CHAPTER 13: SEROUS FLUID Flashcards
Serous fluids provides lubrication between these membranes. (2)
Parietal and Visceral membranes
1) Membrane the lines the cavity wall
2) Membrane that covers the organs with the cavity
a. Visceral Membrane
b. Parietal Membrane
1) Membrane the lines the cavity wall
- parietal
2) Membrane that covers the organs with the cavity
- visceral
Formed as ultrafiltrates of plasma
Serous fluids (unlike CSF - not)
Production and reabsorption of serous fluids are subject to _____________ pressure and ___________ pressure (oncotic pressure) from the capillaries that serve the cavities and the capillary permeability.
Hydrostatic; Colloidal
Pressure in the parietal and visceral capillaries that causes fluid to enter between the membranes.
Hydrostatic Pressure
Filtration of the plasma ultrafiltrate results in increased ____________ pressure in the capillaries that favors reabsorption of fluid back into the capillaries.
oncotic pressure
Increase in serous fluid amount between the membranes
Effusion
Primary causes of effusions (4)
- Increased hydrostatic pressure (CHF)
- Decreased oncotic pressure (hypoproteinemia)
- Increased capillary permeability (inflammation & infection)
- Lymphatic obstruction (tumors)
From disturbances of fluid production and regulation between serous membranes
Transudate (testing not necessary)
Purulent fluid that forms in an body cavity as a result of inflammatory processes (e.g. infection & malignancies)
Exudate
Method of collection for the following:
1) Pleural
2) Peritoneal
3) Pericardial
a. Paracentesis
b. Thoracentesis
c. Pericardiocentesis
1) Pleural
- Thoracentesis
2) Peritoneal
- Paracentesis
3) Pericardial
- Pericardiocentesis
Volume of specimen collected
> 100 mL
Appropriate tubes to be used:
1) Cell counts and differential
2) Microbiology and cytology
a. Heparin tube
b. SPS tube
c. EDTA tube
1) Cell counts and differential
- EDTA
2) Microbiology and cytology
- Heparin or SPS
Serous specimens for pH must be maintained anaerobically in ______.
ice
Most reliable differation between transudates and exudates.
Fluid: Serum LD ratio (>0.6);
Fluid: Serum protein ratio(>0.5)
- except peritoneal fluid
True or False. RBCs and WBCs are not performed routinely on serous fluids.
True. They provide little diagnositc information.
WBC and RBC counts that indicate an exudate
WBC - 1000/uL
RBC - 100,000/uL
Two more procedures for analyzing pleural fluid. What are its ratios providing reliable info?
- Pleural Fluid: Serum Cholesterol (>0.3)
- Pleural Fluid: Bilirubin (>0.6)
Indication of a turbid appearance of pleural fluid
Increased WBC (infection), TB, or RA
Significance of the presence of blood in the pleural fluid
Hemothorax (traumatic injury)
Hematocrit is run on the fluid to differentiate between hemothorax and hemorrhagic exudate. Which of the following match:
- Chronic membrane disease/Hemorrhagic effusion
- Hemothorax
a. HCT >50%
b. Lower HCT
- Chronic membrane disease/Hemorrhagic effusion
- lower HCT - Hemothorax
- HCT >50%
Chylous and Pseudochylous materials produce a milky pleural fluid appearance. Which of the folllowing
1) Contains high conc. of triglycerides, (+) Sudan III staining
2) Contains high conc. of cholesterol, (-) Sudan III staining
1) Contains high conc. of triglycerides, (+) Sudan III staining
- chylous
2) Contains high conc. of cholesterol, (-) Sudan III staining
- pseudochylous
Most diagnostically significant hematology test performed on serous fluids
Differential Count
Its increase indicates bacterial infection, pneumonia, pancreatitis, and pulmonary infarction
Neutrophils
Its elevation are seen in TB, viral infections, malignancy, autoimmune disorders (RA) and SLE
Lymphocytes
Its increased levels may be associated with trauma resulting in the presence of air or blood in the pleural cavity. Also seen in allergic reactions and parasitic infections.
Eosinophils
Indication of the lack of metholelial cells
Tb
Pleural fluid pH lower than ___________ may indicate the need for chest-tube drainage in addition to administration of antibiotics in cases of pneumonia.
7.3
Pleural fluid pH at least _______ degrees lower than the blood pH is considered
significant
0.30
Microorganisms primarily associated with pleural effusions
S. aureus
Enterobacteriaceae
Anaerobes
M. tuberculosis
A more sensitive test to detect M. tuberculosis.
PCR
1) CA 125
2) CA 15.3
3) CA 549
4) CYFRA 21-1
a. Breast cancer
b. Lung cancer
c. Metastatic Uterine cancer
d. Colon cancer
1) CA 125
- metastatic uterine cancer
2) CA 15.3
- breast cancer
3) CA 549
- breast cancer
4) CYFRA 21-1
- lung cancer
Normal volume of fluid found between the pericardial serous membranes
10-50 mL
Function of pericardial fluid
reduces friction
Cells that produce pericardial fluid
Mesothelial cells
a count of >1000 WBCs/μL with a high percentage of neutrophils can indicate
bacterial endocarditis
Refers to the ccumulation of fluid between the peritoneal membranes
ascites
A diagnostic procedure used to detect intra-abdominal bleeding in blunt trauma cases
Peritoneal lavage
Rbc count indicating blunt trauma cases
> 100,000/uL
Recommended to differentiate transudates from exudates in Peritoneal Fluid
Serum Ascites Albumin Gradient (SAAG)
A valuable procedure for identifying the primary source of tumors producing ascitic exudates
CEA and CA 125
What marker/s suggests that the source of tumors producing ascitic exudates is from the ovaries, fallopian tubes or endometrium?
(+) CA 125
(-) CEA
Peritoneal fluid
1) >1.1
2) <1.1
a. Exudate
b. Transudate
1) >1.1
- transudate
2) <1.1
- exudate
