Serous Fluid Flashcards
The closed cavities of the body are lined by two membranes referred to as the
Serous membranes
Membrane that lines the cavity wall
Parietal membrane
Membrane that covers the organs within the cavity
Visceral membrane
The fluid between the membranes is called
Serous fluid
Function of serous fluid
Provides lubrication to prevent the friction between the parietal and visceral membranes
Serous fluids are formed as ultrafiltrates of plasma. True or False?
True
Production and reabsorption of serous fluids are subject to
Hydrostatic pressure
Colloidal pressure
Increase in fluid between the membranes
Effusion
Needle aspiration of the lungs
Thoracentesis
Needle aspiration of the heart
Pericardiocentesis
Needle aspiration of the abdominal organs
Paracentesis
Normal appearance of serous fluid
Clear, pale yellow
Volume of serous fluid to be collected
> 100 mL
Anticoagulant used to collect specimen and their corresponding tests
EDTA tube: cell counts and the differential
Sterile heparinized or sodium polyanethol sulfonate (SPS): microbiology and cytology
Clotted specimens in plain tubes or in heparin tubes: chemistry and serology tests
How to maintain pH of serous fluid specimen?
Must be maintained anaerobically in ice
Performed for better recovery of microorganisms and abnormal cells
Centrifugation
Effusions caused by a systemic disorder that disrupts the balance in the regulation of fluid filtration and reabsorption
Transudate
Effusions caused by conditions that directly involve the membranes of the particular cavity
Exudate
Appearance of a transudate
Clear
Appearance of an exudate
Cloudy
Fluid:serum protein ratio of transudate
<0.5
Fluid:serum protein ratio of exudate
> 0.5
Fluid:serum LD ratio of transudate
<0.6
Fluid:serum LD ratio of exudate
> 0.6
Rivaltas’s Test for transudate
Negative
Rivaltas’s Test for exudate
Positive (heavy precipitation)
The most reliable differentiation between transudates and exudates
Fluid: blood ratios for protein and lactic dehydrogenase
Serous fluid examination is performed in the same manner on all serous fluids. True or False?
True
Serous fluid cell counts can be performed manually by using
Neubauer counting chamber
Pleural fluid is obtained from the
Pleural cavity
Pleural fluid cholesterol
≥60 mg/d
Pleural fluid:serum cholesterol ratio
≥0.3
Pleural fluid:serum total bilirubin ratio
≥0.6
Provides reliable information that the fluid is an exudate
Pleural fluid:serum cholesterol ratio
Pleural fluid:serum total bilirubin ratio
Normal appearance of pleural fluid
Clear, pale yellow
Turbid, white appearance of pleural fluid
Presence of WBCs
Bloody appearance of pleural fluid
Hemothorax (traumatic injury)
Hemorrhagic effusion, pulmonary embolus, tuberculosis, malignancy
Difference between Hemothorax (traumatic injury) and Hemorrhagic effusion in terms of hematocrit
Hemothorax (traumatic injury) = >50% of the whole blood hematocrit
Hemorrhagic effusion = <50% of the whole blood hematocrit
Milky appearance of pleural fluid
Chylous material from thoracic duct leakage
Pseudochylous material from chronic inflammation
Predominant lipid present in chylous effusion
Triglycerides
Predominant lipid present in pseudochylous effusion
Cholesterol
Appearance of chylous effusion
Milky/white
Appearance of pseudochylous effusion
Milky/green tinge
Brown appearance of pleural fluid
Rupture of amoebic liver abscess
Black appearance of pleural fluid
Aspergillus
Viscous appearance of pleural fluid
Malignant mesothelioma (increased hyaluronic acid)
Hematology differential count on serous fluid
Macrophages = 64%-80%
Lymphocytes = 18%-30%
Neutrophils = 1%-2%
Eosinophil = <10%
Normal mesothelial cells: appear
Singly
Reactive mesothelial cells: appear
In cluster
Decreased level of pleural fluid glucose
<60 mg/dL
pH level indicating the need for chest-tube drainage
<7.2
pH level indicating esophageal rupture allowing the influx of gastric fluid
<6.0
Microorganisms primarily associated with pleural effusions
Staphylococcus aureus
Enterobacteriacea
Mycobacterium tuberculosis
Test used to differentiate effusions of immunologic origin from noninflammatory processes
Serologic testing
Most frequently performed serologic test for pleural fluid
Antinuclear antibody (ANA)
Rheumatoid factor (RF)
Normal amount of pericardial fluid
10-50 mL
Primarily the result of changes in the membrane permeability due to infection (pericarditis), malignancy, and trauma-producing exudates
Pericardial effusions
Primary causes of pericardial fluid transudate
Metabolic disorders such as uremia, hypothyroidism, and autoimmune disorders
Clear, pale yellow pericardial fluid indicates
Normal, transudate
Grossly bloody pericardial fluid indicates
Cardiac puncture, misuse of anticoagulant medications
Effusion between the peritoneal membranes is
Ascites
The fluid in the effusion between the peritoneal membrane
Ascitic fluid
Causes of ascitic transudates
Hepatic disorders
Causes of ascitic exudates
Bacterial infections
Recommended ratio to detect transudates of hepatic origin
Serum-ascites albumin gradient (SAAG)
Gradient of ≥1.1 indicates
Transudate effusion
Gradient of <1.1 indicates
Exudative effusions
Normal appearance of peritoneal fluid
Clear, pale yellow
Normal WBC count in peritoneal fluid
< 350 cells/µL
How to distinguish between bacterial peritonitis and cirrhosis?
Perform absolute neutrophil count
Predominant cell in tuberculosis
Lymphocytes
Decreased below serum levels in bacterial and tubercular peritonitis and malignancy
Glucose
Increased in pancreatitis, and in patients with gastrointestinal perforations
Amylase
Increased level is also highly diagnostic of intestinal perforation
Alkaline phosphatase
Requested when a ruptured bladder or accidental puncture of the bladder during the paracentesis is of concern
Blood urea nitrogen and creatinine
Measured when leakage of bile into the peritoneum is suspected following trauma or surgery
Bilirubin
Bile primarily contains
Conjugated bilirubin
Test for malignancy of gastrointestinal origin
Carcinoembryonic antigen (CEA)
Test for malignancy of ovarian, fallopian tubes, or endometrium origin
CA 125
Contains concentric striations of collagen-like material
Psammoma bodies
Macrophage containing fat droplets
Lipophages
