Body Fluids Flashcards
What are effusions and what are they used for?
Are abnormal collections of fluid and can be aspirated from the body to gain information about the disease process that caused the fluid to develop.
Effusions can occur almost anywhere in the body and their presence is abnormal
How are effusions catergorized?
Exudates
Transudates
What is an Exudate?
generally caused by inflammatory, infectious, or neoplastic diseases
What is a Transudate?
generally caused by venous engorgement, hypoproteinemia, or fluid overload
What are potential complications for body fluid studies?
Injury to organ by penetration with needle
Bleeding into fluid space due to blood vessel penetration
Reflex bradycardia and hypotension
Infection of soft tissue around needle aspiration site
Infection of remaining fluid in fluid space
Seeding of the needle tract with tumor when malignant effusion exists (tumor spreads)
Persistent leakage of effusion fluid after needle is withdrawn
What is paracentesis and peritoneal fluid analysis used for?
Fluid is removed for diagnostic and therapeutic reasons.
Used to determine the cause of unexplained ascites and to relieve intraabdominal pressure that develops with large volume ascites.
Therapeutic paracentesis is done to remove large amounts of ascites fluid so patient can experience transient relief of symptoms (dyspnea, distention, early satiety).
Can be exudate or transudate
In general what occurs in Transudate? (What is high/low?)
Total Protein: Low LDH: Low Albumin: Low Specific gravity: Low/Dilute WBC: Low Differential: Mononuclear Glucose: equal to serum Appearance: Clear, thin fluid Etiology: Cirrhosis, neprhosis, heart failure
In general what occurs in Exudate? (What is high/low?)
Total Protein: High LDH: high Albumin: high Specific gravity: High/Concentrated WBC: High Differential: Neutrophils Glucose: Low Appearance: Cloudy, viscous Etiology: Infection, inflammation, malginancy
What is the normal Gross Appearance of a paracentesis and peritoneal fluid analysis?
What can cause abnormal?
Normal is clear, serous, light yellow, < 50 mL.
Transudate may be clear, serous, or light yellow, especially with cirrhosis
Milk colored fluid may be due to escape of chyle from blocked abdominal or thoracic lymphatic ducts, which could be due to lymphoma, carcinoma, and tuberculosis involving the lymph nodes
Exudate will be cloudy or turbid and result from inflammatory or infectious conditions such as peritonitis, pancreatitis, and appendicitis.
Bloody fluid could be from a traumatic tap that penetrates a vessel, intraabdominal bleeding, tumor, or hemorrhagic pancreatitis
Bile stained, green fluid may be due to a ruptured gallbladder, acute pancreatitis, or perforated bowel
What is the normal Cell count for a paracentesis and peritoneal fluid analysis?
Normal is no RBCs and < 300/µL for WBCs.
Presence of RBCs may indicate neoplasms, tuberculosis, or intraabdominal bleeding.
Increased WBCs may be due to peritonitis, cirrhosis, or tuberculosis
What is the normal Protein values for a paracentesis and peritoneal fluid analysis?
Normal is < 4.1 g/dL
Protein levels > 3 g/dL is characteristic of exudates, levels < 3 g/dL characteristic of transudates
A total protein ratio of fluid to serum of greater than 0.5 indicates an exudate
What is the normal Glucose values for a paracentesis and peritoneal fluid analysis?
Normal is 70-100 mg/dL
Levels similar to serum
Decreased levels may indicate tuberculosis or bacterial peritonitis or peritoneal carcinomatosis
What is the normal Amylase values for a paracentesis and peritoneal fluid analysis?
Normal 138-404 units/L
Increased levels seen with pancreatic trauma, pancreatic pseudocyst, acute pancreatitis, and intestinal necrosis, perforation, or strangulation
Amylase is usually 1.5 times higher than serum
What is the normal Ammonia values for a paracentesis and peritoneal fluid analysis?
Normal < 50 µg/dL
High levels seen in ruptured or strangulated intestines and ruptured appendix or ulcer
What is the normal Alkaline Phosphatase values for a paracentesis and peritoneal fluid analysis?
Normal 90-240 units/L
Greatly increased in infarcted or strangulated intestines
What is the normal Lactic Dehydrogenase values for a paracentesis and peritoneal fluid analysis?
Normal is similar to serum LDH
Peritoneal fluid/serum LDH ratio > 0.6 typical of an exudate
Exudate is identified with greater accuracy if protein ratio also favors an exudate
What is the normal Cytology for a paracentesis and peritoneal fluid analysis?
Why is the test performed?
Normal is no malignant cells.
Test is performed to detect tumors, most often ovarian, pancreatic, colon, and gastric.
