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MBChB Yr 3 OSCES > Fluid Analysis > Flashcards

Fluid Analysis Flashcards

1
Q

What is the most common cause of ascites?

A

Portal hypertension, usually due to liver cirrhosis

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2
Q

How much fluid is needed for ascites to be clinically present?

A

At least 500mls

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3
Q

What is the cause of clear/straw coloured ascites?

A

Liver cirrhosis

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4
Q

What are the 3 causes of cloudy ascites?

A
  1. SBP
  2. Perforated bowel
  3. Pancreatitis
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5
Q

What are the 3 causes of Chylous ascites?

A
  1. Lymphoma
  2. TB
  3. Malignancy
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6
Q

What are the 2 causes of bloody ascites?

A
  1. Haemorrhagic pancreatitis

2. Malignancy

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7
Q

What sign is haemorrhage pancreatitis often accompanied by?

A

Grey Turners sign (bruising of the flanks)

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8
Q

What 2 things does an ascitic protein of >4g/dL suggest?

A
  1. SBP

2. TB

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9
Q

What 2 things does an ascitic glucose lower than the serum level suggest?

A
  1. TB

2. Malignancy

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10
Q

What does an ascitic amylase higher than serum levels suggest?

A

Pancreatitis

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11
Q

What 2 things does ascites with >100 red cell count suggest?

A
  1. Malignancy

2. TB

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12
Q

What 2 things does ascites with >100,000 red cell count suggest?

A
  1. Haemorrhage

2. Trauma

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13
Q

What 2 things does ascites with <250 white cell count suggest?

A
  1. Normal

2. Cirrhosis

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14
Q

What does ascites with >250 white cell count & predominantly lymphocytes suggest?

A

TB

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15
Q

What does ascites with >250 white cell count & predominantly neutrophils suggest?

A

SBP

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16
Q

What does Serum Ascitic Albumin Gradient (SAAG) measure?

A

Indirectly measures portal pressure and can be used to determine if ascites is due to portal hypertension

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17
Q

What is SAAG equal to?

A

(Serum albumin) – (Ascitic fluid albumin)

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18
Q

What does a high SAAG (>1.1g/dL) suggest?

A

Presence of portal hypertension (transudate which commonly occurs from increased pressure in the portal vein)

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19
Q

What does a low SAAG (<1.1g/dL) suggest?

A

An exudate

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20
Q

Give 5 causes of a high SAAG?

A
  1. Cirrhosis
  2. Hepatic failure
  3. Venous occlusion e.g. Budd Chiari syndrome
  4. Fulminant hepatic failure
  5. Alcoholic hepatitis
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21
Q

Give 4 causes of a low SAAG?

A
  1. Malignancy
  2. Infection
  3. Pancreatitis
  4. Nephrotic syndrome
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22
Q

What does ascites with an LDH of <225 U/L suggest?

A

Transudate

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23
Q

What does ascites with an LDH of >225 U/L suggest?

A

Exudate

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24
Q

What does this joint fluid result indicate?

  • Colour: Colourless
  • Clarity: Transparent
  • Viscosity: Normal
  • WBC: < 200 cells/mm3
  • Neutrophils: <25 %
  • Gram stain: Negative
  • Crystals: Negative
A

NORMAL JOINT FLUID

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25
Q

What does this joint fluid result indicate?

  • Colour: Straw like
  • Clarity: Translucent
  • Viscosity: Increased
  • WBC: 200 – 2000 cells/mm3
  • Neutrophils: <25 %
  • Gram stain: Negative
  • Crystals: Negative
A

NON-INFLAMMATORY JOINT EFFUSION

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26
Q

What does this joint fluid result indicate?

  • Colour: Yellow
  • Clarity: Cloudy
  • Viscosity: Decreased
  • WBC: 2000–50,000 cells/mm3
  • Neutrophils: >50 %
  • Gram stain: Negative
  • Crystals: Positive
A

INFLAMMATORY JOINT EFFUSION

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27
Q

Describe the joint fluid crystals seen in gout?

A

Needle negative birefringent crystals

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28
Q

Describe the joint fluid crystals seen in pseudogout?

A

Rhomboid positively birefringent crystals

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29
Q

What does this joint fluid result indicate?

  • Colour: Yellow/green
  • Clarity: Cloudy/opaque
  • Viscosity: Decreased
  • WBC: >50 000 cells/mm3
  • Neutrophils: >75 %
  • Gram stain: Often positive
  • Crystals: Negative
A

SEPTIC JOINT EFFUSION

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30
Q

What does this joint fluid result indicate?

  • Colour: Red/xanthochromic
  • Clarity: Bloody
  • Viscosity: Variable
  • WBC: 200-2000 mm³
  • Neutrophils: 50-75%
  • Gram stain: Negative
  • Crystals: Negative
A

HAEMORRHAGIC JOINT EFFUSION

31
Q

What are 2 causes of non-inflammatory joint effusions?

A
  1. Osteoarthritis

2. Trauma

32
Q

List the 5 symptoms of non-inflammatory joint effusions?

