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BVetMed3 Alimentary > Diagnosis Of Effusions > Flashcards

Diagnosis Of Effusions Flashcards

1
Q

What is an effusion?

A

An increased amount of fluid in the abdominal or thoracic cavity

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2
Q

What is the clinical significance of finding an effusion?

A

NOT a disease in itself

Indicative of a pathological process affecting either fluid production and/or removal

May be the only cause of clinical signs

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3
Q

Why should we analyse effusions?

A

Differentiate between different fluid types to allow further diagnostics

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4
Q

What tubes are required for specific test types?

A

Collect into EDTA for counts, cytology and protein

Collect into serum tube for biochem tests or culture

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5
Q

Why should a potentially inflammatory fluid be collected into an EDTA tube?

A

An inflammatory fluid can form a fibrin clot as it has fibrinogen in it

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6
Q

What tests could be run to analyse fluids?

A 
Counts, cytology and protein 
Biochemistry or culture 
Total nucleated cell count (TNCC) 
Cell identification and morphology
Protein concentration
Other - enzymes (amylase and lipase), urea and creatinine, Cholesterol and triglycerides
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7
Q

Describe normal fluid

A

Low volume
Clear, straw colour
Ref range total protein, TNCC
Mesothelial cells and macrophages present

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8
Q

What is the normal role of fluid in the abdominal cavity?

In which species would you expect more?

A

Lubrication of abdominal organs
- forms a film on serosal surfaces

Horses and large animals - can pool due to gravity

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9
Q

How is fluid regulated normally?

A

Hydrostatic pressure

colloid osmotic pressure/oncotic pressure (albumin)

Permeability of capillary wall

Lymphatic drainage

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10
Q

What are the major classifications of effusions?

A

Transudate

Modified transudate

Exudate

(Haemorrhage)

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11
Q

What is the main basis of the system for classifying exudates?

A

TNCC and total protein

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12
Q

Describe a transudate.

What cells might you expect?

A

Low protein and cellularity

Clear (like water)

Mesothelial cells, macrophages, low numbers non-degenerate neutrophils

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13
Q

How do transudates occur?

A

Passive movement across membrane

The relationship between hydrostatic and oncotic pressure favours fluid leaving the capillary

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14
Q

What causes transudates?

A

Decreased colloid osmotic pressure

RAAS activation - more fluid retained therefore increased hydrostatic pressure

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15
Q

When might albumin levels result in a transudate?

A

RARE - needs to be very low

But hypoalbuminaemia can occur as a result of:
glomerular disease
hepatic disease
GI loss (e.g. protein losing enteropathy)

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16
Q

How can liver disease result in transudate formation?

A

Hepatic fibrosis/cirrhosis
Portal hypertension and formation of secondary collateral circulation
Local production of vasodilators (NO)
Splanchnic vasodilation and decreased effective blood flow
Compounded by RAAS Na retention and hypertension
Low protein lymph leaks from intestine

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17
Q

Describe a modified transudate.

A

Yellow to serosanguinous, cloudy

Like transudate + proteins

Mesothelial cells, macrophages, non-degenerate neutrophils, small lymphocytes

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18
Q

What is a mesothelial cell?

A

Cell that lines serous cavities e.g plura, peritoneum, mediastinum, pericardium

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19
Q

When might you see a modified transudate?

A

Cardiac disease,

Chylous effusion

Lymphatic obstruction (neoplasia)

20
Q

How can cardiac disease cause a modified transudate?

A

Congestion -> increased hydrostatic pressure (esp. in hepatic sinusoids)

Leakage of protein rich lymph from liver

+ Na and fluid retention from RAAS

21
Q

Describe an Exudate.

A

High TNCC and protein
Turbid - red, yellow, white

Neutrophils (degenerate or not) and macrophages (+ lymphocytes, eosinophils)

22
Q

How do exudates occur?