Interpretation requires a pathologist.
Malignant cells tend to clump together and have a high nucleus/cytoplasm ratio, prominent multiple nuclei, and unevenly distributed chromatin
What is the normal Bacteria, Gram Stain, and Culture for a paracentesis and peritoneal fluid analysis?
Bacteria – normal is no bacteria.
Presence of bacteria may indicate ruptured intestine, primary peritonitis, or infections (appendicitis, pancreatitis, or tuberculosis).
Test identifies the organisms involved and provides information about antibiotic sensitivity.
Used to diagnose bacterial peritonitis
What is the normal Fungi for a paracentesis and peritoneal fluid analysis?
Normal is none.
Presence may indicate histoplasmosis, candidiasis, or coccidioidomycosis
What is the normal Carcinoembryonic antigen for a paracentesis and peritoneal fluid analysis?
Normal < 5 ng/mL.
Elevated CEA indicates abdominal malignancy, usually from the GI tract
What are the tests results of an exudate for a paracentesis and peritoneal fluid analysis?
Lymphoma – tumors involve lymph nodes of the chest and abdomen. Fluid reabsorption cannot occur, so a chylous effusion develops.
Carcinoma – when peritoneal membranes are involved, fluid reabsorption is decreased. Tumors, especially ovarian, also secrete large volumes of fluid.
Tuberculosis, peritonitis, pancreatitis, ruptured viscus – infections increase capillary permeability so fluid is secreted into the abdomen
What are the tests results of an transudate for a paracentesis and peritoneal fluid analysis?
Hepatic cirrhosis, portal hypertension – capillaries have increased portal venous drainage pressure so reabsorption is diminished.
Nephrotic syndrome, hypoproteinemia – renal albumin wasting leads to decreased intravascular oncotic pressure with leakage of fluid out of the intravascular space into the peritoneum.
CHF – venous drainage of peritoneum is diminished by right heart failure and causes increased venous pressures.
Abdominal trauma, peritoneal bleeding – ruptured viscus can be determined with bloody effusion (hemoperitoneum) or by aspirating bowel contents from the free abdominal cavity
What is a Pericardiocentesis and Pericardial Fluid Analysis done for?
What is normal?
Done to determine the cause of an unexplained pericardial effusion.
Also done therapeutically to relieve intrapericardial pressure that accumulates with large volume of fluid or blood => inhibits diastolic filling. This is called cardiac tamponade.
Normal findings are < 50 mL of clear, straw colored fluid without evidence of any bacteria, blood, or malignant cells
What are the results of a Pericardiocentesis and Pericardial Fluid Analysis?
Pericarditis – can occur due to MI; myocarditis; viral, bacterial or tuberculous infections; or collagen vascular diseases. Fluid is usually exudate.
Hypoproteinemia, nephrotic syndrome – fluid is a transudate.
CHF – normally a small amount of fluid exists within the pericardial space and is constantly secreted and reabsorbed by the pericardium. If venous pressure of pericardium is increased due to passive congestion of the pericardium with CHF, fluid will accumulate. (Transudate)
Metastatic cancer – neoplasms affecting pericardium primarily (mesothelioma) or secondarily (breast, lung, ovarian, lymphoma) secrete excess fluid into the pericardial space. Fluid is an exudate.
Blunt or penetrating cardiac trauma, rupture of ventricular aneurysm – sudden accumulation of blood within closed pericardial space leading to decreased diastolic filling and decreased cardiac output – needs immediate treatment.
Collagen vascular disease – get inflammatory pericardial effusion, usually slowly developing
What is a Thoracentesis and Pleural Fluid Analysis done for?
Performed to determine the cause of unexplained pleural effusion as well as to relieve intrathoracic pressure that accumulates with large volume of fluid and inhibits respiration.
Therapeutically – pleural fluid removed to relieve pain, dyspnea, and other symptoms of pleural pressure and to permit better visualization of lungs on x-ray.
Diagnostically – performed to obtain and analyze fluid to determine the cause of the effusion
What is the normal Gross Appearnace of a Thoracentesis and Pleural Fluid Analysis?
What is abnormal?
Normal is clear, serous, light yellow, < 50 mL
Transudate may be clear, serous, or light yellow, especially with cirrhosis.
Milk colored fluid may be due to escape of chyle from blocked thoracic lymphatic ducts causing a chylothorax, which could be due to lymphoma, carcinoma, or tuberculosis involving the lymph nodes.
Cloudy or turbid fluid may be due to inflammatory or infectious conditions like empyema, which has the presence of foul odor and thick pus-like fluid
Bloody fluid could be from a traumatic tap, intrathoracic bleeding, or tumor
