Body Fluids (lec 1) Flashcards
Effusion is?
Transudate?
Exudate?
Abn fluid in cavity
Trans:
result of pressure diff b/w compartments,
blood filt across intact vascular wall,
(U) from system dz (CHF, etc)
Exu:
results from inflamm/vascular wall damage,
(U) from infect, malig, inflamm dz
Total Fluid Protein tells us?
Fluid:Serum Protein tells us?
types of fluid
FP
< 3 = transu
> 3 = exu
F:S P
< 0.5 = transu
> 0.5 = exu
Lactate DH Fluid:Serum tells us?
types of fluid
< 0.6 = transu
> 0.6 = exu
Glucose level tells us?
transu (transu glu same as plasma glu)
or
exu (exu glu < plasma glu)
Appearance of transu?
WBC count/type?
clear, thin
< 300
mononuclear
Appearance of exu?
WBC count/type?
cloudy, thick
> 500
neutrophils
Amylase tells us?
diag of pancreatitis, bowel perf, metastases
Triglycerides tell us?
confirm chylous (fat/lymph from sm intest) effusion
pH of pleural fluid tells us?
parapneumo effusion
Carcinoembryonic Antigen (CEA) tells us?
CEA-producing tumor
Types of cells in normal serous fluid? (4)
lymphocytes
monocytes
macrophages
mesothelial lining
Nonmalig cells from disease states? (3)
neutrophils (inflamm/infect),
eosinophils (hypersens, malig, MI, infect),
RBCs (hemorr, malig)
Exudates requires what further testing? (4)
Cytology (for malig)
Culture (for infect)
Cell count/diff
Chemistry
Exudative Pleural Effusion values:
Specif Gravity?
Fluid Protein?
Fluid:Serum Protein?
Fluid:Serum LDH?
SG > 1.016
FP > 3
F:S P > 0.5
LDH > 0.6
Hemothorax:
RBCs?
Hct?
RBC > 100k
Hct of fluid ≥ 50% of peripheral blood
Hemothorax caused by? (3)
Trauma
Malig
PE
Empyema is?
WBC count?
if >50% neutro = ?
if >50% lympho = ?
if eosino = ?
pus in pleural space
WBC > 50k
if >50% neutro = inflam/infect
if >50% lympho = neoplasm, TB
if eosino = collagen-vasc dz, drug-induced pleuritis, neoplasm, TB
Add’l Pleural Effusion tests:
pH?
Glucose?
Amylase?
Triglycerides?
pH < 7.2 = infect, neopl, RA, esoph rupture
Glu < 60 = infect, neopl, RA
Amylase = pancreatitis, esoph rupture
Trigly = chylous effusion from trauma, neopl or obstructed lymph
PE cause what effusions?
transu or exu
Exu Pleural Effusions caused by? (2)
1) parapneumo from bacterial PNA, lung abscess, bronchiectasis
2) Malignancy (U) lung, breast, lymphoma
Pericardial fluid obtained how?
Subxiphoid Needle Aspiration:
Echo-guided (preferred)
Alligator clip EKG (emergent)
Peritoneal fluid (Ascites) obtained how?
4 quad abdom tap
Ascites labs/significance?
same as pleural fluid
Post trauma -> r/o intraabdominal bleed
Tenderness -> r/o peritonitis
Malignant -> check cytology
Infection -> G-stain, acid-fast, C/S, biopsy
Ascites method of classification?
Serum:Acites Albumin Gradient (SAAG) =
serum albumin - ascitic fluid albumin
SAAG tells us?
> 1.1 = transudate ascites from portal HTN
< 1.1 = exudate ascites from non-portal HTN (e.g. malig, infection)
Ascites cell counts tell us?
(most useful test)
WBC < 500 = uncomplicated cirrhosis
WBC count ↑ w/ inflamm (e.g. infect, TB, CA)
Spontaneous Bacterial Peritonitis caused by?
Presentation?
Tx?
cirrhosis, ascites
No obvious source of infect,
Abrupt fever/chills, abd pain,
Rebound tender,
Fluid WBC > 500 w/ neutro > 50%
Abx, NO surgery
Synovial Fluid Categories? (4)
Group I = non-inflamm (OA)
Group II = mild inflamm (SLE, scleroderma)
Group III = severe inflamm (gout, RA)
Group IV = infection (bacterial, TB)
Next tests for septic synovial?
Tx?
(URGENT CONDITION)
G-stain
Cx
Abx
Birefringence is?
polarized light test for crystals
shine on dark background = crystal
direction of shine determined (+ or -)
Crystal properties for Gout?
monoNa+ urate
strong negative bifringence,
needle-shaped
Crystal properties for Pseudogout?
Ca2+ pyrophosphate
weakly positive bifringence
rhomboid
Cerebrospinal Fluid collected how?
lumbar puncture
L3-4 or 4-5
CSF analysis detects what dzs?
Hemorr
Infect
Malig
CSF analyzed for?
Chemistry: protein, glu, immuno
Micro: G/Acid-stains, C/S
Hemato: count, diff
Plasma prot/glu drawn for comparison
CSF Glucose tells us?
N = 2/3 of plasma glu, 50-80 mg/dl
High = hyperglycemia
Low = bact meningitis, fungal inf
CSF Protein tells us?
N = 20-50 mg/dl
High = bleed, hemolysis, infect
Oligoclonal bands = multiple sclerosis
Myelin basic proteins = MS and other demyelinating dz
CSF RBCs tell us?
Present = cerebral hemorr or traumatic tap
Spin CSF:
If xanthochromic supernatant = hemorr
If clear = traum tap
CSF WBCs tell us:
Normal?
↑ neutrophils?
↑ lymphocytes?
Eosinophils?
Plasma cells?
N = 1-5 mononuclear cells
↑ neutro = bact meningitis
↑ lympho = virus, fungus, TB
Eosino = parasitic, fungus
Plasma cells = MS, chronic inflamm
Meningitis presentation?
HA
N/V
Photophobia
(P) altered mental status
Blood Cultures used when?
Best time to draw?
assess for bacteremia
during episode of fever/chills
Intermittent/Transient Bacteremia possible when?
during manipulation of infected tissue (e.g. dental procedures)
at onset of infection
Continuous Bacteremia likely when?
endovascular infection (e.g. endocarditis)
Blood Culture collected how?
drawn by syringe from at least 2 diff sites
NOT thru existing catheter
inject into BC media bottles (O2 and
Blood Cx results tell us?
If growth in both Cxs = indicative of bacteremia
If one Cx set + = (P) contamination (esp if N skin flora)
Or
(P) true + if strep A, pneumo, h. flu, pseudo, candidia
