curled ends

Elastic fibers

Microscopic Structures that may be found in sputum: Colorless, hexagonal, double pyramid, often needle-like; arise from disinteg. of eosinophils

Charcot-Leyden crystals

Microscopic Structures that may be found in sputum: Heart failure cells: hemosiderin-laden macroph. Carbon-laden cells: angular black granules

Pigmented cells

Microscopic Structures that may be found in sputum: Coiled mucus strands Can also be observed macroscopically

Curschmann's Spirals

Microscopic Structures that may be found in sputum: Colorless globules occurring in a variety of sizes and bizarre forms

Myelin globules

Microscopic Structures that may be found in sputum: Clusters of columnar cells

Epithelial Cells (Creola bodies)

Microscopic Structures that may be found in sputum: Candida albicans. Cryptococcus neoformans, Coccidioides immitis Histoplasma capsulatum , Blastomyces dermatitidis, Aspergillus fumigatus

Fungi

Microscopic Structures that may be found in sputum: Migrating larva: "ASH" (Heart to Lung migration) Ascaris, Strongyloides, Hookworm E. histolytica, E. gingivalis, T. tenax, P. westermani (egg), E. granulosus, T. canis

Parasites

Clinical Significance of when seen in sputum: Elastic fibers

Tuberculosis

Clinical Significance of when seen in sputum: Charcot-Leyden crystals

Bronchial asthma

Clinical Significance of when seen in sputum: Pigmented cells

Congestive heart failure Heavy smokers

Clinical Significance of when ween in sputum: Curschmann's Spirals

Bronchial asthma

Clinical Significance of when seen in sputum: Myelin globules

No significance Mistaken as Blastomyces

Clinical Significance of when seen in sputum: Epithelial Cells (Creola bodies)

Bronchial asthma

Fungi seen in sputum

Candida albicans. Cryptococcus neoformans, Coccidioides immitis Histoplasma capsulatum , Blastomyces dermatitidis, Aspergillus fumigatus

Parasites seen in sputum

Migrating larva: "ASH" (Heart to Lung migration) Ascaris, Strongyloides, Hookworm E. histolytica, E. gingivalis, T. tenax, P. westermani (egg), E. granulosus, T. canis

Other microscopic structures seen in sputum

Neoplastic cells, bacteria, leukocytes

A procedure for collecting the cellular milieu of the alveoli by the use of bronchoscope through which saline is instilled into distal bronchi and then withdrawn

Bronchoalveolar Lavage (BAL)

Bronchoalveolar Lavage (BAL): A procedure for collecting the ________ of the alveoli by the use of ______ through which ______ is instilled into distal bronchi and then withdrawn

cellular milieu; bronchoscope; saline

Bronchoalveolar Lavage (BAL) Important diagnostic test for _______ in immunocompromised patients

Pneumocystis canni (Pneumocystis jiroveci)

Important diagnostic test for Pneumocystis canni (Pneumocystis jiroveci) in immunocompromised patients

Bronchoalveolar Lavage (BAL)

Cells seen in Bronchoalveolar Lavage

56-80% Alveolar macrophage 1-15% Lymphocytes <3% Neutrophils <1-2% Eosinophils 4-17% Ciliated columnar bronchial epithelial cells

Cells seen in Bronchoalveolar Lavage: most predominant

56-80% Alveolar macrophage

Cells seen in Bronchoalveolar Lavage: interstitial dse, pulmonary lymphoma, nonbacterial infections

1-15% Lymphocytes

Cells seen in Bronchoalveolar Lavage: cigarette smokers, bronchopneumonia, toxin exposure

<3% Neutrophils

Cells seen in Bronchoalveolar Lavage: hypersensitivity reactions

<1-2% Eosinophils

Cells seen in Bronchoalveolar Lavage: 4-17%

Ciliated columnar bronchial epithelial cells