Lecture 9: Effusions and Fluid Analysis Flashcards
Define effusion
abnormal accumulation of fluid in potential spaces in the body
which species has a normally observable amount of fluid in their cavities- not effusion
horses
effusion is drained by __
lymphatics
what are the starling forces
defines the basic forces that are responsible for fluid shift between occultation and interstitium
what would be hydrostatic and oncotic pressure in capillary to cause effusion
high hydrostatic pressure, low oncotic pressure
what would cause lymphatic leakage
obstructed or ruptured lymphatics
how would inflammation cause effusion
increased vascular permeability
what tubes are used to collect fluid
EDTA tube for analysis and no-additive tube for culture
what is normal background on microscopic examination of fluid
clear to pale pink
normal or abnormal fluid
normal- clear to pale pink background
what cell predominates fluid analysis in normal small animals
macrophages
fluid from dog- this normal or abnormal cell type
normal-macrophages
__ cells are commonly seen in canine effusions, typically with chronicity
mesothelioma cells
two different canine effusions- what is seen in both
Left- normal mesothelial cells
Right: reactive mesothelial cells- seen in effusions in dogs with chronicity
if you have suspected uroabdomen what analytes do you want to test for
creatinine and potassium
if you have suspected chylous effusion what analytes do you want to test for
triglyceride and cholesterol
if you have suspected bile peritonitis what analyte do you want to test for
bilirubin
if you have suspected septic peritonitis what analytes do you want to test for
glucose and lactate
what is normal fluid volume in cavities for sampling in dogs/cats/birds and horses
dogs/cats/birds: insufficient to sample
Horses: sufficient to sample
what is color of normal fluid in dogs/cats/birds and horses
dogs/cats/birds: clear
Horses: clear to straw
what is normal turbidity of fluid in dogs, cats, birds, and horses
clear
what is normal total protein of fluid in dogs, cats, birds, horses
<2.5
what is normal total nucleated cell count in fluid of dogs/cats/ birds and horses
dogs/cats/birds: <1000
Horses: <5000-10,000
what is the predominant nucleated cell type in fluid of dogs/cats/birds and horses
dogs/cats/birds: mononuclear cells (Macs)
Horses: mononuclear and neutrophils
what is the gross appearance, total protein, total nucleated cell count dogs/cats and horses, cell type, and mechanism for a low protein (pure) transudate effusion
gross appearance: clear
TP: <2.5
TNCC: dogs/cats: <5000
TNCC: horses: <5000-10000
Cell type: mononuclear cells, neutrophils in horses
Mechanisms: decreased oncotic pressure
what is the gross appearance, total protein, total nucleated cell count in dogs/cats and horses, cell type, and mechanism for a high protein (modified) transudate
gross: clear or serosanguineous, to cloudy
Total protein: 2.5-5.0
TNCC: dogs/cats: <5000
TNCC: horses <5000-10,000
Cell type: mononuclear cells, neutrophils
Mechanism: increased hydrostatic pressure
what is gross appearance, total protein, total nucleated cell count for dogs/cats and horses, cell type and mechanism for exudate effusion
gross: variable color, cloudy to opaque
Total protein >4
TNCC dogs/cats: >5000
TNCC: horses: >5000-10,000
Cell type: neutrophils, macrophages, eosinophils
Mechanism: increased vascular permeability
what are some causes of decreased oncotic pressure leading to low protein (pure) transudate effusion
- Loss: protein losing enteropathy, protein losing nephropathy, burns
- Decreased production: hepatic insufficiency or failure
- Over hydration
what are some causes of increased hydrostatic pressure leading to high protein (modified) transudate effusion
- Post sinusoidal hepatic congestion
- CHF
- Thromboembolic disease
- Intestinal torsion, intussusception, hernia
what is typical cause of exudate effusion
inflammation
how do you determine if exudate is septic or aseptic
- Presence of organisms
- Type of inflammation
- Neutrophil morphology- degenerate vs non-degenerate
what are the nuclear changes seen with degenerate neutrophils
- Swollen nuclei
- Glassy, homogenous, paler nuclei
- Fuzzy nuclear membrane
are degenerate neutrophils found in tissue or blood
tissue
are degenerate or toxic neutrophils indicative of sepsis
degenerate
what are the cytoplasmic changes with toxic neutrophils
- Cytoplasmic basophil is
- Dohle body
- Foamy cytoplasm
- Cytomegaly
are toxic neutrophils found in blood or tissue
blood
what do toxic neutrophils indicate
accelerated granulopoiesis
what is circled and how do you know
degenerate neutrophil- fuzzy nuclear membrane, swollen nucleus
