finals - serous and synovial Flashcards
Viscous liquid found in the cavities of the movable joints
Synovial Fluid
synovial membrane is composed of specialized cells called ___
synoviocytes
The closed cavities of the body—namely, the pleural, pericardial, and peritoneal cavities—are each lined by two membranes referred to as the serous membranes. One membrane
lines the cavity wall (____), and the other
covers the organs within the cavity (_____)
parietal membrane; visceral membrane
The fluid between the membranes is called
___, and it provides lubrication between the parietal and visceral membranes.
serous fluid
Lubrication in the joints
Synovial Fluid
Lubrication is necessary to prevent
the ___between the two membranes that occurs as a
result of movement of the enclosed organs, such as in the
expansion and contraction of the lungs.
friction
Normally, only a small amount of serous fluid is present, because production and reabsorption take place at a ___.
constant rate
how Synovial Fluid works
Reduces the friction between joints
Provides nutrients to the articular cartilage
Synovial Fluid
Lessens the shock of joint compression that occurs during activities
such as walking and jogging
synovial fluid
Production and reabsorption are subject to ____ and ___from the capillaries that serve the cavities and the capillary permeability.
hydrostatic pressure; colloidal pressure (oncotic pressure)
Ultrafiltrate of plasma across the synovial membrane
Synovial Fluid
the filtration of synovial fluid or the filtration of the plasma to become a synovial fluid is non selective except ___
high molecular weight proteins
the synoviocytes secrete mucopolysaccharide to the the fluid, what mucopolysaccharide is it?
hyaluronic acid
the secreted hyaluronic acid and its hyaluronate molecules contribute to what characteristic of synovial fluid?
its viscosity
damage to the articular membrane causes pain and stiffness, this condition is referred to
arthritis
Abundant fluid
(____) is usually collected;
> 100 mL
which anticoagulant is used for cell counts and the differential.
EDTA
which anticoagulants are used for microbiology and cytology.
Sterile heparinized or sodium polyanethol sulfonate (SPS)
Under normal conditions, colloidal pressure from serum proteins is the same in the capillaries on both sides of the membrane. Therefore, which pressure causes fluid to enter between the membranes.
hydrostatic pressure
aspiration procedures in plueral cavity
thoracentesis
aspiration procedures in pericardial cavity
pericardiocentesis
lab findings in non inflammatory joint disorders
clear, yellow synovial fluid
good viscosity
wbc <1000 ul
Neutrophils <30%
Similar to blood glucose
lab findings in inflammatory joint disorders
Cloudy, yellow fluid
Poor viscosity
WBCs 2,000 to 75,000 L
Neutrophils >50%
Decreased glucose level
Possible autoantibodies present
lab findings in crystal induced origin joint disorders
Cloudy or milky fluid
Low viscosity
WBCs up to 100,000 L
Neutrophils <70%
Decreased glucose level
Crystals present
lab findings in septic origin joint disorders
Cloudy, yellow-green fluid
Variable viscosity
WBCs 50,000 to 100,000 L
Neutrophils >75%
Decreased glucose level
Positive culture and Gram stain
lab findings in hemorrhagic origin joint disorders
Cloudy, red fluid
Low viscosity
WBCs equal to blood
Neutrophils equal to blood
Normal glucose level
do normal synovial fluid clots?
nope - but if diseased, it may contain fibrinogen and will form clot
aspiration procedures in peritoneal cavity
paracentesis
Hyaluronic acid is secreted by ___ in the synovial membrane, making the fluid viscous
synoviocytes
Damage to the articular membrane produces pain and stiffness in the joints
Arthritis
needle aspiration or a way of collecting synovial fluid
Arthrocentesis
normal amount of synovial fluid in adult knee cavity
less than 3.5 ml - but can increase to 25 ml due to inflammation
in some instances that drops of synovial fluid is the only amount collected, it must be subjected to what test
microscopic or culturing
non inflammatory causes of joint disorders
degenerative joint disorders
osteoarthritis
inflammatory causes of joint disorders
immunologic disorders, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polymyositis, ankylosing spondylitis, rheumatoid fever, lyme arthritis
crystal induced gout
pseudogout
septic causes of joint disorders
microbial infection
hemorrhagic causes of joint disorders
traumatic injury
tumors
hemophilia
other coagulation disorders
anticoagulant overdose
For better recovery of microorganisms and abnormal cells, ___ of large amounts of fluid is performed by centrifugation.
concentration
Sterile heparinized tube is for what test of synovial
Gram Stain and Culture
Specimens for pH must be
maintained anaerobically in __
ice
Heparin or EDTA
Non-anticoagulant is for what test of synovial
Cell count
Non-anticoagulant Tube is for what test of synovial
Other Tests
Sodium Fluoride is for what test of synovial
Glucose Analysis
specimens for crystal analysis should not be refrigerated because they can produce additional crystals that can interfere with identification of significance
true or false
true
normal color of synovial
less to pale yellow
synovial comes from the latin word for egg “ovum” why is it
the normal viscosity is the same with the egg white’s
a simple and bedside technique to measure the viscosity of a synovial fluid is a string test formed using the tip of a syringe, approx how many cm is considered normal?
