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Clinical Pathology > Cavitary Effusion > Flashcards

Cavitary Effusion Flashcards

1
Q

What are cavities line by?

A

Mesothelial cells

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2
Q

What does the small amounts of clear serous fluid in animals do?

A

Acts as lubricant and medium of transport for electrolytes and other substances

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3
Q

What is serous fluid removed by?

A

Lymphatic system

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4
Q

What is the composition of fluid in health determined by?

A

Permeability of capillaries

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5
Q

What is serous fluid permeable to?

A 
H2O
Electrolytes
Glucose
Urea
Creatinine
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6
Q

What is the cellular composition of serous fluid?

A

No erythrocytes

Low numbers of nucleated cells

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7
Q

What does it mean if pleural and peritoneal fluid is collected?

A

There is an effusion

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8
Q

What is accumulation of fluid or the fluid that is accumulated??

A

Effusion

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9
Q

What is fluid accumulated in the cavity, typically peritoneal?

A

Ascites

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10
Q

What is the passage of fluid or solute through a membrane due to changes in hydraulic or oncotic pressure gradients?

A

Transudation

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11
Q

What is effusion produced by changes in mechanical factors?

A

Transudate

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12
Q

What is pressure of a fluid at rest?

A

Hydrostatic pressure

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13
Q

What is pressure of a fluid in motion?

A

Hydraulic pressure

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14
Q

What is exuding or oozing out through pores?

A

Exudation

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15
Q

What is effusion produced by increase vascular permeability to plasma proteins?

A

Exudate

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16
Q

What is the escape/loss of blood?

A

Hemorrhage

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17
Q

What is the escape/loss of lymph from lymph vessels?

A

Lymphorrhage

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18
Q

What is a transudate that has been modified by addition of protein and/or cells?

A

Modified transudate

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19
Q

What makes up the colloidal particles concentration?

A

Mainly albumin and other proteins

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20
Q

What does colloidal osmotic pressure vary by?

A

Tissue: 30% of the plasma in muscle interstitium, 70% of the plasma in lungs

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21
Q

What is Starling’s law?

A

Capillaries - intersitium forces

Pressure gradient = Δhydraulic - Δoncotic

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22
Q

What is arterial pressure?

A

Hydraulic difference > oncotic

Fluid leaves the vessel

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23
Q

What is venous pressure?

A

Hydraulic difference < oncotic

Fluid enters the vessel

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24
Q

How does fluid that enters the intersitium return?

A

Via permeabl venous capillaries

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25
Q

When does effusion accumulate?

A

Increased fluid into cavity

Decreased removal of fluid from cavity

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26
Q

What does the composition of fluid provide?

A

Evidence for the type of pathologic process

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27
Q

What causes transudates?

A

Excess diffusion of water from the vascular space
Pleural effusion
Portal hypertension

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28
Q

What can transudation from the liver create?

A

Protein rich fluid

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29
Q

What is pleural effusion primarily caused by?

A

Increased hydraulic pressure in alveolar capillaries

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30
Q

What does pleural effusion mostly remain?

A

Lungs

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31
Q

When do protein-poor transudates tend to form?

A

When there is marked hypoproteinemia

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32
Q

What are the most common causes of protein-poor transudates in dogs?

A

Hepatic cirrhosis

PLN

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33
Q

What are the 2 major factors of protein-poor transudates?

A

Decreased plasma oncotic pressure

Increased hydraulic pressure

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34
Q

What causes protein-rich transudates?

A

Increased plasma hydraulic pressure in liver or lungs because of venous congestion

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35
Q

What are the most common disorders that cause protein-rich transudates?

A

Congestive heart failure

Portal venous hypertension

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36
Q

What causes exudates?

A

Infectious or noninfectious agents
Septic (bacterial, fungal, viral, or protozoal)
Noninfectious Inflammation: increased vascular permeability

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37
Q

What is the most common cells in most exudates?

A

Neutrophils

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38
Q

What kind of exudate is associated with FIP?

A

High [protein] exudates

Protein types are very similar to the plasma

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39
Q

When is effusion considered hemorrhagic effusion?

