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BVM3 Alimentary > Diagnosis of Effusions > Flashcards

Diagnosis of Effusions Flashcards

1
Q

What is an effusion?

A

Increased amount of fluid in abdominal or thoracic cavity

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2
Q

Is effusion considered a disease?

A

No - not a disease in itself
Indicative of a pathologic process affecting either fluid production and/or removal

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3
Q

What kind of tube should you use to collect fluid for cytology and protein analysis?

A

EDTA - fluid will not clot

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4
Q

What kind of tube should you use to collect fluid for biochemical tests and culture?

A

Serum (plain - NOT GEL)

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5
Q

What does TNCC mean? What is the normal fluid level in small animals?

A

Total nucleated cell count
Normal level <3 x 10^9/L

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6
Q

What is “normal” TP (total protein) in small animals?

A

TP = 25-30 g/L

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7
Q

Give some features of normal fluid in small animals? Color, turbidity, volume, normal cells

A

Low volume, Clear, Straw colored
Creates thin film on serosal surfaces
Mesothelial cells (line body’s organs) + macrophages normal

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8
Q

What are the classifications of effusions? How are they classified?

A

Transudate, Modified Transudate, Exudate, Hemorrhage
Classified based on cell counts and TP

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9
Q

Transudate: TP, TNCC, Turbidity, SpG
Typical cell type and # found in transudate

A

TP: <25 g/L, TNCC <0.5 x 10^9/L
Clear (like water), SpG <1.018
Low cellularity, mesothelial cells/macrophages
Low # non-degenerate neutrophils

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10
Q

What is Transudate?

A

Transudates are fluids that pass through a membrane or squeeze through tissue or into the EXTRACELLULAR SPACE of TISSUES. Transudates are thin and watery and contain few cells or PROTEINS.

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11
Q

What causes transudates?

A

Combination of low colloid osmotic pressure (low protein levels) and increased hydrostatic pressure
- Hypoalbuminemia
- Secondary to GI, Hepatic or Renal disease
- Protein-losing nephropathy

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12
Q

How does hepatic cirrhosis/portal hypertension cause transudate formation?

A

Secondary to hepatic fibrosis/cirrhosis
Consistent damage to the liver causes fibrosis of healthy tissue, liver cannot filter blood/toxins the way it should
Buildup of blood traveling from portal system (digestive system), which backs up in the portal vein (increased pressure in vein)
Formation of verices (secondary collateral circulation)
Production of local vasodilators to compensate for increased fluid volume –> Lowered BP/SVR –> RAAS kicks in –> retention of sodium/fluid
Results in fluid (low protein lymph) leaking out of vasculature and into the abdominal cavity (ascites)
Also results in porto-systemic shunts (between spleen/kidney and systemic circulation, meaning that non-filtered blood that could potentially contain toxins enters the systemic vasculature)

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13
Q

What kind of effusion is this?

A

Modified Transudate

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14
Q

What kind of effusion is this?

A

Transudate

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15
Q

What kind of effusion is this?

A

Exudate

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16
Q

How does modified transudate compare to transudate?

A

TP 25-50 g/L (higher)
Serosanguinous color, cloudy (more cellular)
TNCC anywhere from 0.3 - 7 x 10^9/L (higher)
SpG 1.018 - 1.030 (higher)
Mesothelial cells, macrophages, non-degenerate neutrophils, small lymphocytes

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17
Q

What are the causes of modified transudate?

A

Cardiac failure = Chronic passive congestion = hepatic venous obstruction –> Leakage of high protein lymph from the liver

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18
Q

Exudate: TP, TNCC, Turbidity, SpG
Typical cell type and # found

A

TP: >30 g/L
TNCC > 3.0 x 10^9/L
SpG >1.018
Neutrophils (degenerate or not)
Macrophages, Lymphocytes, Eosinophils

19
Q

What qualities characterize an exudate?

A

Very active inflammatory process
High TNCC and protein
turbid - red, yellow or white fluid

20
Q

How does an exudate form?

A

VERY well defined process
Occurs due to active inflammation
- bite, wound, infections
- inflammation of pleural/abdominal cavities or their linings
- Infection of long-standing pleural fluid
- Neoplasia (necrotic, inflammatory process)
Cytokine action –> leaky capillaries –> plasma proteins get across barrier –> free movement of high protein fluid

21
Q

What is FIP and what kind of effusion can it cause? What is the difference between wet and dry FIP?

A

Non-septic exudate (non-degenerate neutrophils, no bacteria) or Modified transudate (depends on cellularity) - usually both at different times of disease
High protein (exudate)
Globulins > 0.81 on fluid

Caused by feline coronavirus
Wet FIP = exudative (accumulation of fluid in abdominal cavity as a result of vasculitis)
Dry FIP = no fluid accumulation, but granuloma formation on internal organs

22
Q

How does coronavirus cause FIP?

