Serous Fluid Flashcards
What is serous fluid?
Fluid that is an ultrafiltrate of plasma and therefore has a similar composition to serum.
Where can serous fluid be found?
Primarily the lungs, heart, and abdominal organs.
Where can pleural fluid be found?
Surrounds the lungs.
Where can pericardial fluid be found?
Surrounds the heart.
Where can peritoneal fluid be found?
Surrounds the abdominal organs.
What is another name for peritoneal fluid?
Ascites fluid
What is the name of the serous membrane covering the organs?
The visceral membrane
What is the name of the serous membrane covering the body wall?
Parietal membrane
What is the net pressure favoring fluid formation in the pleural cavity?
+9 mmHg
What is the net pressure favoring fluid absorption out of the pleural cavity?
+10 mmHg
What are characteristics of transudate serous fluid?
- Increased hydrostatic pressure
- Decreased plasma oncotic pressure
- Non-inflammatory changes
What are characteristics of exudate serous fluid?
- Increase in capillary permeability
- Decrease in lymphatic absorption
- Inflammatory changes
What is the clinical significance of transudate serous fluid?
Potential heart or liver failure
What is the clinical significance of exudate serous fluid?
Caused by a primary pathologic state (i.e., bacterial or viral infection)
Generally, what color is serous fluid?
Colorless to a light yellow.
Generally, how much serous fluid can be obtained?
Between 1 and 10 mL
Define Effusion
Accumulation of fluid in a body cavity as a result of a pathologic process
Where on the body does a thoracentesis take place?
Lungs
Where on the body does a pericardiocentesis take place?
Heart
Where on the body does a peritoneocentesis take place?
Abdominal cavity
What occurs when serous fluid is refrigerated after collection?
Decrease the viability of microorganisms
For pH testing on serous fluid, what is the proper collection technique?
Anaerobic sampling, heparinized syringe, on ice.
Why should serous fluid be transported to the lab ASAP?
To decrease viability of microorganisms
What are some physical characteristics of transudate serous fluid?
(1) Color: Pale yellow
(2) Clarity: Clear
(3) Does not spontaneously clot
What are some physical characteristics of exudate serous fluid?
(1) Color: Variable (yellow, green, etc)
(2) Clarity: Cloudy
(3) Clots spontaneously
What are the two types of “milky” effusions that can occur with serous fluid?
Chylous and Pseudochylous
What is indicative of chylous “milky” effusion?
(1) Predominance of lymphocytes
(2) Triglyceride level >110 mg/dL - chylomicrons present
What is indicative of pseudochylous “milky” effusion?
(1) Cholesterol crystals present
(2) Triglyceride levels <50 mg/dL, no chylomicrons present
Using TP and LD ratios, how would you determine transudate serous fluid?
TP ratio <= 0.5; LD ratio <= 0.6
Using TP and LD ratios, how would you determine exudate serous fluid?
TP ratio >0.5; LD ratio >0.6
For serous glucose, what would indicate exudate serous fluid?
<60 mg/dL OR serum-fluid difference greater than 30 mg/dL
What is indicative of low fluid glucose?
Rheumatoid arthritis, bacterial infection, tuberculosis, maglignant neoplasm
For amylase, what increments must it be compared to the serum value to be considered abnormal?
1.5 to 2x higher than the serum value
If serous fluid has a triglyceride level of >110 mg/dL, what is that indicative of?
Chylous effusion
If serous fluid has a triglyceride level of 50-110 mg/dL, what is that indicative of?
Chylomicrons
If serous fluid has a triglyceride level of <50 mg/dL, what is that indicative of?
Pseudochylous effusion
If serous fluid has a cholesterol fluid-to-serum ratio of >1.0, what is that indicative of?
Pseudochylous effusion
If a serous fluid has a cholesterol fluid-to-serum ratio of >0.3, what is that indicative of?
Exudates
If pleural fluid has a pH <7.3, what is that indicative of?
Complicated paraneumonic effusion
If pleural fluid has a pH >7.3, what is that indicative of?
Uncomplicated paraneumonic effusion
What is an important pre-analytical consideration when collecting for pH testing?
Place on ice after collection
An increased carcinoembryonic antigen (CEA) value can indicate what?
Cancer treatment not working/cancer has spread
A decreased or stagnant carcinoembryonic antigen (CEA) value can indicate what?
Cancer treatment working/cancer is not spreading
A WBC count of >1000 cells/uL, may indicate what?
Pericarditis (transudate)
A WBC count of >500 cells/uL may indicate what?
Bacterial peritonitis (exudates)
What are types of cells are these, and what are some characteristics of them?
Mesothelial cells, they exist in the lining of the serous membrane.
(1) Window between cells - indicate noncancerous
(2) Low N/C ratio
Identify these cells
Mesothelial cells
Identify these cells
Signet ring macrophages
What type of stain is needed for microbiological exam?
Gram stain - pleural fluid should also have acid-fast stain
What different types of cultures are ran on serous fluid?
Aerobic, anaerobic, fungal