what this and how do you know
toxic neutrophil- cytoplasmic basophilia, foamy cytoplasm
what type of cells do you see in septic exudate
neutrophils, often degenerate
how do you confirm septic exudate
bacteria within neutrophils
how would you classify this exudate
septic exudate- bacteria in degenerate neutrophils
what do you see with acute gastrointestinal rupture
large amount of mixed bacteria often with protozoal organisms, and yeasts
horse presents with acute GI signs, colic and pain. Based on fluid sample what wrong and why
Acute gastrointestinal rupture- lots of bacteria
how can you use glucose to determine if septic or not
serum glucose - fluid glucose
what fluid glucose difference is indicative of sepsis in dogs and horses
dogs: > or = 20mg/dl
Horses: > 50mg/dl
how can you use lactate to determine if septic exudate
fluid lactate - plasma lactate
what fluid lactate difference in dogs is indicative of septic exudate
> or = 2mmol/L
what are your differentials for septic exudate
- GI leakage/rupture
- FB
- Penetrating wound
- Extension from infected tissues
- Seeding from systemic dz
how do neutrophils appear in aseptic exudate
typically non-degenerate
what are some differentials for aseptic exudate
- Chemical irritation (bile, chyle, urine)
- Sterile FB (suture)
- Post sx
- Tissue inflammation and necrosis (pancreatitis, non-exfoliating neoplasia)
- Internal abscessation
- Yolk
what causes bile peritonitis
gall bladder or biliary tract rupture
what are your cell counts, total proteins and color for suspected bile peritonitis
- Cell count: >5000 dogs, >5k-10k horses
- TP: >4
- Color: brown and cloudy
what paired fluid-serum bilirubin would be indicative of bile peritonitis
fluid bilirubin >2x serum bilirubin
what fluid sample a-g is indicative of bile peritonitis (gall bladder or biliary tract rupture)
G
What is the following microscopic finding indicative of
bile peritonitis- macrophages with yellow to green-brown pigment bilirubin crystals
what is cell count, total protein and color of chylous effusion
- Cell count: >3000
- TP: >2.5
- Color: milky, opaque
what type of effusion would this suggest
chylous effusion
what are the microscopic findings for chylous effusion
- Primarily small lymphocytes
- Neutrophils with chronicity
- Tiny clear vacuoles in background
what effusion are these consistent with
chylous effusion- small lymphocytes, some neutrophils and tiny clear vacuoles
chylous effusion is due to __ rupture, stasis or leakage
lymphatic
what BW value do you want to check for suspected chylous effusion and what would be value
fluid triglyceride >100mg/dl
what is the most common cause of chylous effusion in dogs vs cats
dogs: idiopathic
Cats: CHF
how would cell count and total protein appear in initial/early uroabdomen
- Cell count: mildly decreased
- TP: lower
over time with uroabdomen become more inflammatory and __ cell count and protein
increase
what are some supportive signs of uroabdomen
- Urinary Tract signs
- Male cats, neonatal foals
what paired fluid-serum creatinine would be supportive of uroabdomen
fluid creating >2x serum creatinine
what paired fluid-serum potassium would be supportive of uroabdomen
fluid potassium >1.4x serum potassium
what is cell count and total protein with FIP
- Cell count: low <5000
- TP: >3.5, highly suspicious if >5
what are the microscopic findings consistent with FIP
thick, proteinaceous background, neutrophils to mixed neutrophil-macrophage
cat- what cause
FIP
cat- what show and what wrong
thick proteinaceous background, neutrophils and macrophages—> FIP
is yolk coelomitis fluid analysis usually in low protein, high protein or exudate range
exudate range
what are microscopic findings for yolk coelomitis
variable sized globules of homogenous purple material
from bird- what wrong
Yolk coelomitis
what is cell count, total protein and RBC or PCV consistent with hemorrhagic effusion
- Cell count: variable
- Total protein: variable
- 0.5-1 million RBC/ul
- 1-3.5-5% PCV
what are microscopic findings consistent with hemorrhagic effusion
macrophages with rBC or hemosiderin, typically no platelets
what type of effusion
hemorrhagic effusion
what are some ddx for hemorrhagic effusion
- Trauma
- Coagulopathy (multiple cavities)
- Neoplasia: spleen or liver
what are cell counts and total proteins for neoplastic effusions
- Cell count: variable may be increased due to inflammation of hemorrhage
- TP: typically increased >3gl/dl
neoplastic effusions are define by presence of __ in effusions. Examples are __, __ or __
neoplastic cells
Round cells, carcinoma, mesothelioma
what type of effusion
neoplastic effusion