4-6 cm
hyaluronate - a primary component for the viscosity of a synovial fluid
is can be measured using what test
ropes or mucin clot test
a normal response of synovial fluid to 2-5% acetic acid in mucin clot test
forms a solid clot surrounded by clear fluid
even though mucin clot test is not performed routinely in synovial testing, it can be use to __
identify questionable liquid as synovial
most frequently cell count performed in synovial fluid
total leukocyte count
cells primarily seen in a normal synovial fluid
mononuclear cells - macrophage and monocytes
normal neutro and normal lympho % in normal synovial fluid
> 25% in neutro
15 % in lympho
significance of increase neutrophil in synovial fluid
bacterial sepsis
crystal induced inflammation
significance of increase lymphocyte in synovial fluid
non septic inflammation
significance of increase neutrophil in synovial fluid
normal
viral infections
significance of increase synovial lining cells in synovial fluid
normal
disruption from arthrocentesis
this cell is similar to macrophage, but multinucleated, and resembling mesothelial cell
synovial lining cell
significance of LE cell in synovial fluid
lupus erythematosus
neutrophil containing characteristics ingested round body
LE cell
vacuolated macrophage with ingested neutrophil
reiter cell
significance of reiter cell in synovial fluid
reactive arthritis in other parts of the body
neutrophil with dark cytoplasmic granules containing immune complexes
RA cell (ragocyte)
significance of RA cell (ragocyte)
rheumatoid arthritis
immunologic inflammation
significance of cartilage cells
osteoarthritis
macroscopically resemble polished rice
rice bodies
significance of rice bodies
tuberculosis
septic and rheumatoid arthritis
significance of fat droplets in synovial fluids
traumatic injury
chronic inflammation
microscopically show collagen and fibrin
rice bodies
crystals of synovial fluid that is found in cases of gout
monosodium urate (uric acid)
crystal of synovial fluid found in pseudogout
calcium pyrophosphate dihydrate
is most often associated with degenerative arthritis, producing cartilage calcification, and endocrine disorders that produce elevated serum calcium
pseudogout
monosodium urate’s shape
needles
calcium pyrophosphate dihydrate’s shape
rhomboid, square, rods
significance of corticosteroid crystals in synovial
injection
how many fluids are collected in serous fluid
> 100 ml
edta in serous fluid testing is for
cell counts and the differential
sterile heparinized or sodium polyanethol sulfonate in serous fluid testing is for
microbiology or cytology
Increased capillary hydrostatic pressure is caused by
Congestive heart failure
Salt and fluid retention
Decreased oncotic pressure is caused byy
Nephrotic syndrome
Hepatic cirrhosis
Malnutrition
Protein-losing enteropathy
increased capillary permeability is caused byy
Microbial infections
Membrane inflammations
Malignancy
Lymphatic obstruction is caused by
Malignant tumors, lymphomas
Infection and inflammation
Thoracic duct injury
transudates or exudate?
involvement of systemic disorder that disrupts the balance in the regulation of fluid filtration and reabsorption—such as the changes in hydrostatic pressure created by congestive heart failure or the hypoproteinemia associated with the nephrotic syndrome
transudate
transudates or exudate?
____
are produced by conditions that directly involve the membranes
of the particular cavity, including infections and malignancies.
Exudates
Transudate
Exudate
clear appearance of serous fluid
transudate
is obtained from the pleural cavity, located be
tween the parietal pleural membrane lining the chest wall and
the visceral pleural membrane covering the lungs.
Pleural fluid
Pleural effusions may be ___.
either transudative or exudative
. In addition to the tests routinely performed to differentiate between transudates and exudates, two additional procedures are helpful
when analyzing pleural fluid: __
the pleural fluid cholesterol and
fluid:serum cholesterol ratio and the pleural fluid:serum total bilirubin ratio
A pleural fluid cholesterol _____ or a pleural fluid:serum cholesterol ratio ____ provides reliable information that the fluid is an exudate
> 60 mg/dL; >0.3
A fluid:serum total
bilirubin ratio of ___ also indicates the presence of an exudate.
0.6 or more
Normal and transudate pleural fluids
are what color
clear and pale yellow
Turbidity of pleural fluid is usually related to the
presence of ____ and indicates bacterial infection, tuberculosis, or an immunologic disorder such as rheumatoid arthritis
WBCs
The presence of blood in the pleural fluid can signify a ___
hemothorax (traumatic injury), membrane damage such as
occurs in malignancy, or a traumatic aspiration.
a Milky pleural fluid may be caused by
Chylous material from thoracic duct
leakage
a Brown pleural fluid may be caused by
Rupture of amoebic liver abscess
a black pleural fluid may be caused by
Aspergillus
a Viscous pleural fluid may be caused by
Malignant mesothelioma (increased hyaluronic acid)
To differentiate between a hemothorax and hemorrhagic exudate, a ___ can be run on the fluid.
hematocrit
If the blood is
from a hemothorax, the fluid hematocrit is more than____ of the whole blood hematocrit, because the effusion comes from the inpouring of blood from the injury.