A
  1. Localised joint pain
  2. Gradual onset of symptoms
  3. Pain on movement
  4. Crepitus
  5. Worse at the end of the day
33
Q

What 3 investigations would you do for a non-inflammatory joint effusion?

A
  1. Bloods- WCC/CRP typically normal
  2. X-Ray- may reveal fractures/OA changes
  3. MRI- ligaments & menisci for injury
34
Q

What are 4 causes of inflammatory joint effusions?

A
  1. Rheumatoid arthritis
  2. Reactive arthritis
  3. Psoriatic arthritis
  4. Acute gout or pseudogout
35
Q

List the 4 symptoms of rheumatoid arthritis (inflammatory joint effusion)?

A
  1. Symmetrical swollen, warm, red & painful joints
  2. Usually small joints of hands & feet
  3. Morning stiffness greater than 1hr
  4. Systemic features (fever, weight loss)
36
Q

List the 4 symptoms of psoriatic arthritis (inflammatory joint effusion)?

A
  1. Affected joints are red/warm
  2. Small joints of hand & wrist (distal interphalangeal joints)
  3. Typically asymmetrical
  4. Onycholysis & hyperkeratosis
37
Q

Describe the symptoms for acute gout (inflammatory joint effusion)?

A

Typically a single hot, swollen & tender joint (MTP joint at base of big toe)

38
Q

Describe the symptoms for pseudogout (inflammatory joint effusion)?

A

Single hot, swollen & tender joint (most commonly knee joint)

39
Q

What 2 investigations would you do for an inflammatory joint effusion?

A
  1. Bloods- FBC, CRP/ESR, Urate (raised in gout), Antibodies (anti-CCP, RhF)
  2. X-ray of the joint
40
Q

List 4 causes of septic joint effusion?

A
  1. Staphylococcus aureus
  2. Streptococci
  3. Neisseria gonorrhoeae (young sexually active adults)
  4. Escherichia coli (elderly, IV drug users)
41
Q

Describe the 2 symptoms of septic joint effusion?

A
  1. Painful, swollen & warm

2. Usually a single joint affected

42
Q

What 4 investigations would you do for a septic joint effusion?

A
  1. Bloods- FBC (WCC raised), CRP raised
  2. Blood cultures
  3. Fluid cultures
  4. X-Ray of the joint
43
Q

List 3 causes of a haemorrhagic joint effusion?

A
  1. Trauma
  2. Tumours
  3. Bleeding disorders
44
Q

Describe the 3 symptoms of a haemorrhagic joint effusion?

A
  1. Painful, swollen & warm
  2. Restricted range of movement
  3. Excessive bruising surrounding affected joint
45
Q

What 2 investigations would you do for a haemorrhagic joint effusion?

A
  1. Bloods- FBC (decreased haemoglobin)
  2. Coagulation studies
  3. X-Ray of the affected joint (associated fractures)
46
Q

What does this CSF result suggest?

  • Appearance: Cloudy and turbid
  • Opening pressure: Elevated (>25 cm H₂O)
  • WBC: Elevated >100 cell/µL (primarily polymorphonuclear leukocytes (>90%))
  • Glucose level: Low (<40% of serum glucose)
  • Protein level: Elevated (>50 mg/dL)
A

Bacterial Meningitis

47
Q

List 3 causes of bacterial meningitis in newborn babies?

A
  1. Listeria monocytogenes
  2. E. Coli
  3. Group B Streptococci
48
Q

List 3 causes of bacterial meningitis in older children?

A
  1. Neisseria meningitidis
  2. Haemophilus influenzae Type B
  3. Streptococcus pneumoniae
49
Q

List 3 causes of bacterial meningitis in adults?

A
  1. Neisseria meningitidis
  2. Streptococcus pneumoniae
  3. Listeria monocytogenes
50
Q

List 5 symptoms of bacterial meningitis?

A
  1. Headache
  2. Fever
  3. Neck stiffness
  4. Photophobia
  5. Meningococcal meningitis presents with a characteristic petechial rash
51
Q

List 5 further investigations when suspecting bacterial meningitis on CSF sample?

A
  1. CSF gram stain and cultures
  2. CSF bacterial antigens
  3. CSF PCR
  4. Blood cultures
  5. Imaging to rule out other intracranial pathology: CT / MRI head
52
Q

What does this CSF result suggest?

  • Appearance: Clear
  • Opening pressure: Normal or elevated
  • WBC: Elevated (50-1000 cells/µL, primarily lymphocytes, can be PMN early on)
  • Glucose level: Normal (>60% serum glucose however may be low in HSV infection)
  • Protein level: Elevated (>50 mg/dL)
A

Viral (aseptic) meningitis

53
Q

List 6 causes of viral (aseptic) meningitis?

A
  1. Herpes simplex virus (HSV 2)
  2. Enteroviruses
  3. Varicella zoster virus (VZV)
  4. Mumps
  5. HIV
  6. Adenovirus
54
Q

List 4 symptoms of viral (aseptic) meningitis?

