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module 17 > Recognition & Analysis of Body Fluids > Flashcards

Recognition & Analysis of Body Fluids Flashcards

1
Q

what are the 3 body cavity effusions

A
  1. peritoneum (abdomen)
  2. pleura (thorax)
  3. pericardium
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2
Q

what are the two forces that balance

A

Oncotic pressure

Hydrostatic pressure

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3
Q

what is oncotic pressure

A

Oncotic pressure: form of osmotic pressure that is caused by proteins (mostly albumin) in a blood vessel’s plasma (blood/liquid) that causes water molecules to flow into the circulatory systems

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4
Q

what is hydrostatic pressure

A

Hydrostatic pressure: opposing effect with pushes water and small molecules out of the blood into the interstitial spaces within the arterial end of capillaries and interstitial colloid osmotic pressure

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5
Q

what would you use EDTA tube for

A

prevents clotting of the sample, which can affect cell counts

helps preserve cell morphology during transport to the lab

submit unstained slides as well for best cell morphology preservation

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6
Q

what would you use plain tube for

A

culture

biochemical

or PCR testing

if indicated (EDTA bacteriostatic)

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7
Q

how do you process the sample and fluid analysis (4)

A
  1. protein concentration
  2. nucleated cell count: measured with automated analyzer, microscopic counting chamber
  3. colour turbidity
  4. cytological analysis (direct smear, sediment)
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8
Q

what are the 3 types of body cavity effusions

A
  1. transudate
  2. modified transudate
  3. exudate
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9
Q

what does a transudate effusion result from (2)

A
  1. decreased plasma oncotic pressure
  2. increased hydrostatic pressure
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10
Q

what would cause decreased plasma oncotic pressure that results from a transudate

A

severe hypoalbuminemia

  • decreased production (hepatic insufficiency)
  • loss (portein-losing nephropathy or enteropathy)
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11
Q

what would cause increased hydrostatic pressure that results from a transudate (2)

A
  1. myocardial insufficiency
  2. portal hypertension
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12
Q

what is the appearance of a transudate

A

grossly range from colourless to straw coloured

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13
Q

what is the cell count of a transudate

A

<1.5 x 10^9 cells/L

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14
Q

what is the protein content of a transudate

A

<25 g/L

values towards the lower end suggest hypoalbuminemia

values at high end may be seen with CHF, portal hypertension

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15
Q

what other cells would you expect to see in a transudate (3)

A
  1. macrophages
  2. mesothelial cells
  3. rare non-degenerate neutrophils

exception is horse –> may have up to 10 cells x 10^9/L with up to 75-80% non-degenerate neutrophils and still be considered a transudate

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16
Q

how does an exudate form

A

Increased capillary permeability

Mediators which increase the vascular permeability —> allow cells to transit out of the blood and into the tissues or body cavity

Fluid and proteins also leak out of the spaces

Chemotaxis of leukocytosis

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17
Q

what is the protein content of an exudate

A

>25 g/L

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18
Q

what is the cell count of an exudate

A

>5 x 10^9 cells/L

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19
Q

what could cause an exudate (4)

A
  1. pancreatitis
  2. bacterial infections
  3. bowel perforation
  4. irritants (bile, urine)
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20
Q

what is a septic exudate

A

microorganisms are present, especially intracellular organisms

just because you don’t see bacteria doesn’t mean they are not there –> when in doubt culture

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21
Q

what would the neutrophils look like in a septic exudate

A

neutrophils may be non-degenerate or degenerate depending on type of infectious agent present

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22
Q

what is shown here

A

degenerate neutrophils with intracytoplasmic rods

nuclei are puffy, and starting to break apart

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23
Q

compare a transudate and exudate protein and cell count

A
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24
Q

what is a modified transudate

A

a catch all category

nucleated cell count or protein concentration is increased but doesn’t fit with exudate range

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25
Q

how do modified transudates form

A

accumulation of transudative fluid causes increased pressure that irritates mesothelial cells

mesothelial cells respond by proliferating and sloughing into the effusion

when they die they draw macrophages

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26
Q

what can mesoethial cells resemble

A

reactive mesothelial cells can resemble neoplastic cells

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27
Q

what cell is shown here

A

reactive mesothelial cell

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28
Q

what are special body cavity effusions (6)

A
  1. chylous effusions
  2. FIP effusions (‘wet form’)
  3. neoplastic effusions
  4. hemorrhagic effusions
  5. urinary tract rupture
  6. bile peritonitis
29
Q

how does a chylous effusion form

A

formed by leakage of chyle from the lymphatic system into the body cavity (usually thorax)

30
Q

what does a chylous effusion look like

A

chylomicrons give a “milk” appearance

or a strawberry milkshake appearance if RBCs are present

if the animal is anorexic, chylomicrons will be not present, and they will not give a whitish appearance to the effusion