A

Coronaviruses are common and found in the faeces of many cats. In most cats, infection causes no signs or just mild diarrhoea that resolves without treatment. However, occasionally, the virus mutates (changes) inside a cat, and if their immune system reacts in a certain way, they could develop a disease called FIP. This is important, as finding coronavirus in a cat does not mean they have FIP, and it is not possible to consistently tell the difference between a coronavirus causing FIP and one causing no signs at all by just finding the virus itself.

23
Q

What kind of effusion is this? What can this kind of be caused by (cats)?

A
24
Q

What kind of effusion is this?

A
25
Q

What does hemorrhage indicate?

A

Frank blood

26
Q

Hemorrhage: TP, TNCC, Turbidity, SpG
Typical cell type and # found

A

TP - >30 g/L
TNCC - 1.5 - 10 x 10^9/L
SpG 1.025
Turbid (red)
WBC from peripheral blood, neutrophils, macrophages
Siderophages (macrophages digesting RBC’s/Hb)

27
Q

What is the difference between Iatrogenic, Acute and Chronic hemorrhage?

A

Iatrogenic - platelet clumps (platelets indicate active bleeding) + erythrocytes
Acute - Erythrophagia
Chronic - Siderophages (Hb breakdown within macrophage), Hematoidin (RBC breakdown without Oxygen)

28
Q

What do platelets within hemorrhage indicate?

A

Immediate, active bleeding

29
Q

What do erythrophagia + siderophages indicate?

A

Either frequent bleeding episodes or chronic bleeding

30
Q

What is chylous effusion? Which category of effusions does it fall under?
TP, TNCC, and visible features of chylous effusion?

A

Accumulation of lipid-rich chyle (lymph)

Modified transudate
Moderate proteins >30 g/L, Moderate TNCC
Opaque, milky substance (chylomicrons)
Formation of “cream top” (chylomicrons) on refrigeration
Does not separate in centrifuge

31
Q

What causes chylous effusion?

A

Damage or obstruction (traumatic or iatrogenic) of thoracic duct = chylous effusion in pleural space

32
Q

What are typical cholesterol and triglyceride levels in chylous effusion?

A

Cholesterol = lower than serum levels
Triglycerides = higher than serum levels

33
Q

What are mesothelial cells? What can they be confused with and how do you differentiate them (tests)?

A

Normal lining cells of abdominal/thoracic cavities
Can be confused with neoplastic cells (requires biopsy and histopathology)

34
Q

How do mesothelial cells change in response to inflammation or effusions?

A

Show reactive change with inflammation/effusions

35
Q

Which of these examples is a normal mesothelial cell, reactive mesothelial cell, and carcinoma?

A
36
Q

Give some examples of ectopic sources of fluid? What kind of effusion do they cause?

A

Urine - uroabdomen (bladder leakage or rupture)
- Transudate/modified transudate (low cellularity)
Bile - bile peritonitis (gallbladder leakage or rupture)
- Modified transudate/exudate (higher cellularity)
Pancreatitis - modified transudate/exudate

37
Q

In uroabdomen what is the level of creatinine in fluid vs. blood?

A

Creatinine - Fluid > Plasma

38
Q

In pancreatitis what is the level of lipase in fluid vs blood?

A

Lipase - Fluid > Plasma

39
Q

In bile duct/gallbladder rupture what is the level of bilirubin in fluid vs blood?

A

Bilirubin - Fluid > Plasma

40
Q

Is it normal to find ventral accumulation of fluid in a horse? What does an increased volume of this fluid indicate?

A

Yes - normally find low volume (100-300 mL) in lower part of equine abdomen (can easily collect 3-5 mL from any normal horse)
Increased volume = effusion

41
Q

Give the characteristics of normal “modified transudate” of horse peritoneal fluid

A

Pale yellow, clear
TNCC -.5-9.0 x 10^9/L
Protein <15 g/L (variable)
SpG 1.000-1.010
Approximately 50/50 macrophages and non-degenerate neutrophils

42
Q

Give the characteristics of Non-septic exudate of horse peritoneal fluid?

A

Slightly amber turbid fluid
TNCC >10 x 10^9/L
Protein >25 g/L
Neutrophils (non-degenerate) > Macrophages

43
Q

Give the characteristics of septic exudate of horse peritoneal fluid? Why should you look for evidence of plant material?

A

Yellow/Brown turbid fluid
TNCC >10 x 10^9/L
Protein >34 (very high)
Degenerate neutrophils, bacteria
Plant material = entered the gut on sampling (contaminated sample)

44
Q

How can you differentiate between gut tap vs peracute rupture of intestines?

A

Look at clinical signs of the horse - with gut rupture there will be significant cardiovascular compromise and horse will become very systemically ill/go into shock very shortly

BVM3 Alimentary (24 decks)

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