Body Fluids Flashcards
1
Q
Normal formation of serous fluid
- Colloid osmotic pressure
A
COP is the pressure caused by protein. If protein is higher on one side of semi-permeable membrane, water tends to flow there to dilute it
2
Q
Define pleural fluid
A
Fluid from thoracic area (thoracic, chest, or lung fluid)
3
Q
This fluid is found in its highest concentration in the eyes and joints
A
Hyaluronic acid
4
Q
List two conditions which cause neutrophils to be present in stool specimens
A
- Ulcerative colitis - Bacillary dysentery - Ulcerative diverticulitis - Intestinal TB - Abscesses or fistulae
5
Q
Clinical signifance of abnormal synovial fluid glucose
A
If markedly decreased, indicates Group II or III disorders
6
Q
Define peritoneal fluid
A
Fluid secreted by cells of teh peritoneum (ascitic or abdominal fluid)
7
Q
CNS neoplasm
- Clarity
- CSF Cell count
- CSF protein
- CSF glucose
- Microbiology data
A
- Clarity: clear or xanthochromic
- CSF cell count: Normal or ↓ lymphocytes/blasts
- CSF protein: normal or ↓
- CSF glucose: normal or ↓
- Microbiology data: N/A
8
Q
Clinical significance of abnormal synovial fluid total protein
A
Increased in inflammatory or hemorrhage disorders
9
Q
Clinical significance of pleural fluid glucose
A
Decreased in tubercular and rhematoid inflammations
10
Q
Urine vs. amniotic fluid - Urea - Creatine - Glucose - Protein levels
A
- Urea: high in urine; plasma (normal) levels in amniotic fluid - Creatine: high in urine; plasma levels in amniotic fluid - Glucose: normal (negative) levels in urine; plasma levels in amniotic fluid - Protein: normal (negative) for urine; plasma levels for amniotic fluid
11
Q
Possible cause for the appearance of red stool
A
Lower gastrointestinal bleeding
12
Q
Exudates
- Appearance
- Specific gravity
- Total protein
- LD
- Cell count
- Presence of spontaneous clotting
- Associated condition
A
- Appearance: Cloudy
- Specific gravity: > 1.015
- Total protein: > 3.0 g/dL
- LD: > 200 IU
- Cell count: >1000/uL
- Presence of spontaneous clotting: Possible
- Associated condition: Pneumonia, malignancy, inflammation, infection
13
Q
Define chylous effusion
A
Accumulation of lymph (chyle) in the body cavities
14
Q
Tubercular meningitis
- Clarity
- CSF Cell count
- CSF protein
- CSF glucose
- Lactate
- Microbiology data
A
- Clarity: Cloudy
- CSF cell count: ↑ neutrophils (early); ↑ lymphocytes (later)
- CSF protein: > 45 mg/dL (~75 mg/dL)
- CSF glucose: < 50 mg/dL (~35 mg/dL)
- Lactate: increased
- Microbiology data: positive acid-fast stain and culture
15
Q
Define parietal membrane
A
Surface membrane which lines the body wall
16
Q
Clinical significance of an increased CSF IgG index calculation
- Equation?