A

When the primary reason for effusion is hemorrhage

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40
Q

What is the decision threshold for hemorrhagic classification?

A

Many factors affecting hematocrit
Sometimes there are hemorrhage and other processes
If effusion’s Hct >3%, hemorrhage is contributing to the effusion

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41
Q

What are the pathologic states associated with lymphorrhagic effusions?

A

Traumatic: physical damage
Nontraumatic: lymph stasis, lymphatic hypertension, defective lymphatic valve function, increased permeability of lymphatic vessels

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42
Q

What are many chylous pleural effusions caused by?

A

Obstruction of thoracic duct or cranial vena cava

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43
Q

What is a cause of lymphorrhagic effusions?

A

Blockage of lymphatic vessels by neoplastic cells

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44
Q

What are the 2 major groups lymphorrhagic effusions are classified into?

A

Chylous (chylomicron-rich)

Nonchylous

45
Q

What causes chylous effusions?

A

Chylomicron-rich lymph leaks from vessels and enters the cavity

46
Q

What does chylous effusion indicate?

A

Damage to the lymphatic vessels between the SI and thoracic vena cava

47
Q

What is chylothorax common in?

A

Cats

48
Q

What disorders can cause chylous effusions?

A 
Neoplasms
Cardiomyopathy
Heart failure
Lung lobe torsion
Infections
49
Q

What do almost all chylous effusions look like?

A

Milky-white to pink-white fluids

50
Q

What are pseudochylous effusions?

A

Grossly similar appearance to chylous effusions

Have a high cholesterol content due to degeneration of cell membranes in the body cavity

51
Q

What is uroperitoneum?

A

Leakage of urine from bladder, ureter, urethra, or kidney

52
Q

What does uroperitoneum initiate?

A

Inflammatory response

53
Q

What is the nucleated cell count like with uroperitoneum?

A

Low because of the relatively large amount of urine entering the body

54
Q

What will the leakage of bile cause?

A

Low-moderate grade inflammation –> exudate

55
Q

What does the leakage of gastric/intestinal contents cause?

A

Inflammation and exudate

56
Q

What can causes cavitary effusions to accumulate?

A

Abdominal neoplasia
Heart failure
Urine or bile

57
Q

What samples should be collected for pleural and peritoneal fluids?

A

EDTA to inhibit fibrin clot formation

Sterile for microbiologic testing

58
Q

What does it mean if fluid is clear/hazy?

A

Cellularity probably low, concentration method is needed

59
Q

What does it mean if fluid is cloudy/opaque?

A

Concentration method is probably not needed

60
Q

What will fluid look like if it’s supernatant contains bilirubin?

A

Yellow-orange

61
Q

What will fluid looks like if it’s supernatant contains Hgb?

A

Pink-red-brown

62
Q

What will fluid look like if it’s supernatant contains stercobilinogen?

A

Brown

63
Q

What will fluid look like if it’s supernatant contains chorophyll?

A

Green

64
Q

What will fluid look like if it’s supernatant contains lipoproteins/chylomicrons?

A

White/creamy

65
Q

What does it mean if the supernatant has color?

A

Pigment solutes in the fluid

66
Q

What does it mean if the sediment has color?

A

Pigments in the cells or particles

67
Q

What physical analysis is used for pleural and peritoneal effusion?

A

Refractometric estimates of [total protein]

Refractometric estimates of specific gravity

68
Q

What does total nucleated cell concentration measure?

A

Fluids that contain leukocytes, mesothelial cells, potentially other cells

69
Q

What kind of fluid is present if TNCC is at its lowest values (<1,000/ul)?

A

Protein-poor transudates

70
Q

What kind of fluid is present if TNCC is at its greatest values (>100,000/ul)?

A

Exudates and neoplastic lymphoid effusions

71
Q

What is the most important part of the fluid analysis if the fluid is not clear and colorless?

A

Microscopic exam

72
Q

What are the major aspects of microscopic exams?

