Lecture 13 Body Fluids Flashcards
What are the types of body fluids that can be analzyed?
- Pleural fluid
- Pericardial fluid
- Peritoneal (Ascitic) fluid
- Synovial fluid
- Cerebral Spinal fluid
- Seminal fluid
- Amniotic fluid
What three types of cavities are serous fluids obtained from?
- Pleural cavity (covers lungs and lines the thorax).
- Pericardial cavity (covers and surrounds the heart)
- Abdominal cavity (covers the organs - esp GI tract and lines abdomen).
All share a common physiology, histology, cytology and embryology. Membranes are continuous within cavity forming closed spaces.
What are serous membranes?
Connective tissue support containing capillaries, lymphatics; normally lined by single layer of mesothelial cells.
What is synovial fluids?
Viscous fluid which acts as lubricant between joints (e.g. shoulder, knee, etc.)
What should the testing of body fluids include?
- Color
- Turbidity
- Cell counts
- WBC examination.
What does thoracentesis mean?
Aspiration of pleural fluid.
What does pericardiocentesis mean?
Aspiration of pericardial fluid.
What does paracentesis mean?
Aspiration of peritoneal fluid.
What is the term for aspiration of joint synovial fluid?
Arthrocentesis.
Why is aspiration performed?
For testing the fluids and to remove large effusions which may interfere with organ or joint function.
What is the purpose of serous fluids?
Serves as a lubricant and cushion between membrane of organ and sac in which it is housed. Allows for organ movement without friction and pain.
What is the fluid volume in the respective cavities dependent on?
- Formation: Hydrostatic pressure, plasma osmotic pressure (mostly albumin), and capillary permeability.
- Reabsorption: Lymphatics (protein, particular matter), capillaries, venules (water, etc.)
- Effusion: excess amount of fluid. Always due to pathological process. Can be transudate or exudate.
Draw a diagram of the fluid balance as per slide 11.
What is the different between transudate and exudate effusion?
Transudate is excess fluid due to systemic disease such as CHF, alcoholic liver cirrhosis, hypoproteinemia, etc.
Exudate is excess fluid due to a localized cause such as infection, inflammation, hemorrhage, pulmonary embolism, malignancy, autoimmune disease (SLE), etc.
What are the main physical mechanisms of effusion due to transudates?
- Increased hydrostatic pressure.
- Decreased osmotic pressure due to low albumin as seen in cirrhosis, nephrosis, and malnutrition.
What are the main causes of effusion due to exudates?
- Increased capillary permeability due to infections, inflammations, hemorrhage or autoimmune disease (SLE).
- Decreased lymphatic absorption due to malignant tumor obstruction (benign rarely cause exudates)
How does transudate (ultrafiltrate) compare to exudate (unfiltered) in terms of colour and specific gravity?
Transudate has a pale yellow or clear colour and a S.G. < 1.016.
Exudate has a cloudy or yellow amber or even bloody colour and a S.G. > 1.016.
How does the protein content vary between transudate and exudate?
Transudate has a protein content of <30g/L or <50% of serum level.
Exudate has a protein >30g/L or >50% of serum level.
Transudate has less protein than exudate.
How does the cell count and WBC differential compare between transudate and exudate?
Transudate has a low cell count <1000x10^6/L and its WBC diff shows mononuclear, mostly mesothelial, and macrophages.
Exudate has a high cell count >1000x10^6/L and its WBC diff shows neuts early, mononuclear later; macrophages, reactive mesothelial, and tumor cells.
How does clot formation vary between transudate and exudate?
Transudate has no clot formation due to absence of fibrinogen and exudate has clots that form readily due to presence of fibrinogen.
What are the advantages of the cytocentrifuge for preparation of body fluid differential?
- Greater sensitivity
- Better morphology
Good preparation allows for accurate correlation with cell count.
What does a turbid/yellow - white body fluid indicate for possible disease versus a watery, brown transudate or green fluid?
Turbid/Yellow…. –> Increased leukocyte count –> infection, malignancy.
The water brown fluid indicates transudate bilirubin.
Green fluid indicates bile-ruptured bowel, bilary tract disease.
What does milk white (chlylous) body fluid indicate versus silk sheen or “gold paint?
Milk white fluid indicates chyle or increased fat, malignancy, lymphoma, leukemia, blocked thoracic duct.
The sild sheen/gold paint fluid indicates cholesterol crystals, -TB, RA old effusion.
What does watery, clear, or pale yellow fluid indicate versus bloody or chocolate brown fluid?
Water, clear or pale yellow fluid indicates transudate - CHF, nephrosis, cirrhosis, further testing usually not necessary.
Bloody or chocolate brown fluid indicates hemorrhage, malignancy, infection, or trauma.
See slide 20 for more descriptions.
What do you expect to see in a microscopic view of fluid from an acute bacterial infection versus a chronic bacterial infection?
Acute bacterial infection has:
- increased neuts,
- macrophages,
- mesothelial cells,
- may contain bacteria (gram stain).
Chronic bacterial infection shows mixed population of neuts, lymphs, plasma cells, macrophages, and reactive mesothelial cells.
What does body fluid from a viral infection show under the microscope versus a metastatic tumor?
Viral Infection - Increased Lymphs
Plasma Cells
Mesothelial Cells
Macrophages
Metastatic Tumor - malignant cells, single or in clusters, signet rings, cell balls.
See slide 21 for more descriptions.