50%
A chronic membrane
disease effusion contains both blood and increased pleural fluid, resulting in a much ___ hct
lower hematocrit
a milky pleural fluid is caused by Chylous material which contains a high concentration of
____
triglycerides
a milky pleural fluid is caused by pseudoChylous material which contains a high concentration of
____
cholesterol
which staining is
strongly positive with chylous materia
Sudan III
pseudochylous effusions contain which crystals
cholesterol crystals
____ is the most
diagnostically significant hematology test performed on serous fluids
differential cell count
Primary cells associated with pleural fluid include
macrophages, neutrophils, lymphocytes, eosinophils, mesothelial cells, plasma cells, and malignant cells
number of macrophages, lymphocytes, and neutrophil in pleural fluid
Macrophages 64% to 80%
lymphocytes (18% to 30%)
neutrophils (1% to 2%)
Similar to other body fluids, an increase in pleural fluid neutrophils indicates a _____, such as pneumonia.
bacterial infection
rentiate be
tween a pleural transudate and a pleural exudate, the most
common chemical tests performed on pleural fluid are
glucose,
pH, adenosine deaminase (ADA), and amylase
Glucose chem test for pleural signiies
Decreased in rheumatoid
inflammation
neutrophils found in pleural fluid is a sign of pneumonia but it can be seen as well in ___
pancreatitis and pulmonary infarction
increased eosinophil in pleural fluid is associated with trauma resulting in the presence of __
air or blood (pneumothorax/hemothorax)
mesothelial cells in pleural fluid resembles
lymphocytes, plasma cells, malignant cells
most frequent serological test for pleural fluid
ana and rf
is a sensitive test to detect intra-abdominal bleeding in blunt trauma cases
peritoneal lavage
Transudate
Exudate
cloudy appearance of serous fluid
exudate
is recommended over the fluid:serum total protein and LD ratio to detect transudate of hepatic origin
serum-ascites albumin gradient
Synovial comes from the word → ___
Egg
normal color of synovial
Colorless to Pale Yellow
Deeper Yellow color of synovial fluid means
Inflammatory and
Noninflammatory effusions
Green synovial means
Bacterial Infection
red synovial means
Hemorrhagic arthritis
Turbidity
o Presence of WBC
o Synovial cell debris and fibrin
o Can be milky (Presence of crystals)
if the synovial is milky, it has a presence of __
crystals
viscosity is Caused by __
hyaluronic acid
Arthritis affects the production of __
hyaluronidase
Arthritis ___ synovial viscosity
decreases
Methods for viscosity
o String test → 4-6 cm
o Ropes (Mucin clot test)
o Synovial +2%-5% acetic acid → Clotti
Reporting for synovial fluid
o Good → Solid Clot
o Fair → Soft Clot
o Low → Friable Clot
o Poor → No Clot
good in synovial means
solid clot
fair in synovial means
soft clot
low in synovial means
friable clot
poor in synovial means
no clot
is the (Most Frequent) requested cell count
Total leukocyte counts
Diluting fluid for synovial fluid
: Normal saline (0.3%)
Methylene blue in synovial fluid is for
staining wbc nuclei
Neutrophils
Polymorphonuclear leukocytes
Mononuclear leukocytes
Lymphocytes
Large mononuclear leukocytes
Maybe vacuolated
Macrophages (Monocytes)
Similar to macrophage, but may be
multinucleated resembling a mesothelial cell
Synovial lining c
Neutrophil containing characteristics
ingested: Round Body
LE cells
Vacuolated macrophage with ingested
neutrophils
Reiter cells
Neutrophils with dark cytoplasmic granules
containing immune complexes
RA cells (Ragocytes) Neutrophils with dark cytoplasmic granules
containing immune complexes
Large, multinucleated
Cartilage cells
Macroscopically resemble polished rice
Microscopically show collagen and fibrine
Rice bodies
Refractile intracellular and extracellular
globules
Fat droplets
Inclusions within clusters of synovial
Hemosiderin
- Important diagnostic tests in evaluation of arthritis
Crystal identification
Crystal formation in a joint frequently results in:
Acute, painful inflammation
Cause of Crystal formation:
o Metabolic disorders
o Decreased renal excretion
o Degeneration of cartilage and bones
o Injection of medication such as corticosteroids
Monosodium
Urate shape
needle - gout
Calcium
pyrophosphate
dihydrate shape
Rhombic
square, rods - psegout
Cholesterol shape
Notched,
rhombic
plates - extracellular
Corticosteroid crystal
Flat, variable
shape plates - injection
Calcium oxalate crystal
envelop - renal dialysis
Apatite (CA
phosphate)
Small
particles
require
electron
microscopy - osteoarthritis
