Chapter 15 Serous Fluids Flashcards
1
Q
Fluid between the membranes of closed body cavities
A
Serous fluid
2
Q
Lines the cavity walls
A
Parietal membrane
3
Q
Covers the organs within the cavity
A
Visceral membrane
4
Q
Provides lubrication to prevent friction between 2 membranes when organs move
A
Serous fluid
5
Q
Label the missing visceral and parietal membranes
A
6
Q
Space between each lung and the chest wall
A
Pleural cavities
7
Q
A thin membrane lines the pleural cavities
- composed of thin layer of mesothelial cells
- provides a moist surface to minimize friction
A
Pleura
8
Q
Surrounds the heart
A
Pericardial cavity
9
Q
Thin membrane that covers the pericardial party
- composed of a single layer of mesothelial cells
A
Pericardium
10
Q
Pericardial fluid reactions
A
- Fluid can accumulate
- can restrict the normal heart beat (cardiac tamponade)
11
Q
Name the cavity or cells
A
12
Q
Space between the abdominal wall and outside of the stomach, small and large intestine, liver, and superior aspect of the urinary bladder and uterus
A
Peritoneal cavity
13
Q
Consists of one layer of mesothelial cells
A
Peritoneal lining
14
Q
Accumulation of peritoneal fluid
A
Ascites
15
Q
3 types of body fluids
A
Pleural, pericardial, peritoneal
16
Q
Similar findings for all 3 fluids (6)
A
- Minimal amount of fluid
- produced by the parietal lining
- absorbed by the visceral lining
- fluid is produced by plasma filtration through capillary endothelial cells
- amount produced depends on 4 factors
- pathological state results in effusion - abnormal fluid collection
17
Q
What 4 factors does the amount produced depend on
A
- Increased capillary hydrostatic pressure
- decreased plasma oncotic pressure
- decreased lymphatic resorption
- increased capillary permeability
18
Q
Types of effusion
A
Transudate and exudate
19
Q
Contain a small amount of fluids to lubricate and cushion organ movement
A
Body cavities
20
Q
Amount of fluid is maintained by an equilibrium between
A
The fluid, capillaries, and lymphatic vessels of an organ
21
Q
Any compromise can cause an escape and buildup of fluids into the body cavity called
A
Effusion
22
Q
Needle puncture for aspiration of fluids from body cavities
A
Centesis
23
Q
Thoracentesis
A
Pleural
24
Q
Pericardiocentesis
A
Pericardial
25
Paracentesis or peritoneocentesis also known as ascitic fluid
Peritoneal
26
Intermittent drainage of excess fluid through a catheter that remains in the pleural space
Pleural catheter
27
Repeated fluid removal via a syringe or temporary external catheter connected to a vacuum container
Serial thoracenteses
28
Creation of scar tissue in pleural space
Pleurodesis
29
Increased capillary hydrostatic pressure causes
Congestive heart failure
| Salt and fluid retention
30
Decreased oncotic pressure causes
Nephrotic syndrome
hepatic cirrhosis
Malnutrition
Protein-losing enteropathy
31
Increased capillary permeability causes
Microbial infections
Membrane inflammations
Malignancy
32
Lymphatic obstruction causes
Malignant tumors
Lymphomas
Infection and inflammation
Thoracic duct injury
33
Causes of exudate
Increased capillary permeability
| Decreased lymphatic absorption
34
Causes of transudate
Increased hydrostatic pressure
| Decreased oncotic pressure
35
Conditions of exudate
Infections, inflammatory, neoplasms
36
Conditions of transudate
Congestive heart failure, renal disease, cirrhosis, malnutrition
37
Specific gravity: >1.015
Protein: >3.0 g/dL
Fluid:serum ratio: >0.5
Lactic dehydrogenase fluid:serum ratio: >0.6
WBC: >1000 per microliter
Diff: >25% PMN, many mesothelial cells, malignant cells
Fibrinogen: cause clotting
Exudate
38
```
Specific gravity: <1.015
Protein: <3.0 g/dL
Fluid:serum ratio: <0.5
Lactic dehydrogenase fluid:serum ratio: <0.6
WBC: <1000 per microliter
Diff: <25% PMN and lymphs
Fibrinogen: none
```
Transudate
39
Decreased in infection, tuberculosis, rheumatoid inflammation
Glucose
40
Elevated in bacterial infections
Lactate
41
Increased in pancreatitis, esophageal rupture and malignancy
Amylase
42
Decreased in pneumonia resistant to antibiotics and esophageal rupture
pH
43
Increased in tuberculosis and malignancy
Adenosine deaminase
44
Infections: bacteria, tuberculosis, fungal and viral
Microbiological studies
45
Malignancies
Cytology studies
46
Normal appearance
Clear, pale, yellow
47
Microbial infection appearance
Turbid, cloudy
48
Hemothorax, hemorrhagic effusion, pulmonary embolism, TB, cardiac puncture, anticoagulants, malignancy appearance
Bloody (hematocrit is run >50% indicates hemothorax)
49
Chylous or pseudochylous material appearance
