Pleural and peritoneal fluid analysis

Question 1

Blood in the pleural space?

Answer 1

Haemothorax.

lymph a chylothorax and pus an empyema.

Question 2

Unilateral pleural effusions are more likely to be?

Answer 2

Exudates

Question 3

Exudate and transudate protein levels

Answer 3

exudate >30g/L of protein

transudate <3g/L of protein

Question 4

The lights criteria?

Answer 4

It is exudat when:

Pleural fluid:serum protein ratio >0.5

Pleural fluid LDH >200IU/L

Pleural fluid:serum LDH ratio >0.6

Question 5

Total protein is used for what?

Answer 5

Differentiate between exudate and transudate

Question 6

Lactate dehydrogenase

Answer 6

Differentiate exudate and transudate

Question 7

Microbiology

Answer 7

Identify infection

Question 8

pH

Answer 8

Low in empyeme. if pH <7.2 chest drain is advised

Question 9

Cytology examination?

Answer 9

To identify and characterise malignant cells

Question 10

Glucose

Answer 10

Low in rheumatoid disease

Question 11

Rheumatoid factor?

Answer 11

High in rheumatoi disease

Question 12

Amylase?

Answer 12

High in pacreatitis

Question 13

Zielh-Neelsen stain and culture

Answer 13

To diagnose TB

Question 14

Haematocrit?

Answer 14

High in haemothorax

Question 15

Causes of transudate pleural effusion?

Answer 15

Cardiac failure

liverfailure

nephrotic syndrome (kidney failure)

hypoalbunimaemia (nutritional failure)

hypothyroidism

Question 16

Causes of exudate?

Answer 16

Cancer

Pneumonia

Pulmonary embolus/infarct

TB

Connective tissue disease

Acute pancreatitis

Question 17

Colour of pleural fluid?

Answer 17

Straw = normal

yellow = infected

blood stained = traumatic, malignancy

frank blood = Mesothelioma, tramua, other malignancy

Pus = Empyema

Food debris = Oesophageal rupture

Question 18

Abnormal collection of peritoneal fluid is termed?

Answer 18

Ascites

Question 19

Paracentesis (peritoneal tap) is used for?

Answer 19

Remove fluid,

characterise disease, detect infection

Question 20

ascites protein levels

Answer 20

exudate >25g/L of proetine

transudate <25 g/L of protein

Question 21

causes of transudate ascites?

Answer 21

Cirrhosis

Cardiac Failure

Hypoalbuminaemia

Nephrotic Syndrome

Question 22

Causes of Exudate Ascites?

Answer 22

Intraperitoneal malignancy

Intraperitoneal infection including tuberculosis

Pancreatitis

Hypothyroidism

Chylous Ascites

Question 23

Serum Ascites Albumin Gradient?

Answer 23

SAAG (g/L) = Serum albumin (g/L) - Ascites albumin (g/L)

>11 g/L= portal hypertension

Question 24

ascites associated with cirrhosis, peritonitis is a primary problem, is it called?

Answer 24

Spontaneous bacterial peritonitis

Question 25

An alternative cause of peritonitis shoulc be suspected when multiple organisms are seen on gram staining?

Answer 25

Perforated Bowel

Question 26

Purpose of detecting:

WCC

Total protein content and albumin

Microscopy including gram staing

Culture

Glucose

Cytology

Amylase?

Answer 26

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