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420 Body fluid > Serous fluid > Flashcards

Serous fluid Flashcards

1
Q

Serous membrane

A
  • Visceral membrane: layer lining the organ

- Parietal membrane: layer lining body cavity

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2
Q

Sample collecting

A 
Needle aspiration:
- Thoracentesis (pleural)
- Pericardiocentesis (pericardial)
- Paracentesis (peritoneal)
V >= 100mL
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3
Q

Tube used for sample

A

EDTA (Lavender): cell counts and differential
SPS (Yellow): microbiology & cytology
Heparin (Green): Chemistry
–> Centrifuge for better microorganisms and abnormal cells.
* pH test must be anaerobically on ice
* Blood collected at the same time for comparison

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4
Q

Transudate

A

Mostly water in the body cavity
Appearance: Clear, pale yellow
Reason: Systemic disorder that disrupts the balance of fluid filtration & reabsorption
Example: Increased capillary hydrostatic pressure, Decreased oncotic pressure

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5
Q

Exudate

A

Protein-rich fluid in a body cavity
Appearance: cloudy, turbid, purulent, bloody
Reason: Increased capillary permeability, Impaired cavity membranes
Example: Lymphatic obstruction

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6
Q

Physical examination

A

Clear: normal
Turbid: infection, malignancy
Deep green: bile leakage into the abdominal cavity
Bloody: TB, malignancy, hemorrhagic, hemothorax
Clot: severe hemorrhage
Milky: chylothorax, chylous from thoracic leakage
Brown: amoebic liver abscess
Black: aspergillus
Viscous: malignant mesothelioma

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7
Q

Chylous fluid

A
  • Milky
  • Made up of chyle (lymph and chylomicrons)
  • Caused by an obstruction, damage to the lymphatic system
  • Pleural: tumor, invasive procedure
  • Peritoneal: hepatic cirrhosis and clots
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8
Q

Pseudochylous fluid

A
  • Milky
  • Made up of high cholesterol –> different lipid content with chylous fluid
  • Caused by the breakdown of cellular components, chronic disease like TB, rheumatoid arthritis, collagen vascular damage
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9
Q

Difference between chylous and pseudochylous

A

Chylous has chylomicron and an elevated triglyceride content (> 110mg/dL), low cholesterol (< 200mg/dL)

Pseudochylous has no chylomicron and a low triglyceride content (< 50mg/dL), and high cholesterol ( > 200mg/dL)

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10
Q

Pleural Fluid Exudate - Bacterial infx

A
  • Thick & cloudy
  • Microscope: Incr Neutrophils, Lymphocytes, “signet-ring” macrophage, LE (lupus erythematosus) cells, mesothelial cells
  • Chemistry: Low pH, decr Glucose, high LDH
  • Microbes: MRSA, Strep. milleri, Strep. pneumonia, Norcadia, etc
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11
Q

Pleural Fluid Exudate - TB

A
  • Straw-colored
  • Microscope: RBC
  • Chemistry: Low pH, decr glucose, incr ADA (adenosine deaminase)
  • Microbes: Mycobacterium tuberculosis
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12
Q

Pleural Fluid Exudate - Malignancy

A
  • Bloody
  • Microscope: Lymphocytes and RBC
  • Chemistry: CEA, amylase
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13
Q

Pleural Fluid Exudate - Rheumatoid arthritis

A
  • Turbid
  • Lymphocytes
  • Chemistry: low pH, decr glucose, high LDH
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14
Q

Pericardial Fluid - Normal

A

V: 10-15 mL
- In acute: up to 80-200mL
- In chronic condition: up to 2L if slow accumulation
Contain: WBC, LDH, proteins

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15
Q

Pericardial Fluid - Viral infection

A
  • Turbid, bloody streaked, size < 100mL
  • WBC > 5000/uL, activated lymphocytes, macrophages
  • Chemistry: use PCR, ELISA: TNF, IL-6, IL-8, TP > 3g/dL, ADA neg
  • Upregulate of cytokines in viral infections noted in pericardial effusion but not the serum –> Serological test is ineffective
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16
Q

Pericardial Fluid - Bacterial infection

A
  • Turbid, bloody streaking, variable size
  • WBC > 10,000 (Neutrophils incr markedly, granulocytes, macrophages)
  • Chemistry: use PCR: TP > 3g/dL, ADA neg
  • Use GS to examine microbes
17
Q

Pericardial Fluid - TB infection

A
  • Bloody, size > 500 mL
  • WBC > 10,000: granulocytes, macrophages,
  • Chemistry: use PCR: TP > 3g/dL, ADA pos, IFN
  • Microbiological: Acid fast stain, culture, etc.
18
Q

Pericardial Fluid - Post Myocardial Infarction

A
  • Bloody
  • WBC > 5000: Monocytes, Lymphocytes
  • Chemistry: TP > 3g/dL, elevated of B-type natriuretic peptide
19
Q

Pericardial Fluid - Autoreactive

A
  • Turbid
  • WBC > 5000: monocytes, lymphocytes & autoreactive lymphocytes
  • Chemistry: Antibody against cardiomyocytes, complement, fluid antinuclear-Ab titers
20
Q

Peritoneal Fluid - Physical exam

A

Clear: normal
Cloudy: Peritonitis, Intraperitoneal dz, Retroperitoneal dz, drugs, allergic Rxn
Bloody: hemoperitoneum : ovulation, trauma,
Chylous: lymphatic obstruction, trauma, pancreatitis, drugs

21
Q

Peritoneal Fluid - Microscopic exam

A
  • WBC/RBC count: incr WBC –> infx, cancer. Incr RBC: trauma, cancer
  • WBC types: neutrophils incr –> bacterial infx.
22
Q

Peritoneal Fluid - Chemical exam

A
  1. Differentiate between exudate and transudate
  2. Other tests:
    - Alpha fetoprotein
    - Amylase: incr in pancreatitis pt
    - Glucose: Compared with plasma level –> decr: bacterial infx.

420 Body fluid (6 decks)

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