A
Calculated to determine if there is a compromised BBB or increased endogenous production of Igs; > 0.7 indicates Multiple Sclerosis (MS)
(IgGCSF x ALBserum) ÷ (IgGserum x ALBCSF)
17
Q
Aspects of a CSF protein
- Two most common specific causes of its increase
A
- Damage to the BBB (increased capillary permeability or hemorrhage) - Bacterial meningitis
18
Q
Diagnostic use and principle for fecal occult blood analysis
A
To detect hidden blood; screening for colorectal cancer and for GI bleed
19
Q
Clinical significance of pleural fluid amylase determinations
A
Elevated in pancreatic disorders
20
Q
Specific clinical significance of CSF lactate measurements
A
Increased in any conditions that decreases oxygen blood flow to the brain - > 25 mg/dL indicates bacterial, tubercular, or fungal meningitis, w/ a better predictive value than CSF glucose
21
Q
Define thoracentesis
A
Surgical puncture of the chest wall, done to obtain pleural fluid
22
Q
Fecal occult blood
- Principle of the test
A
To detect color change in samples positive for WBCs
23
Q
Fecal occult blood - Reagents used
A
Peroxidase and pseudoperoxidase; guaiac used as the most common indicator
24
Q
Clinical significance of abnormal pericardial fluid CEA determinations
A
Indicates malignancy
25
Pleural fluid pH \< 7.2
Indicates need for ATB's and chest tube drainage
26
Define hemorrhagic fluid
Bloody fluid which can come from a traumatic tap, malignancy, pulmonary infarction, trauma, pancreatitis, TB, but usually malignancy
27
Fungal meningitis
- Clarity
- CSF cell count
- CSF protein
- CSF glucose
- Microbiological data
- Clarity: Clear to cloudy
- CSF cell count: increased monocytes
- CSF protein: \>45 mg/dL (~75 mg/dL)
- CSF glucose: slightly decreased \<50 mg/dL (~35 mg/dL)
- Microbiological data: positive gram stain and fungal culture; possibly positive India ink if organism is encapsulated
28
Clinical significance of CSF creatine kinase isoenzyme measurements
CK-BB - If elevated post-cardiac arrest, a poor prognosis is indicated
29
Clinical significance of abnormal peritoneal fluid CEA and CA 125
Elevated in malignancy
30
Clinical significance of abnormal synovial fluid lactate
If \< 7.5 mmol/L, septic arthritis is excluded If \> 7.5 mmol/L, septic or rheumatoid arthritis are indicated
31
Define serous cavity
Formed by the visceral and parietal membranes; area b/w them contains the serous fluid
32
Aspects of a CSF protein
- Fraction that is in greatest concentration?
Albumin Reference range: 15-45 mg/dL
33
Clinical significance of abnormal peritoneal fluid alkaline phosphatase
Increased in intestinal perforations
34
Pleural fluid pH \> 7.4
Commonly noted in malignancy
35
Possible cause for the appearance of mucus in stool
- Malignancy - Colitis
36
Define pericardial fluid
Fluid around the heart
37
Transudates
- Appearance
- Specific gravity
- Total protein
- LD
- Cell count
- Presence of spontaneous clotting
- Associated condition
- Appearace: clear
- Specific gravity: \< 1.015
- Total protein: \< 3.0 g/dL
- LD: \<200 IU
- Cell count: \<1000/uL
- Presence of spontaneous clotting: No
- Associated condition: cardiovascular, hypoalbuminaemia, hypothyroidism
38
Define ascites
Comes from the Latin for "bag" and describes the bloated abdomen from patient affected w/ massive accumulation of peritoneal fluid
39
Aspects of a CSF protein
- Reason for its spurious elevation
Spurious elevations occur when fluid is contaminated w/ serum or blood cells during traumatic tap
40
Possible cause for the appearance of ribbon-like stool
Intestinal constriction
41
Bacterial meningitis
- Clarity
- CSF cell count
- CSF protein
- CSF glucose
- Lactate
- LD
- Microbiological data
- Clarity: Cloudy
- CSF cell count: Mk'd increased neutrophils '
- CSF protein: much greater than 45 mg/dL (~100 mg/dL; may rise to 500 mg/dL)
- CSF glucose: (Mk'd decrease) much less than 50 mg/dL (~25 mg/dL)
- CSF lactate: increased
- LD: increased LD4 and LD5
- Microbiological data: possible positive Gram stain; positive bacterial culture
42
Explain the routing of a three-tube cerebrospinal fluid collection
Tube 1: Chemistry, Serology Tube 2: Microbiology Tube 3: Hematology (Microbiology) Tube 4: Additional tests
43
Viral meningitis
- Clarity
- CSF cell count
- CSF protein
- CSF glucose
- Microbiological data
- Clarity: Clear to cloudy
- CSF cell count: increased lymphocytes
- CSF protein: \>45 mg/dL, NOT Mk'd increased (\< 100 mg/dL)
- CSF glucose: Normal to slight decrease (~50 mg/dL)
- Microbiological data: negative Gram stain for oraganisms or polys (segs)
44
Increased or decreased will cause the formation of effusions
- Colloid osmotic pressure
Decreased - Hypoproteinemia - Cirrhosis - Nephrotic syndrome
45
Intracranial hemorrhage
- Clarity
- CSF Cell count
- CSF protein
- CSF glucose
- Microbiology data
- Differential
- Clarity: Bloody w/ xanthochromia
- CSF cell count: ↑ due to PB
- CSF protein: \> 45 mg/dL (due to PB protein)
- CSF glucose: Normal or ↓
- Microbiology data: negative Gram stain and culture
- Differential: PB percentages
46
What is the typical appearance of CSF from a traumatic tap?
