Serous Fluid Flashcards
Serous Cavities
Serous cavities surround various organs (heart, lungs, abdomen) Serous membrane Visceral portion lines organs Parietal portion lines body wall Membrane consists of mesothelial cells Serous fluids fill the space between membrane portions
Serous Fluid
Resembles serum Ultrafiltrate of plasma Volume maintained by tissue and capillary pressures Excessive accumulation is an effusion Exudates Transudates
Testing: Macroscopic
Color and Clarity
Pale yellow and clear - normal
Sanguineous (bloody)– hemorrhage or traumatic tap
Purulent - white blood cells (WBCs),
Milky - chyle or pseudochylous
Golden-green shimmery iridescence - cholesterol crystals
Clotted
Testing: Chemical
Glucose
Lactate dehydrogenase, (LD)
Protein
Testing: Chemical – less common
Alkaline phosphatase (intestinal perforation)
Ammonia (ruptured appendix or bladder, perforated peptic ulcer, bowel strangulation and necrosis)
Amylase (bowel necrosis, esophageal perforation, metastatic adenocarcinoma, pancreatitis
pH (acidic in esophageal ruptures <7.3)
Chloride (less than half of serum – bacteria or WBCs)
Lipid levels differentiate effusions
Triglycerides higher in chylous effusions
Cholesterol high in pseudochylous effusions
Testing: Microscopic
Cell Counts
- perform within 1 hour of collection - saline for diluent if needed
WBCs (may see mesothelial cells)
RBCs
Differential - Cytocentrifuge preparations
Normal: Some lymphocytes, Few monocytes (histiocytes), Few neutrophils
Crystals
Microscopic
Cytospin preparation of peritoneal fluid containing RBCs, lymphocytes, monocytes, and mesothelial cells
Microscopic
Cytospin preparation of pleural fluid containing RBCs and lymphocytes in acute inflammation.
Microscopic
Cytospin preparation of pleural fluid containing RBCs, neutrophils, and a mesothelial cell in bacterial infection.
Microscopic
Cytospin preparation of pericardial fluid containing RBCs, WBCs, and cells resembling adenocarcinoma
Microscopic Crystals
Cholesterol crystals in pleural fluid.
Cholesterol crystals in pleural fluid. A. Polarized light. B. Polarized, compensated light
Testing: Microbiology
Cytospin preparation of peritoneal fluid containing RBCs, WBCs, and many bacteria Most common bacteria found in effusions Pleural Staphylococcus aureus Mycoplasma tuberculosis Pericardial Hemophilus influenzae M. tuberculosis Peritoneal Escherichia coli Pneumococci
Transudates
Disorders that disrupt fluid filtration, reabsorption or both
Congestive heart failure
Hepatic cirrhosis
Nephrotic syndrome
Exudates
Inflammatory damage to blood vessel and body cavity membranes
Decreased reabsorption of fluids by the lymphatic system.
Infections
Inflammations
Hemorrhages
Malignancies
Chylous
Contains an emulsion of lymph and chylomicrons.
Obstruction or damage of lymphatic vessels.
Milky and may appear shimmery.
Sheets of cholesterol crystals may be present.
Psuedochylous
Disorders that produce effusions that contain a high amount of cellular debris and cholesterol
Rheumatoid arthritis
Tuberculosis
Pericardial
The heart and pericardium. Surrounds the heart and is enclosed in the paricardium. Is obtained by pericardiocentesis. Normally pale yellow and clear. Effusions are usually exudates damage to the mesothelium not mechanical factors
Pericardiocentesis
Aspirating pericardial fluid
Pleural
Normally pale yellow and clear
Abnormal appearance includes
Sanguineous (if not a traumatic tap)
Milky (indicates the presence of fat or extremely high WBC count)
Shimmery (indicates the presence of cholesterol crystals)
Peritoneal
The organs of the abdomen
Normally pale yellow and clear.
Abnormal appearance includes
Sanguineous (if not a traumatic tap)
Brown (degradation of hemoglobin)
Green (bilirubin due to liver disorder/rupture)
Milky (indicates the presence of fats or extremely high WBC count)
Paracentesis
Paracentesis of the abdominal cavity in midline
CHYLOUS EFFUSION (LYMPHATIC OBSTRUCTION OR DAMAGE)
Milky/creamy (clears after extraction with ether and acidification with HCl) Primarily lymphocytes Lower than serum level Higher than serum level Marked elevation of chylomicrons Alkaline
PSEUDOCHYLOUS EFFUSION
CHRONIC DISORDERS)
Milky Mixture of cells Usually higher than serum level Lower than serum level Chylomicron portion is low or may be absent Variable
Causes for Pericardial Effusions: Transudates
Acute atelectasis
Congestive heart failure
Cirrhosis with ascites
Causes for Pericardial Effusions: Exudates
Cardiovascular disease Coagulation disorders Collagen vascular disorders Infections Metabolic diseases Neoplasms Trauma Gastrointestinal diseases Infections (primary and secondary)
Causes for Pleural Effusions: Transudates
Hypoproteinemia Peritoneal dialysis Postoperative Postpartum Venous obstruction Congestive heart failure
Causes for Pleural Effusions: Exdates
Neoplasms
Postmyocardial infarct
Pulmonary emboli or infarct
Trauma
Causes for Peritoneal Effusion: Transudates
Cirrhosis Infections
Hypoproteinemia
Causes for Peritoneal Effusion: Exdates
Bile peritonitis
Neoplasms
Pancreatitis
Trauma
Thoracentesis
A thoracentesis is performed to remove this excess fluid (over 30 mL). Removal of pleural fluid not only provides a
specimen for laboratory examination but also helps improve patient symptoms and allows for better visualization
of the lungs and pleural cavity upon radiological procedures.
Pleural effusions may be primary or can be secondary to accumulation of peritoneal fluid (ascites).
Secondary accumulation occurs because the lymphatic system drains the abdomen toward the right side passing through the diaphragm.