A

Inflammation of the pleural/abdominal cavity and their linings

Increased capillary permeability, plasma leaks into fluid

Recruitment of inflammatory cells

23
Q

What can cause an exudate?

A

Septic (bacteria / non-septic

Long standing modified transudate irritates the lining leading to inflammation

Neoplasia

24
Q

How can neoplasia cause exudates?

A

Neoplasia outgrows blood supply

Becomes necrotic leading to the recruitment of inflammatory cells

25
Q

Describe a non-septic exudate.

What could cause this?

A

Non-degenerate neutrophils

No bacteria

E.g. FIP (viral)

26
Q

Describe a septic exudate.

A

Degenerate neutrophils

Intracellular bacteria

27
Q

Describe the fluid you would expect to see from a patient with FIP

A

Variable TNCC
HIGH PROTEIN

Non-degenerate neutrophils and macrophages

Acute phase protein elevation

28
Q

How can the classification of FIP fluid vary?

A

Can be classed as an exudate or modified transudate based on the cell count

29
Q

How can you tell whether haemorrhagic fluid is iatrogenic or not?

A

Platelets should adhere to the peritoneum almost immediately therefore FEW/NO platelets = fluid

(Platelet clumps present = needle in wrong place OR active bleeding)

30
Q

How can you tell whether haemorrhage is acute or chronic?

A

Acute - erythrophagia - macrophages eat RBCs.

Chronic - siderophages and haematoidin - 2-3 days ago

31
Q

What could you conclude about the bleeding if erythrocytes and siderophages were present?

A

Bleeding started 2-3 days ago and still happening

32
Q

Describe a chylous effusion

A

Opaque and milky (chylomicrons)

Acute- 80% lymphocytes, variable macrophages and neutrophils

Chronic - Mixed population 30-40% lymphocytes, increased neutrophils

33
Q

Explain the composition of a chronic chylous effusion

A

If fluid stays in cavity, inflammation occurs

34
Q

Explain the appearance of a chylous effusion

A

Chylomicrons

Lymph coming from intestines contains fat from diet in lymph

35
Q

When would it be necessary to carry out further tests on a chylous effusion?

A

If animal is off its food

Animal needs to be eating for chylous effusion to be obvious

36
Q

How can you confirm that an effusion is a chylous effusion?

A

Higher triglycerides than in serum and lower cholesterol

Formation of ‘cream top’ when refrigerated

Sudan III staining for lipid droplets

Does not separate on centrifugation

37
Q

Why can mesothelial cells be problematic?

A

When activated (by inflammation or presence of fluid), look malignant, even thought they’re normal

38
Q

What fluid would you expect in a case of uroabdomen?

A

Transudate/modified transudate

Light yellow clear fluid

39
Q

What fluid would you expect in a case of bile peritonitis?

A

Modified transudate/ exudate

Green colour

40
Q

What fluid would you expect in a case of pancreatitis?

A

Modified transudate / exudate

41
Q

What volume of peritoneal fluid can normally be collected in a healthy horse ?

A

3-5 mls

100-300 ml present

42
Q

Describe normal equine peritoneal fluid.

A

Pale yellow, clear

50% macrophages, 50% non-degenerate neutrophils

Modified transudate - quite a few cells and inflammatory cells and proteins

43
Q

Describe a septic exudate in horses.

A

Yellow, brown, turbid

High TNCC and protein

Degenerate neutrophils, bacteria

Look for plant material and Protozoa - indicates gut wall rupture

44
Q

Describe a non-septic exudate in horses

A

Amber, slightly turbid

High TNCC
High protein
High neutrophils
More neutrophils than macrophages

45
Q

How can you tell if you have performed enterocentesis?

A

Low cell count

46
Q

How can you differentiate between enterocentesis and peracute GIT rupture?

A

Clinical impression

Horses with GIT rupture quill quickly develop CV collapse

BVetMed3 Alimentary (16 decks)

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