- No xanthochromia b/c there is fresh blood - Blood decreases as more tubes of CSF are collected
47
Pleural fluid \< 6.0
Indicative of esophageal rupture (influx of gastric fluid)
48
Define empyema
Pus in the pleural cavity
49
Define visceral membrane
Surface membrane which lines the organs; aka peritoneum
50
Clinical significance of abnormal peritoneal fluid amylase
Increased in pancreatitis and GI perforations
51
There is a sharp peak at 450nm which indicates bilirubin in the amniotic fluid; this will tell us how bad HDN is
52
Clinical significance of abnormal peritoneal fluid glucose
Decreased in tubercular peritonitis and malignancy
53
Normal formation of serous fluid
- Hydrostatic pressure
HP exerted by the pumping heart drives fluid OUT of the capillaries into tissue spaces and the serous cavity
54
Define effusion
Escape of fluid into a part of the body
55
What is the clinical significance of abnormal CSF appearance?
If its very bloody, something is wrong
56
Increased or decreased will cause the formation of effusions
- Capillary permeability
Increased - Infection - Inflammation
57
Purpose of pilocarpine
Purpose is to induce sweat on electrodes in order to analyze chloride
58
List two conditions which cause the presence of muscle fibers in stool specimens
- Impaired digestion - Rapid intestinal transit time
59
Increased or decreased will cause the formation of effusions
- Hydrostatic pressure
Increased - Congestive heart failure, impaired venous return, constrictive pericarditis → generalized edema - Venous obstruction, deep vein thrombosis, external pressure (mass), arteriolar dilation, heat, neurohormonal dysregulation → localized edema
60
Diagnositc usefulness of sweat analysis
Performed to diagnose cystic fibrosis, a value of \> 60 mEq/L is bad
61
Possible cause for the appearance of pale yellow/white gray stool
Bile duct obstruction
62
Normal formation of serous fluid
- Capillary permeability
Refers to the normal ability of water, protein, and particular matter form the extravascular space to be absorbed by the lymphatic system
63
Describe the clinical use of bronchoalveolar lavage (BAL) analysis
Used to detect organisms at the alveolar level; usually Pneumocystis jirovecii (carinii) in HIV patients
64
Possible cause for the appearance of black stool
Upper gastrointestinal bleed
65
Clinical significance of CSF lactate dehydrogenase isoenzyme measurements
LD-1 adn LD-2 are found in brain tissue LD-2 and LD-3 are found in lymphocytes LD-4 and LD-5 are found in neutrophils
66
Principle and diagnostic usefulness of fecal Clinitest assays
To detect increased reducing substances indicating CHO malabsorption (intolerance)
67
Clinical significance of abnormal synovial fluid uric acid
May indicate crystal-induced joint disorder, such as gout, when uric acid crystals are not seen on crystal examination
68
Possible cause for the appearance of bulky/frothy stool
Steatorrhea (in pancreatic dysfunction or fat malabsorption)
69
Clinical significance of abnormal peritoneal fluid BUN and creatinine
Indicates a ruptured bladder or accidental puncture of bladder during paracentesis
70
Define hemothorax
Whole blood in the pleural cavities
71
Clinical significance of abnormal pericardial fluid glucose determinations
Decreased in bacterial infections and malignancy
72
Aspects of a CSF protein
- 4 general conditions that cause its increase (150-200 mg/dL)
- Inflammatory disease - Intracranial tumors - Subarachnoid hemorrhage - Cerebral infarction
73
What is the typical appearance of a CSF from a patient w/ subarachnoid hemorrhage?
All tubes will be equally bloody w/ xanthochromia
74
Normal proportion of CSF glucose related to concomitant blood glucose measurements
Should be 60-70% of concomitant blood glucose
75
Define paracentesis
Aspiration of fluid from a cavity (in general)
76
Increased or decreased will cause the formation of effusions
- Lymphatic absorption
Decreased - Tumors - Leukemias/Lymphomas - Superior vena cava obstruction
