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Clinical Chemistry > Serous Fluid > Flashcards

Serous Fluid Flashcards

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1
Q

Serous Cavities

A 
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
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2
Q

Serous Fluid

A 
Resembles serum
Ultrafiltrate of plasma
Volume maintained by tissue and capillary pressures
Excessive accumulation is an effusion
Exudates
Transudates
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3
Q

Testing: Macroscopic

A

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

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4
Q

Testing: Chemical

A

Glucose
Lactate dehydrogenase, (LD)
Protein

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5
Q

Testing: Chemical – less common

A

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

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6
Q

Testing: Microscopic

A

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

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7
Q

Microscopic

A

Cytospin preparation of peritoneal fluid containing RBCs, lymphocytes, monocytes, and mesothelial cells

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8
Q

Microscopic

A

Cytospin preparation of pleural fluid containing RBCs and lymphocytes in acute inflammation.

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9
Q

Microscopic

A

Cytospin preparation of pleural fluid containing RBCs, neutrophils, and a mesothelial cell in bacterial infection.

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10
Q

Microscopic

A

Cytospin preparation of pericardial fluid containing RBCs, WBCs, and cells resembling adenocarcinoma

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11
Q

Microscopic Crystals

A

Cholesterol crystals in pleural fluid.

Cholesterol crystals in pleural fluid. A. Polarized light. B. Polarized, compensated light

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12
Q

Testing: Microbiology

A 
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
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13
Q

Transudates

A

Disorders that disrupt fluid filtration, reabsorption or both
Congestive heart failure
Hepatic cirrhosis
Nephrotic syndrome

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14
Q

Exudates

A

Inflammatory damage to blood vessel and body cavity membranes
Decreased reabsorption of fluids by the lymphatic system.
Infections
Inflammations
Hemorrhages
Malignancies

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15
Q

Chylous

A

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.

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16
Q

Psuedochylous

A

Disorders that produce effusions that contain a high amount of cellular debris and cholesterol
Rheumatoid arthritis
Tuberculosis

17
Q

Pericardial

A 
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
18
Q

Pericardiocentesis

A

Aspirating pericardial fluid

19
Q

Pleural

A

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)

20
Q

Peritoneal

A

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)

21
Q

Paracentesis

A

Paracentesis of the abdominal cavity in midline

22
Q

CHYLOUS EFFUSION (LYMPHATIC OBSTRUCTION OR DAMAGE)

A 
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
23
Q

PSEUDOCHYLOUS EFFUSION

CHRONIC DISORDERS)

A 
Milky
Mixture of cells
Usually higher than serum level
Lower than serum level
Chylomicron portion is low or may be absent
Variable
24
Q

Causes for Pericardial Effusions: Transudates

A

Acute atelectasis
Congestive heart failure
Cirrhosis with ascites

25
Q

Causes for Pericardial Effusions: Exudates

A 
Cardiovascular disease
Coagulation disorders
Collagen vascular disorders
Infections
Metabolic diseases
Neoplasms
Trauma
Gastrointestinal diseases
Infections (primary and secondary)
26
Q

Causes for Pleural Effusions: Transudates

A 
Hypoproteinemia
Peritoneal dialysis
Postoperative
Postpartum
Venous obstruction
Congestive heart failure
27
Q

Causes for Pleural Effusions: Exdates

A

Neoplasms
Postmyocardial infarct
Pulmonary emboli or infarct
Trauma

28
Q

Causes for Peritoneal Effusion: Transudates

A

Cirrhosis Infections

Hypoproteinemia

29
Q

Causes for Peritoneal Effusion: Exdates

A

Bile peritonitis
Neoplasms
Pancreatitis
Trauma

30
Q

Thoracentesis

A

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.

Clinical Chemistry (8 decks)

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