A
  1. Headache
  2. Fever
  3. Neck stiffness
  4. Photophobia
55
Q

What are 3 other investigations when suspecting viral (aseptic) meningitis on CSF sample?

A
  1. CSF PCR for viruses (Herpes simplex virus (HSV) / Varicella-zoster virus (VZV))
  2. Blood cultures
  3. Imaging to rule out other intracranial pathology: CT / MRI head
56
Q

What does this CSF result suggest?

  • Appearance: Clear or cloudy
  • Opening pressure: Elevated
  • WBC: Elevated (10 – 500 cells/µL)
  • Glucose level: Low
  • Protein level: Elevated
A

Fungal meningitis

57
Q

List 2 causes of fungal meningitis?

A
  1. Cryptococcus neoformans

2. Candida

58
Q

List 6 symptoms of fungal meningitis?

A
  1. Patients are often immunocompromised
  2. Headache
  3. Confusion
  4. Nausea
  5. Vomiting
  6. Fever and neck stiffness are less common
59
Q

List 7 other investigations when suspecting fungal meningitis on CSF sample?

A
  1. CSF cultures
  2. CSF PCR
  3. CSF staining
  4. HIV test
  5. Blood cultures
  6. Imaging to rule out other intracranial pathology: CT / MRI head
60
Q

What does this CSF result suggest?

  • Appearance: Opaque, if left to settle it forms a fibrin web
  • Opening pressure: Elevated
  • WBC: Elevated (10 – 1000 cells/µL, Early PMNs then mononuclears)
  • Glucose level: Low
  • Protein level: Elevated (1-5 g/L)
A

Tuberculosis meningitis

61
Q

List 6 symptoms of tuberculosis meningitis?

A
  1. Headache
  2. Fever
  3. Neck stiffness
  4. Photophobia
  5. Delirium
  6. Cranial nerve palsies
62
Q

List 7 other investigations when suspecting tuberculosis meningitis on CSF sample?

A
  1. CSF cultures
  2. CSF bacterial antigens
  3. CSF PCR
  4. HIV test
  5. Blood cultures
  6. Imaging to rule out other intracranial pathology: CT / MRI head
  7. Chest X-ray
63
Q

What does this CSF result suggest?

  • Appearance: Blood stained initially, then xanthochromia (yellowish) >12 hours later
  • Opening pressure: Elevated
  • WBC: Elevated (WBC to RBC ratio of approx 1:1000)
  • RBC: Elevated
  • Glucose level: Normal
  • Protein level: Elevated
A

Subarachnoid haemorrhage

64
Q

List 2 causes of a subarachnoid haemorrhage?

A
  1. Trauma

2. Vascular malformations (e.g. aneurysms, arteriovenous malformations)

65
Q

List symptoms of a subarachnoid haemorrhage?

A
  1. Sudden onset “thunderclap” headache (patients may describe it as the “worst headache ever”)
  2. Stiff neck
  3. Vomiting
  4. Seizures
  5. Confusion
  6. Neurological deficits (weakness / sensory disturbance)
66
Q

List 2 other investigations when suspecting a subarachnoid haemorrhage on CSF sample?

A
  1. Cerebral angiogram

2. CT angiography

67
Q

What does this CSF result suggest?

  • Appearance: Clear or xanthochromia
  • Opening pressure: Normal or elevated
  • WBC: Normal
  • Glucose level: Normal
  • Protein level: Elevated (>5.5 g/L)
A

Guillain Barre Syndrome

68
Q

List 5 causes of Guillain Barre Syndrome?

A
  1. Campylobacter jejuni
  2. CMV
  3. EBV
  4. Mycoplasma pneumonia
  5. VZV
69
Q

List 2 symptoms of Guillain Barre Syndrome?

A
  1. Often occurs after a recent bacterial / viral illness

2. Symmetrical ascending muscle weakness primarily affecting proximal musculature (trunk/respiratory muscles)

70
Q

List 4 further investigations when suspecting Guillain Barre Syndrome on CSF sample?

A
  1. Serologic studies
  2. Nerve conduction studies
  3. EMG
  4. Imaging to rule out other intracranial pathology: CT / MRI head
71
Q

What does this CSF result suggest?

  • Appearance: Clear
  • Opening pressure: Normal
  • WBC: 0 – 20 cells/µL (primarily lymphocytes)
  • Glucose level: Normal
  • Protein level: Mildly elevated (0.45 – 0.75 g/L)
A

Multiple sclerosis

72
Q

List 5 symptoms of multiple sclerosis?

A
  1. Optic neuritis
  2. Limb weakness
  3. Sensory disturbances
  4. Diplopia
  5. Ataxia
73
Q

List 3 further investigations when suspecting multiple sclerosis on CSF sample?

A
  1. MRI head
  2. Oligoclonal bands of IgG on electrophoresis (CSF and Serum)
  3. Evoked potential tests (visual/somatosensory)

MBChB Yr 3 OSCES (5 decks)

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