A

Percentages of each nucleated cell
Diagnostic features of cells
Nucleated cell differential count
Extracellular structures

73
Q

What cells are routinely identified on microscopic exams of fluid?

A 
Neutrophils
Lymphocytes
Mesothelial cells
Macrophages
Mononuclear cells
Erythrocytes
Platelets
74
Q

What does increased neutrophils usually indicate?

A

Exudation

75
Q

What can degenerate appearing neutrophils occur without?

A

Sepsis

76
Q

What may nondegenerate neutrophils occur with?

A

Sepsis

77
Q

What should you look for if degenerate neutrophils are present?

A

Organisms

78
Q

What may lymphocytes of fluid have features of when stimualted?

A

Reactive lymphocytes, plasmacytoid lymphocyte, or plasma cells

79
Q

What is the structural function of mesothelial cells?

A

Involved in inflammatory response

80
Q

What becomes more prominent the longer blood is in the cavity?

A

Erythophages, siderophages, and other macrophages

81
Q

What happens when there is recurring or persistent low-grade hemorrhage (neoplasm)?

A

Properties of both acute (high Hct) and chronic (siderophages) hemorrhagic effusion are present

82
Q

What does the presence of platelets suggest?

A

Ongoing or very recent hemorrhage or blood contamination

83
Q

What does the presence of clots in the sample indicate?

A

Fibrinogen was in the sample and could be because of exudation, hemorrhage, or blood contamination

84
Q

What will the analysis should if there is a suspicion that they effusion is chylous?

A

TG will be higher in fluid than in the serum
Cholesterol:TG ratio will be low
TG >100 mg/dL

85
Q

What will urea and creatinine be like if there is recent urine in the cavity?

A

They will be greater than in plasma

86
Q

What electrolytes are freely diffusible through most capillary walls?

A

Na, Cl, K

87
Q

Where are the concentrations of Na, Cl, and K nearly the same?

A

In plasma, interstitial fluids, and most effusions

88
Q

What is the exception to the concentrations of Na, Cl, and K?

A

Uroperitoneum has low Na and Cl and high K compared to plasma

89
Q

What is L-lactate a product of?

A

Anaerobic glycolysis, which is increased in hypoxia

90
Q

What is L-lactate increased in?

A

Peritoneal fludis

91
Q

Is glucose lower in dogs and cats with bacterial effusions of nonbacterial effusions?

A

Bacterial effusions

92
Q

What do protein concentrations in effusions represent?

A

Proteins that leaked through the capillary wall

93
Q

What does increased lipase in fluid indicate?

A

Acute pancreatitis

94
Q

When is septic used to describe exudates?

A

When bacteria was found in the microscopic exam of an exudate

95
Q

What is bacterial exudate like?

A

Few to numerous leukocytes, often degenerate, TP >2 g/dL

96
Q

What is intestinal content like?

A

Not many neutrophils

97
Q

What are effusions with neoplastic lymphocytes like?

A

> 10um nuclei, high cellular activity

98
Q

What may carcinomas and adenocarcinomas do?

A

Exfoliate cells into effusion

99
Q

Do metastatic sarcomas exfoliate or cause effusions?

A

Not typically

100
Q

True or False: metastatic mast cell neoplasias may exfoliate cells into fluid

A

True

101
Q

Will have hemangioma or hemangiosarcome have neoplastic cells in effusions?

A

Rarely

102
Q

Will metastatic melanomas exfoliate neoplastic cells?

A

Yes

103
Q

What can mesotheliomas produce?

A

Effusions with numerous anaplastic cells

104
Q

What are the most common causes of lymphocyte rich effusions?

A

Lymphoid neoplasia

Accumulation of lymph

105
Q

What are pericardial effusions associated with?

A

Neoplasia and infection, often idiopathic

106
Q

What do pericardial effusions frequently have features of?

A

Hemorrhagic effusion

107
Q

What is amniotic fluid like?

A

Clear and watery

108
Q

What are the cells present in amniotic fluid?

A

Numerous nucleated or anucleate cornified squamous epithelial cells

Clinical Pathology (16 decks)

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