Milky, opaque. Remains in the supernatant after centrifugation
50
Rupture of liver abscess, bile appearance
Brown
51
Gallbladder, pancreatic disorders appearance
Green
52
Aspergillous appearand
Black
53
Results from leakage of lymphatic vessels of the major thoracic duct
Chylous effusion in pleural cavity
54
Results from blockage of the lymphatic vessel
Chylous effusion of peritoneal fluid
55
Associated with malignancy and trauma
Chylous effusion
56
Rich in chylomicrons, high triglycerides >110 mg/dL, lymphocyte predominant cell
Chylous effusion
57
Results from conditions such as TB and rheumatoid pleuritis
Pseudochylous effusions
58
Cholesterol high with crystals, chylomicrons not present, triglycerides < 50 mg/dL
Pseudochylous effusions
59
Mixed reactive cell population
| - inflammatory cells, necrotic cells
Psuedochylous effusions
60
No question
61
Bacterial endocarditis differential
Increased neutrophils or gram stain and culture
62
Metastatic carcinoma differential
Malignant cells or carcinoembryonic antigen
63
Tubercular effusion differential
Acid-fast stain or adenosine deaminase
64
Best differentiation for peritoneal transudates and exudates
Serum-ascites
65
Serum and fluid albumin levels are measured; fluid level is subtracted from serum level; difference (gradient) > than 1.1 =
Transudate (hepatic origin)
66
Serum albumin 3.8 - fluid albumin 1.2 =2.6 =
Hepatic transudate
67
Segmented neutrophils are found in
Pleural, pericardial, and peritoneal fluid
68
Artifactual change in neutrophils
69
Differences in segmented neutrophils (3)
- Artifactual changes due to cytocentrifugation
- degeneration
- immature neutrophils
70
Lymphocytes in various morphologies are present in
All body fluid types
71
Lymphocyte difference in cytocentrifugation (3)
- Nucleoli can be more prominent
- Irregular nuclear shape
- cytoplasmic projections
72
Overly prominent nucleoli in lymphocytes
73
Not seen in normal fluids; found in chronic inflammatory disorders
Plasma cells
74
Small numbers in pleural, pericardial, peritoneal, joint fluid
High in various disorders
Eosinophils, basophils, mast cells
75
Appear similar to those in PB smears
Monocytes
76
Larger, abundant vacuolated cytoplasm
Histiocytes
77
Has phagocytosed material
Macrophages, phagocyte
78
Large vacuoles fuse, nucleus flattened against membrane
Signet ring
79
Cell and fluid type
Monocytes in pleural fluid
80
Cell and fluid type
Histiocyte in pleural fluid
81
Cell and fluid type
Macrophage in pleural fluid (“signet ring” appearance)
82
- Seen in any BFs
| - must be differentiated from malignant cells
Benign tissue cells
83
- Pleural, pericardial, peritoneal fluid
- cytoplasm = moderate to abundant, light or dark blue, may contain granules or phagocytosed debris
- nucleus- eccentric, homogenous chromatin pattern, nucleoli blue with smooth membrane
Benign mesothelial cells
84
Single cell layer lines membranes; "fried egg appearance"
Mesothelial Cells
85
Benign mesothelial cells
86
Mesothelia cells that may be multinucleated
Reactive Cells
87
Reactive mesothelial cells
88
Wright's stain of cytocentrifage prep test for what
Bacteria, fungi, yeast
89
- Stains blue with wright's stain
- intracellular establishes pathogenicity
- gram stain
Bacteria
90
- CSF
- can be seen intracellulary
- most frequent fungal organisms: cryptococcus, histoplasma, candida albicans, candida tropicalis
Yeast
91
Intracellular and extracellular bacteria, bacilli
92
Candida tropicalis
93
- Can contain malignant cells
- ID critical for making correct diagnosis
- may establish a condition of tumor metastasis
- may be the initial diagnosis of malignancy
Pleural, pericardial, and peritoneal fluids
94
Malignant: hematopoietic examples
Leukemia, lymphoma
95
Malignant: nonhematopoietic examples
Carcinoma, sarcoma
96
General malignant cell features
- Irregular nuclear membrane - jagged or multiple folds
- unevenly distributed chromatin
- Nucleoli irregular membrane, prominent, irregular shape
- N:C ratio varies
97
Must common nonhematopoietic malignancy
Adenocarcinomas
98
- Larger than small cell carcinoma
- moderate to abundant cytoplasm
- nuclear chromatin-partially clumped, heterogeneous, prominent nucleoli
- cytoplasmic vacuoles
Adenocarcinoma
99
Carcinoembryonic antigen gastric cancer tumor marker
CEA
100
Metastatic uterine cancer tumor marker
CA125
101
Breast cancer tumor markers
CA15.3 and CA540
102
Lung cancer tumor marker
CYFRA 21.1
103
Metastatic breast carcinoma cells
104
Small cell carcinoma
105
Adenocarcinoma
106
Small cell carcinoma
107
Pancreatic carcinoma
108
Bile pigment in macrophage due to cholangiocarcinoma
