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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
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
NON-INFLAMMATORY JOINT EFFUSION
26
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
INFLAMMATORY JOINT EFFUSION
27
Describe the joint fluid crystals seen in gout?
Needle negative birefringent crystals
28
Describe the joint fluid crystals seen in pseudogout?
Rhomboid positively birefringent crystals
29
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
SEPTIC JOINT EFFUSION
30
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
HAEMORRHAGIC JOINT EFFUSION
31
What are 2 causes of non-inflammatory joint effusions?
1. Osteoarthritis | 2. Trauma
32
List the 5 symptoms of non-inflammatory joint effusions?
1. Localised joint pain 2. Gradual onset of symptoms 3. Pain on movement 4. Crepitus 5. Worse at the end of the day
33
What 3 investigations would you do for a non-inflammatory joint effusion?
1. Bloods- WCC/CRP typically normal 2. X-Ray- may reveal fractures/OA changes 3. MRI- ligaments & menisci for injury
34
What are 4 causes of inflammatory joint effusions?
1. Rheumatoid arthritis 2. Reactive arthritis 3. Psoriatic arthritis 4. Acute gout or pseudogout
35
List the 4 symptoms of rheumatoid arthritis (inflammatory joint effusion)?
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
List the 4 symptoms of psoriatic arthritis (inflammatory joint effusion)?
1. Affected joints are red/warm 2. Small joints of hand & wrist (distal interphalangeal joints) 3. Typically asymmetrical 4. Onycholysis & hyperkeratosis
37
Describe the symptoms for acute gout (inflammatory joint effusion)?
Typically a single hot, swollen & tender joint (MTP joint at base of big toe)
38
Describe the symptoms for pseudogout (inflammatory joint effusion)?
Single hot, swollen & tender joint (most commonly knee joint)
39
What 2 investigations would you do for an inflammatory joint effusion?
1. Bloods- FBC, CRP/ESR, Urate (raised in gout), Antibodies (anti-CCP, RhF) 2. X-ray of the joint
40
List 4 causes of septic joint effusion?
1. Staphylococcus aureus 2. Streptococci 3. Neisseria gonorrhoeae (young sexually active adults) 4. Escherichia coli (elderly, IV drug users)
41
Describe the 2 symptoms of septic joint effusion?
1. Painful, swollen & warm | 2. Usually a single joint affected
42
What 4 investigations would you do for a septic joint effusion?
1. Bloods- FBC (WCC raised), CRP raised 2. Blood cultures 3. Fluid cultures 4. X-Ray of the joint
43
List 3 causes of a haemorrhagic joint effusion?
1. Trauma 2. Tumours 3. Bleeding disorders
44
Describe the 3 symptoms of a haemorrhagic joint effusion?
1. Painful, swollen & warm 2. Restricted range of movement 3. Excessive bruising surrounding affected joint
45
What 2 investigations would you do for a haemorrhagic joint effusion?
1. Bloods- FBC (decreased haemoglobin) 2. Coagulation studies 3. X-Ray of the affected joint (associated fractures)
46
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)
Bacterial Meningitis
47
List 3 causes of bacterial meningitis in newborn babies?
1. Listeria monocytogenes 2. E. Coli 3. Group B Streptococci
48
List 3 causes of bacterial meningitis in older children?
1. Neisseria meningitidis 2. Haemophilus influenzae Type B 3. Streptococcus pneumoniae
49
List 3 causes of bacterial meningitis in adults?
1. Neisseria meningitidis 2. Streptococcus pneumoniae 3. Listeria monocytogenes
50
List 5 symptoms of bacterial meningitis?
1. Headache 2. Fever 3. Neck stiffness 4. Photophobia 5. Meningococcal meningitis presents with a characteristic petechial rash
51
List 5 further investigations when suspecting bacterial meningitis on CSF sample?
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
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)
Viral (aseptic) meningitis
53
List 6 causes of viral (aseptic) meningitis?
1. Herpes simplex virus (HSV 2) 2. Enteroviruses 3. Varicella zoster virus (VZV) 4. Mumps 5. HIV 6. Adenovirus
54
List 4 symptoms of viral (aseptic) meningitis?
1. Headache 2. Fever 3. Neck stiffness 4. Photophobia
55
What are 3 other investigations when suspecting viral (aseptic) meningitis on CSF sample?
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
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
Fungal meningitis
57
List 2 causes of fungal meningitis?
1. Cryptococcus neoformans | 2. Candida
58
List 6 symptoms of fungal meningitis?
1. Patients are often immunocompromised 2. Headache 3. Confusion 4. Nausea 5. Vomiting 6. Fever and neck stiffness are less common
59
List 7 other investigations when suspecting fungal meningitis on CSF sample?
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
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)
Tuberculosis meningitis
61
List 6 symptoms of tuberculosis meningitis?
1. Headache 2. Fever 3. Neck stiffness 4. Photophobia 5. Delirium 6. Cranial nerve palsies
62
List 7 other investigations when suspecting tuberculosis meningitis on CSF sample?
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
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
Subarachnoid haemorrhage
64
List 2 causes of a subarachnoid haemorrhage?
1. Trauma | 2. Vascular malformations (e.g. aneurysms, arteriovenous malformations)
65
List symptoms of a subarachnoid haemorrhage?
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
List 2 other investigations when suspecting a subarachnoid haemorrhage on CSF sample?
1. Cerebral angiogram | 2. CT angiography
67
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)
Guillain Barre Syndrome
68
List 5 causes of Guillain Barre Syndrome?
1. Campylobacter jejuni 2. CMV 3. EBV 4. Mycoplasma pneumonia 5. VZV
69
List 2 symptoms of Guillain Barre Syndrome?
1. Often occurs after a recent bacterial / viral illness | 2. Symmetrical ascending muscle weakness primarily affecting proximal musculature (trunk/respiratory muscles)
70
List 4 further investigations when suspecting Guillain Barre Syndrome on CSF sample?
1. Serologic studies 2. Nerve conduction studies 3. EMG 4. Imaging to rule out other intracranial pathology: CT / MRI head
71
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)
Multiple sclerosis
72
List 5 symptoms of multiple sclerosis?
1. Optic neuritis 2. Limb weakness 3. Sensory disturbances 4. Diplopia 5. Ataxia
73
List 3 further investigations when suspecting multiple sclerosis on CSF sample?
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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