L35 Miscellaneous fluids Flashcards
What are the tests in general we can do to examine fluids like pleural fluid, CSF, etc.? (5)
- Appearance
- Biochemistry
- Cell count and differential
- Microbiology
- Cytology
What is transudate (1), main difference from exudate (1) and state all the causes of transudate formation. (8)
Fluid with low protein content which accumulates
Protein <30 g/l
- Increased hydrostatic pressure
- congestive heart failure
- liver cirrhosis
- portal hypertension (ascites) - Decreased oncotic pressure
- nephrotic syndrome
- cirrhosis with hypoalbuminemia
- protein malabsorption
- protein losing enteropathy - Decreased drainage:
- lymphatic obstruction
What is exudate (1), main difference from exudate (1) and state all the causes of exudate in pleural fluid (3) and ascitic fluid (3)
Exudate is fluid with high protein content which accumulates due to increased capillary permeability
Protein >30g/L
- Pleural fluid
- Pneumonia
- Malignancy
- Vasculitis - Ascitic fluid
- Pancreatitis
- Peritonitis
- Malignancy
CSF is produced by the __________ and it is an ultra filtrate of plasma with ________ secretions.
choroid plexus;
intrathecal (= spinal canal)
How is CSF collected?
What color of the CSF is preferred?
- Lumbar puncture at L4/L5
- Clear specimen is preferred;
blood causes false elevation of CSF protein
State the cause of the coloured CSF below
A. Blood-stained
B. Yellow
C. Turbid
A: recent subarachnoid hemorrhage, traumatic tap
B. xanthrochromic: SAH >12h, jaundice
C. presence of WBC
Pleural fluid is from the ________ of the lung, and it is collected by?
interstitial space;
pleural tap/ thoracocentesis (same)
State the cause of the coloured pleural fluid below A. Straw colored B. Blood-stained C. Purulent/turbid D. Chylous
A: transudate from Congestive heart failure
B. malignancy, vasculitis
C. bacterial infection
D. cholesterol > lymphatic leakage (from thoracic duct)/ obstruction
Ascites is the accumulation of excess fluid in the ______________. MC is cirrhosis > malignancy > CHF.
It can be collected by?
peritoneal cavity;
paracentesis
State the cause of the coloured ascitic fluid below A. Straw colored B. Blood-stained C. Purulent/turbid D. Chylous
A: Congestive heart failure, cirrhosis
B: malignancy, hemorrhagic pancreatitis
C. peritonitis
D. cholesterol > lymphatic leakage (from thoracic duct)/ obstruction
What is the normal percentage of plasma glucose should the CSF have?
> 60%, thus requiring concurrent plasma glucose sample
What may a decreased <50% glucose in CSF indicate? (4)
- Bacterial meningitis
- increase in WBC,
- malignant infiltration,
- traumatic tap
NOT viral! *bacterial can use up the glucose, highly metabolically active cells use up glucose
To delineate viral and bacterial causes of meningitis, we can use level of _____________ which is elevated in __________ only.
Procalcitonin;
bacterial meningitis
(in addition to decreased glucose in CSF)
CSF total protein should be less than?
If there is an increase, it indicates?
<0.7g/L;
- infection (increase Ig)
- malignant infiltration
- chronic inflammation (MS, GBS)
- spinal canal blockage
- false positive traumatic tap
If CSF protein is very high, what should be done to rule out false positively high protein by traumatic tap?
Red cell count