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FA2 Clinical Pathology > Lecture 15 10/29/24 > Flashcards

Lecture 15 10/29/24 Flashcards

1
Q

What is oncotic pressure?

A

water following solids

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2
Q

What is hydraulic pressure?

A

force of flow when fluid encounters resistance

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3
Q

Which system in the body drains fluid from body cavities?

A

lymphatic system

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4
Q

What are the characteristics of fluid formed by plasma exiting the arterial capillary bed?

A

-low protein conc.
-low cellularity
-normal fluid in body cavity

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5
Q

What is the cycle for normal body cavity fluid?

A

-fluid moves out of capillaries
-fluid lubricates organs
-fluid is drained by lymphatics
-fluid goes back into the vascular space

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6
Q

What is an effusion?

A

pathological fluid accumulation

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7
Q

What are the mechanisms of pathologic fluid accumulation?

A

-disturbances in fluid circulation
-inflammation in a body cavity
-organ rupture
-neoplasia

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8
Q

What is the clinical presentation of abdominal/peritoneal effusions?

A

-distended abdomen
-exercise intolerance
-possible respiratory difficulty

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9
Q

What is the clinical presentation of thoracic/pleural effusions?

A

-increased resp. rate
-difficulty breathing
-exercise intolerance/weakness

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10
Q

What is the clinical presentation of pericardial effusions?

A

-exercise intolerance/weakness/collapse
-respiratory difficulty
-muffled heart sounds
-weak pulses
-jugular distension
-ECG abnormalities
-abdominal effusion possible

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11
Q

What is a purple top tube/EDTA tube used for when collecting effusion samples?

A

-total protein
-total nucleated cell count
-cytology

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12
Q

What is a green top tube/heparin tube used for when collecting effusion samples?

A

-K+
-creatinine
-bilirubin
-triglycerides
-glucose
-lactate

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13
Q

What is a red top tube/non-additive tube used for when collecting effusion samples?

A

bacterial culture and susceptibility

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14
Q

How should smear samples be shipped?

A

-should include direct smear of fresh fluid +/- stained smear
-slide shipped in room temp. slide holder

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15
Q

How should tube samples be shipped?

A

-refrigerated EDTA tube +/- additional heparin and additive free tubes
-shipped overnight on cool pack

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16
Q

How does a fluid analysis differ from a cytology (UTCVM specific)?

A

-fluid analysis looks at total protein refractometry, total nucleated cell count, and microscopic eval.
-cytology only looks at microscopic eval.

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17
Q

What type of effusion is typically seen with disturbances in fluid circulation?

A

transudate

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18
Q

What are the mechanisms of transudate production?

A

-decreased oncotic pressure
-increased hydraulic pressure
-altered lymphatic drainage

19
Q

What is a clinical example of decreased oncotic pressure?

A

protein losing nephropathy

20
Q

What is a clinical example of increased hydraulic pressure?

A

right-sided heart failure

21
Q

What is a clinical example of lymphatic obstruction?

A

space-occupying mass

22
Q

What is a transudate?

A

fluid with low cellularity and variable protein concentration

23
Q

What difference determines if a transudate will have high or low protein?

A

-transudates that come from vessels with small fenestrations will have low protein
-transudates that come from vessels with large fenestrations will have high protein

24
Q

What is the pathophysiology of exudates?

A

-sterile or infectious inflammatory stimulus
-inflammation leads to increased vascular permeability
-leaky vessels allows for exudation of fluid, protein, and cells
-chemokines attract inflammatory cells

25
Q

What is an exudate?

A

fluid with high cellularity and high protein

26
Q

What are the characteristics of a sterile exudate?

A

-high protein
-high cellularity
-non-degenerate neutrophils
-submitted for bact. culture as a precaution

27
Q

What is sepsis?

A

systemic inflammation due to bacterial infection

28
Q

What are the two meanings of septic?

A

-“a patient that has sepsis”
-“containing bacteria,” but not having the clinical syndrome of sepsis

29
Q

What are the characteristics of a septic effusion?

A

-high protein
-high cellularity
-degenerate neutrophils
-bacteria phagocytized by neutrophils and/or macrophages
-positive bact. culture is gold standard for diagnosis

30
Q

What are the characteristics of glucose as an effusion biochemical marker?

A

-helps ID septic effusion
-fluid glucose is typically less than plasma glucose

31
Q

What are the characteristics of lactate as an effusion biochemical marker?

A

-helps ID septic effusion or strangulating obstruction
-fluid lactate is typically greater than plasma lactate

32
Q

What are the characteristics of a low-protein transudate?

A

-colorless and clear
-total protein less than 2.5
-total nucleated cell count less than 5000
-mononuclear cells predominate

33
Q

What are the characteristics of a high-protein transudate?

A

-light yellow and clear
-total protein greater than 2.5
-total nucleated cell count less than 5000
-mononuclear cells predominate

34
Q

What are the characteristics of an exudate?

A

-variable color
-turbid/cloudy/opaque
-total protein greater than 2.5
-total nucleated cell count greater than 5000
-neutrophils predominate

35
Q

What type of effusion is typically seen with inflammation in a body cavity?

A

exudate

36
Q

Which types of effusion are typically seen with organ rupture?

A

-exudate
-hemorrhage

37
Q

What are the characteristics of effusions due to GI rupture?

A

-variable appearance
-find mixed bacteria and debris
-can perform glucose and lactate testing
-caused by linear foreign body or necrosis from neoplasia

38
Q

What are the characteristics of uroabdomen?

A

-variable appearance
-looks like a transudate early on
-looks like an exudate later on
-crystals that are typically found in urine may be seen
-can test creatinine and potassium conc.; confirmatory if 2x greater than plasma conc.
-caused by urinary tract rupture

39
Q

What are the characteristics of chylous effusion?

A

-white, milky, lactescent
-highly vacuolated light purple background with many small lymphocytes
-triglyceride conc. greater than 100mg/dL is confirmatory
-caused by lymphatic duct rupture or leakage

40
Q

What are the characteristics of bile peritonitis?

A

-exudate appearance
-presence of bile in background and within macrophages
-bilirubin conc. 2x greater than plasma bilirubin is confirmatory
-caused by biliary tract rupture

41
Q

What are the characteristics of hemorrhagic effusion?

A

-grossly bloody
-looks like a blood smear, but minus platelets
-may see erythrophagocytosis and/or presence of hemosiderin
-PCV >3% suggests hemorrhagic component
-caused by organ rupture or coagulopathy

42
Q

What are the characteristics of neoplastic effusion?

A

-variable appearance
-will see cells with malignancy features
-flow cytometry, PARR, and special stains help to confirm
-caused by tumor rupture or exfoliation

43
Q

What are the characteristics of pericardial effusion?

A

-often hemorrhagic but can appear like a transudate
-typically appears like a hemorrhagic effusion +/- mesothelial cells
-can be caused by idiopathic pericarditis, neoplastic rupture, or atrial rupture

FA2 Clinical Pathology (21 decks)

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