Pleural and peritoneal fluid analysis Flashcards
Blood in the pleural space?
Haemothorax.
lymph a chylothorax and pus an empyema.
Unilateral pleural effusions are more likely to be?
Exudates
Exudate and transudate protein levels
exudate >30g/L of protein
transudate <3g/L of protein
The lights criteria?
It is exudat when:
Pleural fluid:serum protein ratio >0.5
Pleural fluid LDH >200IU/L
Pleural fluid:serum LDH ratio >0.6
Total protein is used for what?
Differentiate between exudate and transudate
Lactate dehydrogenase
Differentiate exudate and transudate
Microbiology
Identify infection
pH
Low in empyeme. if pH <7.2 chest drain is advised
Cytology examination?
To identify and characterise malignant cells
Glucose
Low in rheumatoid disease
Rheumatoid factor?
High in rheumatoi disease
Amylase?
High in pacreatitis
Zielh-Neelsen stain and culture
To diagnose TB
Haematocrit?
High in haemothorax
Causes of transudate pleural effusion?
Cardiac failure
liverfailure
nephrotic syndrome (kidney failure)
hypoalbunimaemia (nutritional failure)
hypothyroidism
Causes of exudate?
Cancer
Pneumonia
Pulmonary embolus/infarct
TB
Connective tissue disease
Acute pancreatitis
Colour of pleural fluid?
Straw = normal
yellow = infected
blood stained = traumatic, malignancy
frank blood = Mesothelioma, tramua, other malignancy
Pus = Empyema
Food debris = Oesophageal rupture
Abnormal collection of peritoneal fluid is termed?
Ascites
Paracentesis (peritoneal tap) is used for?
Remove fluid,
characterise disease, detect infection
ascites protein levels
exudate >25g/L of proetine
transudate <25 g/L of protein
causes of transudate ascites?
Cirrhosis
Cardiac Failure
Hypoalbuminaemia
Nephrotic Syndrome
Causes of Exudate Ascites?
Intraperitoneal malignancy
Intraperitoneal infection including tuberculosis
Pancreatitis
Hypothyroidism
Chylous Ascites
Serum Ascites Albumin Gradient?
SAAG (g/L) = Serum albumin (g/L) - Ascites albumin (g/L)
>11 g/L= portal hypertension
ascites associated with cirrhosis, peritonitis is a primary problem, is it called?
Spontaneous bacterial peritonitis
An alternative cause of peritonitis shoulc be suspected when multiple organisms are seen on gram staining?
Perforated Bowel
Purpose of detecting:
WCC
Total protein content and albumin
Microscopy including gram staing
Culture
Glucose
Cytology
Amylase?
infection
distinguish between exudates and transudates/ calculate serum-ascites albumin gradient
To visulaise bacteria
To identify bacteria
low in malignancy ascites
to detect malignant cells
raised in ascites associated with pancreatitis