31
Q

what are the causes of chylous effusions (5)

A
  1. idiopathic (~70% of feline chylothorax cases),
  2. thoracic neoplasia
  3. cardiac disease
  4. diaphragmatic hernia
  5. thoracic duct rupture (rare)
32
Q

what cells are present in a chylous effusion

A

small mature lymphocytes should predominate

neutrophils and macrophages may accumulate with time due ot irritating properties of effusion

33
Q

what additional test could you do to determine a chylous effusion

A

triglycerides effusions > serum (may not be noted if the animal has been anorexic)

34
Q

what cells are shown here and what type of fluid with this be

A

lymphocytes are small round purple cells

pinocytosis of chylomicrons

35
Q

what is the appearance of an FIP effusion

A

odorless, straw colored to gold

36
Q

what is the protein content of FIP effusion

A

high protein (>35 g/L)

37
Q

what is the cell count of FIP effusion

A

variable often low, cell counts (neutrophils usually predominate)

38
Q

what additional tests would you do to determine a FIP effusion (3)

A
  1. FCoV antibody titre
  2. alpha 1-AGP and A:G ratio
  3. PCR
39
Q

what cells are shown here

A

granular protein precipitate

non degenerate neutrophils (dark purple)

40
Q

what causes neoplastic effusions

A

neoplasms commonly cause effusions but tumour cells may or may not exfoliate

41
Q

what cells are shown here

A

neoplastic effusions

42
Q

what is shown here

A

erythrophagocytosis

macrophages phagocytozed RBCs

43
Q

what is a uroperitoneum

A

urine acts as an irritant and causes inflammation

44
Q

what type of effusion would a urinary tract rupture be

A

type of effusion may vary depending on the dilution caused by leakage urine (transudate, modified transudate, or exudate)

urine crystals may be present

45
Q

what additional tests could you perform for a urinary tract rupture

A

creatinine

effusion > serum

urea will more rapidly equilibrate between the peritoneum and the vascular space and may not be different from serum

46
Q

what is shown here

A

urine crystals in an effusions

47
Q

what is shown here

A

bile peritonitis

bilirubin levels will be higher in fluid when compared to serum

48
Q

what are the confirmatory tests to determine a chylous effusions

A

triglyceride

fluid > serum

49
Q

what are the confirmatory tests to determine a non-septic exudate of FIP effusions

A

FCoV antibodies

A:G ratio

a1-AGP

PCR

50
Q

what are the confirmatory tests to determine a neutrophilic inflammation effusions

A

bacterial culture

51
Q

what are the confirmatory tests to determine a urinary tract rupture

A

creatinine

fluid > serum

52
Q

what are the confirmatory tests to determine a bile peritonitis

A

bilirubin

fluid > serum

53
Q

what is a cerebrospinal fluid test useful in (3)

A
  1. neurological disease
  2. neck or limb pain
  3. fever of unknown origin
54
Q

how do you process CSF

A

requires prompt analysis

total protein & nucleated cell count (low in healthy animals)

plain serum tube

55
Q

how do you count the cells of CSF

A

use hemocytometer

numbers often too low for automated analyser

56
Q

what cells are shown here

A

CSF

red cell on left

white cells on right

57
Q

what stain would you use on CSF

A

romanowsky stain

58
Q

what cells are shown here

A

CSF

meningeal cells

59
Q

what cells are shown

A

neutrophils

larege mononuclear cells/macrophages

in CSF

60
Q

what cells are shown here

A

CSF with yeast with narrow based budding –> cryptococcus sp

neutrophils

61
Q

why would you sample the synovial fluid (7)

A
  1. joint swelling
  2. limping
  3. monoarthropathy
  4. polyarthropathy
  5. fever of unknown origin
  6. generalized pain
  7. weakness
62
Q

what is the gross analysis of synovial fluid (3)

A
  1. normally transparent to colourless
  2. note any turbidity
  3. blood (iatrogenic or hemorrhage)
63
Q

what should the viscosity of synovial fluid be

A

normal synovial fluid can produce long strands (2cm) when slowly expressed from a needle or touched with an applicator

64
Q

how do you process synovial fluid

A

small volume (one drop)

make a smear

allows cytological evaluation and estimated NCC

larger volume allows NCC proteins and cytology

65
Q

what would the cell count in synovial fluid be in dogs and cats

A

dogs <3000 cells/ul

<1000 cells/ul in cats

66
Q

what tube would you put synovial fluid in for cytology and protein

A

EDTA

67
Q

what tube would you put synovial fluid in for bacteria

A

plain

68
Q

what is shown here

A

windrowing in synovial fluid

69
Q

what is shown here in the synovial fluid

A

intracellular cocci

module 17 (31 decks)

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