Body Cavity Effusion Analysis Flashcards
What are the cells lining the body cavities?
mesothelial cells
What are the common causes of body effusions?
trauma
CV dz/altered starling forces
hemorrhage
neoplasia
infection/inflammation
ruptured organs
What is the most common clinical sign associated with severe effusions?
dyspnea
If you know there will be a delay in assessing the effusion sample, what should be done?
Make a direct smear at collection
store fluid in fridge
If performing an estimate of the cell count in an effusion, how can it be determined?
Average number of cells in at least 10 representative fields is multiplied by the square of the objective used to perform the count
What are the normal findings in a body cavity effusion for small animals?
minimal reactive mononuclear cells
low # of small lymphocytes & mesothelial cells
Normal effusion cellular makeup in the horse?
Low numbers of mesothelial cells
Minimally reactive mononuclear phagocytes
Low number of small lymphocytes
Mature non-degenerate neutrophils often predominate
What are the cell # present in small animal & equine exudative effusions?
horse >10,000
small animals >5,000
What is a transudate?
Diffusion of plasma water from the vessels
What causes transudate effusions?
Reduced plasma oncotic pressure
Increased hydrostatic pressure
What clinical conditions result in transudate effusions?
Liver dz ( Portal hypertension
Shunting
Malnutrition
Hepatic insufficiency)
Intestinal Dz (malabsorption/digestion, PLE)
Renal dz (PLN)
Iatrogenic fluid overload and dilution of plasma albumin
With acute transudates, what is the predominant cell type in small animals? In chronic transudates? Why?
acute: mononuclear
chronic: NT (fluid irritates mesothelial cells that release cytokines that recruit NT)
What causes exudate effusions?
inflammation results in increased vascular permeability
Clinical conditions that result in non-septic exudates?
chronic modified transudates
Chemical peritonitis: uroperitoneum, bile peritonitis
FIP
Misc: sterile FB, neoplasia, pancreatitis, abscessed organs
What question is critical to ask when assessing an exudate as being septic or not and you do not see any intracellular organisms but you do see degenerate NT?
did the animal receive abx?
What is the major difference between septic & non-septic exudates?
septic: degenerate NT with intracell organisms
non-septic: non-degenerate NT
What clinical condition could result in a septic exudate?
puncture/bite wound
perforation of the GI tract
abscessed organs
Iatrogenic
Abdominal effusion in a horse- protein >5 mg/dL, 30,000 cells
Type?
septic exudate
How large would the difference in BG and effusion glucose have to be to indicate exudate?
>20 mg/dL
What is the difference in vascular permeability in transudates vs. exudates?
transudates: normal
exudates: increased
Clinical conditions that result in modified transudate effusions?
CHF (peritoneal in dogs, pleural in cats)
thrombosis of CVC
Misc: diaphragmatic/ peritoneal/pericardial hernias, organ torsion (acute), neoplasia
Main difference between modified transudate & transudate?
MT: higher protein and cells
Main reason for modified transudates to occur?
increased hydrostatic pressure
How does a chylous effusion appear grossly and cytologically?
gross: pale, turbid, white
cytology: lymphocytes dominant, macrophages/NT with lipid vacuoles
What causes chylous effusions?
blockage of the lymphatics
What levels of triglycerides would make you suspicious for a chylous effusion?
>100 mg/dL
Clinical conditions that result in chylous effusions?
lymphangiectasia: physical vs. functional obstructions
physical (congenital, fungal, neoplasia, venous thrombus)
functional (cardiac dz (common in cat)/HW dz)
Idiopathic (dogs)
diaphragmatic hernia, lung lobe torsion, thoracic duct rupture
Where do chylous effusions typically occur?
thoracic cavity
What test would you like to run on this effusion obtained from the thorax of a cat to confirm your suspicion? What is the most likely dx?
TG (if >100= chylous)
Cardiac dz
What is the component of pseudochylous effusions that makes it appear chylous?
cholesterol from breakdown products in chronic effusions
A foal presents with lethargic and dyspnea. An amber colored fluid is removed from the abdomen. On chemistry, the foal has a ____ & _____. What is the diagnostic test result that will confirm your suspicion of uroperitoneum?
hyperK & hypoNa
fluid: Creatinine ration >2:1
A yellow/green/brown colored fluid is removed from the abdomen of a dog. The cytology indicate what likely dx? What test can confirm your suspicion?
Bile peritonitis
Fluid:Serum bilirubin concentration >2:1
A feline presents with a light amber color fluid from the abdomen. TP >5 g/dL. What is the likely dx? What on the cytology indicated that?
FIP
granular eosinophilic background, protein crescents
What Albumin:Globulin ratio in effusions with a
total protein >3.5 g/dL and neutrophilic and
macrophagic inflammation would exclude FIP? Include FIP?
Exclude: >0.8
Include: <0.45
Acute or chronic hemorrhage?
Chronic (hemosiderin breakdown products in macrophage)
Type of effusion? Characteristics? Acute or chronic?
Hemorrhagic (erythrophagia & hemosiderin breakdown products, PCV 10-25% of peripheral blood)
Acute (erythrophagia), chronic (hemosiderin breakdown products)
True hemorrhage or iatrogenic? How do you know?
True hemorrhage (erythrophagia)
iatrogenic: would have PLT
True hemorrhage or iatrogenic?
Iatrogenic
Clinical conditions that can cause hemorrhagic effusions?
- Trauma
- Acquired clotting disorder (Rodenticide)
- Inherited clotting disorders
- Idiopathic/benign (dogs & horses)
- Neoplasia (hemangiosarcoma, adrenal tumors, thyroid carcinoma)
Most common clinical condition associated with chylous and hemorrhagic effusions in dogs?
Idiopathic
If you are concerned fro lymphoma vs. chylous effusion, what test can be run?
PPAR
Type of effusion?
Neoplastic (carcinoma)
Most common type of neoplasia seen with neoplastic effusions?
hemangiosarcoma
adrenal tumors
thyroid carcinoma
mesothelioma
