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CLIN PATH > BODY FLUIDS > Flashcards

BODY FLUIDS Flashcards

1
Q

is an ultrafiltrate of plasma containing glucose, electrolytes, amino acids, and other small molecules found in plasma, but it has very little protein and few cells.
ANS:

A

Cerebrospinal fluid (CSF)

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2
Q

CSF is withdrawn from the

A

subarachnoid space

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3
Q

performed by inserting the needle between the fourth and fifth lumbar vertebrae (L4-L5).

A

Lumbar puncture (spinal tap)

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4
Q

This location is used because the spinal cord stops near L2, and a needle introduced below this level will miss the cord.

A

L4-L5

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5
Q

Precautions in getting CSF

A

= only a small amount of CSF for analysis
= only if the benefits are thought to outweigh the risks.
a) In bleeding disorders, lumbar puncture can cause hemorrhage that can compress the spinal cord.
b) increased spinal column pressure, (brain tumor and other conditions), removal of CSF can cause the brain to herniate, compressing the brain stem and other vital structures and leading to irreversible brain damage or death.
c) Meningitis may be caused by bacteria introduced during the puncture.
d) avoid contamination with skin flora.
e) CSF should be refrigerated if analysis is delayed.

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6
Q

AFTER CARE OF GETTING CSF

A
  • puncture site covered with a sterile bandage.
  • patient should remain lying for four to six hours after the lumbar puncture.
  • Vital signs should be monitored every 15 minutes for four hours, then every 30 minutes for another four hours.
  • The puncture site should be observed for signs of weeping or swelling for 24 hours.
  • The neurological status of the patient should also be evaluated for such symptoms as numbness and/or tingling in the lower extremities.
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7
Q

Risk of Lumbar Tap

A

a) headache
b) stiff neck and nausea
c) puncture site leak
d) puncture site appears red and swollen
e) puncture site infection

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8
Q 
NORMAL RESULTS of CSF
•gross appearance: 
•specific gravity: 
•glucose: 
•total protein: 
•LD: 
•lactate: 
•leukocytes (white blood cells):
 - (adults and children); 
 - in infants; 
 - (newborns)
•differential: 
 - lymphocytes; 
 - monocytes and macrophages; 
 - other cells 
•culture: 
•RBC count:
A

• gross appearance: clear and colorless
• specific gravity: 1.006–1.009
• glucose: 40–80 mg/dL
• total protein: 15–45 mg/dL
• LD: 1/10 of serum level
• lactate: less than 35 mg/dL
• leukocytes (white blood cells):
- 0–6/microL (adults and children);
- up to 19/microL in infants; up to 30/microL (newborns)
• differential: 60–80 percent lymphocytes;
up to 30 percent monocytes and macrophages;
other cells 2 percent or less.
Monocytes and macrophages are somewhat higher in neonates, and make up as much as 80 percent or more, with only 20 percent or less being lymphocytes.
•culture: sterile
• RBC count: normally, none unless the needle passes though a blood vessel on route to the CSF

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9
Q

Assignments of Test Tubes for CSF

A

1st tube: chemical or serologic tests
2nd tube: microbiological tests including molecular diagnostics
3rd tube: microscopic examination, Differential Count
4th tube: cytological examination

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10
Q

This tube assignment reduces

A
  • the chances of a falsely elevated white cell count caused by a traumatic tap (bleeding into the subarachnoid space at the puncture site),
  • and contamination of the bacterial culture by skin germs or flora.
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11
Q

GROSS EXAMINATION OF CSF:

Straw, pink, yellow, or amber pigments (xanthochromia)

A

presence of bilirubin, hemoglobin, red blood cells, or increased protein

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12
Q

GROSS EXAMINATION OF CSF:

Turbidity

A

increased number of cells

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13
Q

Differente a subarachnoid hemorrhage from a traumatic tap.

A

The latter is often associated with sequential clearing of
CSF as it is collected; streaks of blood in an otherwise clear
fluid; or a sample that clots.

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14
Q

CSF GLUCOSE

<40mg/dl

A

bacterial and fungal meningitis and in malignancy

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15
Q

CSF PROTEIN

Normal:

A

15-40mg/dl

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16
Q

CSF LACTATE

  • increased lactate
  • no increase
A
  • bacterial and fungal meningitis =increased lactate

- viral meningitis = no increase

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17
Q

This enzyme is elevated in bacterial and fungal meningitis, malignancy, and subarachnoid hemorrhage.

A

LACTATE DEHYDROGENASE

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18
Q

The number of white blood cells in CSF is very low, predominated by

A

Lymphocytes

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19
Q

WBC Differential Counting of CSF

1) viral infection =
2) bacterial and fungal infections =
3) allergy and ventricular shunts =
4) indicating meningitis
5) indicating hemorrhage
6) indicating possible cerebral infarction
7) indicate leukemia
8) Metastatic ___ characteristic of the tissue of origin.

A

1) viral infection = Lymphocytosis
2) bacterial and fungal infections = Neutrophilia
3) allergy and ventricular shunts = Eosinophilia
4) macrophages with ingested bacteria (indicating meningitis)
5) RBCs (indicating hemorrhage)
6) lipids (indicating possible cerebral infarction)
7) blasts (immature cells) that indicate leukemia
8) Metastatic malignant cells characteristic of the tissue of origin.

