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Alimentary - Icterus and Hepatic Encephalopathy > Effusions > Flashcards

Effusions Flashcards

1
Q

What is an effusion?

A

Increased amount of fluid in the abdominal or thoracic cavity

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2
Q

What are the three reasons for analysis of effusions?

A

Differentiate between different fluid types

  • Allow further diagnostic procedures

Identify fluid types with a more specific etiology

Definitive diagnosis

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3
Q

Describe fluid collection for counts, cytology and protein

A

Collect into EDTA so fluid won’t clot

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4
Q

Which tubes should be used for biochemical tests or culture with fluid analysis?

A

Serum (plain) tubes

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5
Q

Describe the normal fluid in small animals

A

Low volume

Clear, straw colour

Total protein: 25-30 g/l

Nucleated cell count <3 x10e9/l

Cells:

  • Mesothelial cells
  • Macrophages
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6
Q

What four factors affect movement of fluid in and out of the pleural/peritoneal cavities?

A

Hydrostatic pressure

Colloid osmotic pressure (albumin)

Permeability of the capillary wall

Lymphatic drainage

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7
Q

What are the three classifications of effusion based on cell counts and total protein?

A

Transudate

Modified transudate

Exudate

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8
Q

Describe transudate fluid

A

Low protein and low cellularity

Clear

Specific gravity < 1.018

Total protein <25g/l

TNCC <0.5x10e9/l

Cells:

  • Mesothelial cells
  • Macrophages
  • Low numbers non-degenerate neutrophils
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9
Q

What are some causes of transudate fluid?

A

Decreased colloid osmotic pressure

Hypoalbuminemia second to:

  • Glomerular disease
  • Hepatic disease
  • GI loss
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10
Q

What levels will hypoalbuminemia cause transudate?

A

<10g/l

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11
Q

Describe how hepatic cirrhosis and portal hypertension cause transudate formation

A

Secondary from hepatic fibrosis/cirrhosis

Prolonged portal hypertension and formation of secondary collateral circulation

Local production of vasodilators

Leads to splanchnic vasodilation and decreased effective blood flow

Compounded by renal retention of sodium via renin/angiotension system and generalized hypertension

End result causes expansion of plasma volume and leakage of low protein lymph from the intestines

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12
Q

Describe modified transudate

A

Yellow to serosanguinous

Cloudy

TNCC 0.3-5.5x10e9/l

S.G. 1.018-1.030

Protein variable 25-50 g/l

Cells:

  • Mesothelial cells
  • Macrophages
  • Non-degenerate neutrophils
  • Small lymphocytes
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13
Q

What are the causes of modified transudates?

A

Cardiac disease:

  • Congestion
  • Leakage of protein rich lymph from the liver
  • Sodium and fluid retention

Chylous effusion

Lymphatic obstruction

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14
Q

Describe exudate

A

Turbid - red, yellow or white

High TNCC and protein

S.G. >1.018

Total protein > 30g/l

TNCC > 3.0x10e9/l

Cells:

  • Neutrophils
  • Macrophages
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15
Q

What are the causes of exudate?

A

Inflammation of pleural/abdominal cavities

Inflammation of pleural/abdominal cavity lining

Long standing modified transudate

Neoplasia

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16
Q

What is seen in a non-septic exudate?

A

Non-degenerate neutrophils

No bacteria

17
Q

What is seen in septic exudate?

A

Degenerate neutrophils

Intracellular bacteria

18
Q

Describe the appearance of haemorrhage

A

Turbid - red

S.G. 1.025-1.040

Total protein > 30g/l

TNCC 1.5-10x10e9/l

Cells:

  • WBC from peripheral blood
  • Macrophages
19
Q

What are the three types of haemorrhage and what can cause them?

A

Iatrogenic or ongoing:

  • Erythrocytes
  • Platelet clumps

Acute:

  • Erythrophagia

Chronic:

  • Siderophages
  • Haematoidin
20
Q

Describe chylous effusion

A

Opaque, milky

S.G. > 1.017

Variable protein

TNCC 1.5-20x10e9/l

Acute:

  • Small lympocytes
  • Mature macrophages
  • Variable neutrophils

Chronic:

  • Mixed population
  • Increased neutrophils
21
Q

What occurs with cylous effusions if refrigerated?

A

Formation of cream top

22
Q

What is the difference between triglyceride levels in serum and fluid? Cholesterol?

A

Triglycerides higher in fluid

Cholesterol lower in fluid

23
Q

What are mesothelial cells?

A

Normal lining cells of the abdominal and thoracic cavities

24
Q

What do mesothelial cells show with inflammation or effusions?

A

Reactive change

25
Q

What are the three ectopic sources of fluid?

A

Urine - uroabdomen

  • Transudate
  • Modified transudate

Bile - bile peritonitis

  • Green colour
  • Modified transudate
  • Exudate

Pancreatitis

  • Modified transudate
  • Exudate
26
Q

How do biochemistry ratios differ between fluids and plasma?

A

Usually greater in fluid than in plasma

27
Q

How much peritoneal fluid could be collected from a normal horse?

A

3-5ml

28
Q

Describe normal equine peritoneal fluid

A

Pale yellow or clear

TNCC 0.5-9x10e9/l

Protein < 15g/l

Specific gravity 1.000-1.010

Cells:

  • 50% macrophages
  • 50% non-degenerate neutrophils
29
Q

What does non-septic exudate of equine peritoneal fluid look like?

A

Amber slightly turbid fluid

TNCC > 10x10e9/l

Protein > 25g/l

Cells:

  • More neutrophils than macrophages
30
Q

Describe septic exudate in horses

A

Yellow, brown turbid fluid

TNCC > 10x10e9/l

Protein > 34g/l

Cells:

  • Degenerate neutrophils
  • Bacteria
  • Can have plant material
31
Q

How can you tell the difference between tapping into the gut or peracute rupture in horses?

A

Both have:

  • Plant material
  • Bacteria
  • Possibly protozoa

Cell count will be low with peracture rupture

Gut rupture will quickly develop cardiac collapse

Alimentary - Icterus and Hepatic Encephalopathy (3 decks)

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