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Clinical Medicine LAB - Professor Sample > Gastro - Parancetesis > Flashcards

Gastro - Parancetesis Flashcards

1
Q

What is the peritoneum ?

A

The space between the visceral peritoneum and the parietal peritoneum

Membrane consists of capillaries and lymphatic vessels ( which allows the fluid to leak into that space)

If secretion is increased or reabsorption blocked-ascites

**if secretion is increase and more pearmeadle and leaky*

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2
Q

Indications for Paracentesis ?

A

Performed on cases of unexplained ascites to determine cause

Performed to relieve intra-abdominal pressure from the fluid

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3
Q

Paracentesis pre-procedure?

A

Obtain informed consent (written)

Pt should empty bladder before procedure
so we don’t puncture it

Measure abdominal girth - we wanna know how much fluid we are taking out

Obtain pt weight

Obtain baseline VS

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4
Q

Paracentesis procedure?

A

Use sterile technique

Anesthetize locally

Make small stab wound incision

A trocar, cannula, or catheter can be placed through the incision.

Plastic tubing is then connected to vacuum device or collection device

4L max removed at one time

**fluid in the abd push intestines up and posterior *

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5
Q

Paracentesis post-procedure?

A

Labs on the fluid should be performed immediately

Measure abdominal girth

Measure pt weight

Monitor VS (watch for hypotension)

Monitor serum protein and sodium levels

Albumin?? its a transport protein - might be abnormal because of lover disease

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6
Q

Transudate examples?

A

CHF
Chirrosis
Nephrotic Syndrome
hypoproteinemia

** happening from something or somewhere else *

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7
Q

Exudate examples?

A

Infection - SBP
Neoplasm
Less likey: pulmonary infarction, trauma, drug hypersensitivity

** happening right thee in the abd*

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8
Q

Paracentesis fluid Normal fluid color?

A

Normal: clear-light yellow, serous

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9
Q

Paracentesis milk-colored fluid color?

A

lymphoma, carcinoma , TB

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10
Q

Paracentesis cloudy/turbid color fluid?

A

Cloudy/turbid: peritonitis, pancreatitis, appendicitis

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11
Q

Paracentesis bloody color fluid?

A

Bloody: traumatic tap, hemorrhage, tumor

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12
Q

Paracentesis bile-stained fluid color?

A

Bile-stained: ruptured GB, acute pancreatitis, ruptured intestines

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13
Q

Paracentesis cell counts: RBC normal count?

A

none

if there is some then it indicates neoplasm, TB, bleeding

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14
Q

Paracentesis cell counts: WBC if transudate?

A

normal

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15
Q

Paracentesis cell counts: WBC if exudate?

A

Exudate = elevated, neutrophils ( cancers and infections)

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16
Q

Total protein fluid/serum ratio if transudate?

A

Transudates: <0.5

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17
Q

Total protein fluid/serum ratio if exudate?

A

Exudates: >0.5 ( 8/4 ration = 2) - high protein in fluid than serum

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18
Q

What is the most accurate way to differentiate between transudate vs. exudate?

A

Total protein fluid/serum ratio

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19
Q

Protein count if transudate?

A

Transudates: <3g/dL

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20
Q

Protein count if exudate?

A

Exudates: >3 g/dL - more protein in th fluid-

21
Q

Usually glucose serum _______ peritoneal fluid levels?

A

equals

22
Q

When will glucose be decreased?

A

Bacterial infections

SBP (spontaneous bacterial peritonitis)

b/c glucose being eaten up back bacteria

23
Q

When is Amylase increased?

A

Pancreatic trauma
Pancreatic pseudocyst
Acute pancreatitis
Intestinal necrosis or perforation

**high amylase and concern for intestinal necrosis and they have ascites then at can further dx ywhat you thought it was /*

24
Q

ammonia appears on paracentesis if?

A

Ruptured ulcer, appendix, intestine

**ammonia coming out of the bowel *

25
Q

When is alk. pos. increased?

A

Found in intestinal mucosa so elevated with intestinal infarction or strangulation

**elevated with intestinal necrosis *

26
Q

Lactate Dehydrogenase is an enzyme found in?

A

many body tissues

27
Q

If using peritoneal fluid/serum LDH ratio what would the number be if it is exudate?

A

Exudate: > 0.6

** more stuff in the fluid than the serum*

28
Q

What does cytology examine?

A

paracentesis fluid for cancerous cells:

Ovarian
Pancreatic
Colon
gastric

29
Q

What if bacteria is present in the paracentesis fluid?

A 
Present:
Primary peritonitis
Appendicitis
Pancreatitis
TB

**Peritoneal fluid is sent for gram stain, culture, and sensitivity testing (C&S)
*

30
Q

When is carcinoembryonic antigen elevated?

A

GI cancers

31
Q

Contrindications to Paracentesis?

A

DIC - they will bleed out

AC therapy - anti coagulated - weight risk vs. benefits

Bleeding disorders

Extensive previous abd surgeries - be cautious cause scarring / adhesions - adhesions obscuring normal morphology

Small amount of fluid

32
Q

Potential complication of Paracentesis?

A

Peritonitis

Hypovolemia

Seeding needle tract with malignant cells

33
Q

Causes of Transudate fluid?

A 
Hepatic cirrhosis
Portal HTN
Nephrotic syndrome
CHF
Abdominal Trauma
Peritoneal Bleeding
34
Q

causes of exudate fluid?

A 
Lymphoma
Carcinoma
TB
Peritonitis
Pancreatitis
Ruptured viscus
35
Q

Stool Studies include?

A 
C.diff
Culture
Fecal fat
Fecal leukocytes
Occult Blood
Ova and parasites
36
Q

Fecal leukocytes evaluates for the presence of ___ in the stool

A

WBC

37
Q

Fecal leukocytes normal ?

A

Normal: none

May be normal with viral diarrhea or parasitic infection

38
Q

When is fecal leukocytes elevated?

A

Bacterial or infectious diarrhea

Perirectal abscess

Anorectal fistula

39
Q

Stool cultures look for what ?

A 
Salmonella
Shigella
Campylobacter
Yersinia
E.coli
Staph aureus
40
Q

Indication to check for C.Diff?

A

Abx for > 5 days

Immunosuppressed patients

Unrelenting watery, foul-smelling diarrhea

41
Q

C.Diff toxin assay?

A

stool

colonic-rectal tissue

42
Q

C.diff stool studies?

A

toxin assay

culture

positive = infection

43
Q

Indications for fecal fat test?

A

Confirm diagnosis of steatorrhea

44
Q

Test explanation for fecal fat?

A

Total output of fecal fat per 24 hours in 3 day stool collection

**pancreatic stuff / CF *

45
Q

Interfering factors to fecal fat test: increased?

A

Enemas

Laxatives

mineral oil

**anything that has oils in it *

46
Q

Interfering factors to fecal fat test: decreased?

A

Barium

Fiber laxatives

47
Q

Fecal Fat test results show increased levels because of what?

A

Cystic Fibrosis

Malabsorption : celiac disease, Crohns etc

Short-gut syndrome

Maldigestion secondary to obstruction of the pancreatobiliary tree

48
Q

Tumor markers?

A 
AFP
BRAF mutation 
CA 19-9
CA 125
CEA
CD20
KIT

Clinical Medicine LAB - Professor Sample (36 decks)

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