20
Q

Red cells in CSF signal

A
  • hemorrhage,
  • stroke ,
  • traumatic tap
21
Q

RED BLOOD CELL (RBC) COUNT

A

1) counting RBCs and WBCs in both blood and CSF.
2) The ratio of RBCs in CSF to blood is multiplied by the blood WBC count.
3) This value is subtracted from the CSF WBC count to
eliminate WBCs derived from hemorrhage or traumatic tap.

22
Q

GRAM STAIN:

= bacterial meningitis

A
  • Culture is performed for both aerobic and anaerobic bacteria.
  • Other stains (acid-fast stain for Mycobacterium tuberculosis)
  • Other Tests: fungal culture, and rapid identification tests
    = tests for bacterial and fungal antigens.
23
Q

The VDRL test and fluorescent treponemal antibody-
absorption (FTA-ABS) test are often used and are positive
in persons with active and treated it.

A

syphilis

24
Q

fluid pushed through the capillary due to high pressure within the capillary.
↑ hydrostatic pressure, ↓ colloid osmotic pressure

A

Transudate

25
Q

fluid that leaks around the cells of the capillaries caused by inflammation.

A

Exudate

26
Q

Light’s Criteria: Fluid is exudate if:

A
  • Effusion protein/serum protein ratio >0.5
  • Effusion (LDH)/serum LDH ratio > 0.6
  • Effusion LDH >2/3 upper limits of serum normal
  • Pleural-fluid/serum cholesterol ratio >0.3
27
Q

Appearance of Effusion: Clear (T)

  • Specific Gravity
  • Protein content
  • SAAG = Serum [albumin] - Effusion [albumin]
A
  • Specific Gravity: < 1.012
  • Protein content: < 2.5 g/dL
  • SAAG = Serum [albumin] - Effusion [albumin]: > 1.2 g/dL
28
Q

Appearance of Effusion: Cloudy (E)

  • Specific Gravity:
  • Protein content:
  • SAAG = Serum [albumin] - Effusion [albumin]:
A
  • Specific Gravity: > 1.020
  • Protein content: > 2.9 g/dL
  • SAAG = Serum [albumin] - Effusion [albumin]: < 1.2 g/dL
29
Q 
State whether transudate or exudate
• Congestive heart failure
• Pneumonia
• Cancer
• Pulmonary embolus
• Viral disease
• Coronary-artery bypass surgery
• Cirrhosis with ascites
• Infectious: tuberculosis
A
  • Congestive heart failure: transudate
  • Pneumonia: exudate
  • Cancer: exudate
  • Pulmonary embolus: transudate/ exudate
  • Viral disease: exudate
  • Coronary-artery bypass surgery: exudate
  • Cirrhosis with ascites: transudate
  • Infectious: tuberculosis: transudate/exudate
30
Q

serum-ascites albumin gradient or gap (SAAG) Formula

A

(serum albumin) - (albumin level of ascitic fluid). Ideally, measured at the same time.

31
Q

result of Starling’s forces between the fluid of the circulatory system and ascitic fluid.

A

ASCITIC FLUID

32
Q

NORMAL VALUES OF SAAG

A

<1.7

33
Q

Protein in Ascitic Fluid

A

<3g/dL

34
Q

High gradient SAAG values

A

> 1.1 g/dL, >11 mmol/L

35
Q

ascites due to portal hypertension (High gradient SAAG)

A

a) cirrhosis of the liver ;
b) heart failure;
c) Budd-Chiari syndrome ;
d) Portal vein thrombosis;
e) Idiopathic portal fibrosis

36
Q

ascites not associated with increased portal pressure (Low gradient SAAG):

A

a) tuberculosis;
b) pancreatitis ;
c) infections
d) serositis;
e) peritoneal carcinomatosis;
f) pulmonary infarcts.
g) nephrotic syndrome

37
Q

SAAG with <1.1 and Total Protein of <2.5

A

Nephrotic syndrome

38
Q

SAAG with >1.1 and Total Protein of <2.5

A

Cirrhosis

39
Q

SAAG with >1.1 and Total Protein of >2.5

A

Right HF, Budd-chiari

40
Q

SAAG with <1.1 and Total Protein of >2.5

A

Cancer, TB

41
Q

analysis may be ordered to help diagnose the cause of joint inflammation, pain, swelling, and fluid accumulation. {acute and chronic septic arthritis)

A

SYNOVIAL FLUID

42
Q

Causes in synovial fluid:

a) Infectious diseases –
b) Bleeding –
c) Inflammatory diseases –
d) Degenerative diseases –

A

a) Infectious diseases – bacteria, fungi, or viruses.
b) Bleeding – bleeding disorders and/or joint injury
c) Inflammatory diseases – gout, synovitis, or other immune responses [include autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus]
d) Degenerative diseases – such as osteoarthritis

43
Q

analysis is used to help diagnose the cause of inflammation of the pericardium {pericarditis} and/or fluid accumulation around the heart (pericardial effusion).

A

PERICARDIAL FLUID

44
Q

Exudates causes in the pericardial fluid include:

a) Infectious diseases –
b) Bleeding –
c) Inflammatory conditions –
d) Cancer –

A

a) Infectious diseases – viruses, bacteria, or fungi. = may originate in pericardium or from other parts
b) Bleeding – bleeding disorders and/or trauma
c) Inflammatory conditions – pericarditis may follow a heart attack, radiation treatment, or be part of autoimmune disorders such as rheumatoid arthritis and systemic lupus
erythematosus.
d) Cancer – such as mesothelioma [pericardium] or metastatic cancer

45
Q

Other Pulmonary Specimens:

A
  • Bronchial lavage

- bronchial washing

CLIN PATH (19 decks)

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