Serous Fluid Flashcards by Eldren Joi Malsi

The closed cavities of the body are lined by two membranes referred to as the

Serous membranes

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Membrane that lines the cavity wall

Parietal membrane

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Membrane that covers the organs within the cavity

Visceral membrane

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The fluid between the membranes is called

Serous fluid

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Function of serous fluid

Provides lubrication to prevent the friction between the parietal and visceral membranes

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Serous fluids are formed as ultrafiltrates of plasma. True or False?

True

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Production and reabsorption of serous fluids are subject to

Hydrostatic pressure
Colloidal pressure

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Increase in fluid between the membranes

Effusion

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Needle aspiration of the lungs

Thoracentesis

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Needle aspiration of the heart

Pericardiocentesis

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Needle aspiration of the abdominal organs

Paracentesis

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Normal appearance of serous fluid

Clear, pale yellow

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Volume of serous fluid to be collected

> 100 mL

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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

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How to maintain pH of serous fluid specimen?

Must be maintained anaerobically in ice

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Performed for better recovery of microorganisms and abnormal cells

Centrifugation

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Effusions caused by a systemic disorder that disrupts the balance in the regulation of fluid filtration and reabsorption

Transudate

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Effusions caused by conditions that directly involve the membranes of the particular cavity

Exudate

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Appearance of a transudate

Clear

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Appearance of an exudate

Cloudy

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Fluid:serum protein ratio of transudate

<0.5

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Fluid:serum protein ratio of exudate

> 0.5

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Fluid:serum LD ratio of transudate

<0.6

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Fluid:serum LD ratio of exudate

> 0.6

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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