The Case of the Swollen Belly Flashcards
5 F’s of enlarged abdomen
fluid flatus (obstruction) faeces fat foetus
caput medusae
swollen abdo wall veins due to portal hypertension
abdominal paracentesis
puncture of the abdomen for aspiration of fluid in the peritoneal cavity
how much fluid filtered into large body cavities per day?
how much fluid filtered into large body cavities per day?
20L
how much fluid is reabsorbed back into circulation?
how much fluid is reabsorbed back into circulation?
90%, rest returns as lymph fluid
why does fluid leave capillaries?
high pressure pushes fluid into interstitial space
why does fluid reenter venous circulation?
low pressure causes reabsorption
what 4 things affect Qf/filtration/reabsorption rate of fluid?
change in hydrostatic pressure
change in oncotic pressure
change in permeability
change in exchange area
Where are serous membranes located?
pericardium
pleura
peritoneum
tunica vaginalis of testis
are effusions always pathological?
yes, but only clinically detectable once a certain size
transudate
plasma filtrate forced into tissues, low protein content
what causes transudate?
↑ Hydrostatic pressure
or
↓ Oncotic pressure
what causes exudate?
increased vascular permeability, change in exchange area
exudate
unfiltered plasma with high protein content
what causes hydrostatic pressure change?
portal hypertension
what causes 80% of portal hypertension?
liver cirrhosis
Other causes of portal hypertension (aside from liver cirrhosis)
alcoholic hepatitis
chronic cardiac failure
what causes oncotic pressure change?
hypoalbuminuria (caused by nephrotic syndrome, malnutrition, protein losing enteropathy)
what affects exchange area or vascular permeability?
malignancy, infection
Serum Albumin Ascites Gradient (SAAG)
a value which suggests portal hypertension if >1.1g/dl, if lower not portal hypertension
diagnostic technique for ascites
ascitic aspiration
risk of ascitic drainage (5)
bleeding infection pain leakage at drainage site procedure failure
Seldinger technique
A technique that involves inserting a needle with a syringe, then inserting a guide wire into the needle, removing the needle, making an incision, and inserting a catheter over the guide wire; the guide wire is then removed
what does pale yellow watery fluid aspirated suggest?
transudate
Low protein
what does brown aspirated fluid suggest?
haemorrhage
what does turbid and white/yellow aspirated fluid suggest?
infection or malignancy
what does green aspirated fluid suggest?
bile
what cells might be present in effusions?
mesothelial cells macrophages lymphocytes neutrophils eosinophils plasma cells artefacts
Ferruginous bodies
asbestos fibers coated with iron, usually seen trying to be absorbed by 2 macrophages
what do lupus cells look like morphologically?
what do lupus cells look like morphologically?
large macrophages with an engulfed nucleus
what does lymphocytes all at same stage of maturation in an effusion suggest?
lymphoma
Features of mesothelioma
DIFFUSE nodular pleural thickening (not discrete)
Often unilateral
Thickening of fissures
DIFFUSE nodular pleural thickening (not discrete)
Often unilateral
Thickening of fissures
= features of…
Features of mesothelioma
melanoma markers
S-100, HMB-45, melan A, SOX-10
small cell carcinoma of the lung markers
Napsin A, TTF-1
what is seen on doppler US in portal hypertension?
reversal of flow in portal vein
issues with iodine contrast for CT
can cause allergic reactions
contrast induced nephropathy
fine needle aspiration (FNA)
biopsy technique that uses a narrow hollow needle to obtain tiny amounts of tissue for pathologic examination
benefits of FNA
outpatient, minimal discomfort
rapid results
excellent cell preservation
2 ways of fixing cytology samples
air dry
alcohol fixation
can you use formalin in cytology
no destroys the cells
Cytospin
- cytological technique specifically designed to concentrate cells on a slide in a
uniform monolayer using high speed centrifuge. The monolayer distribution improves the
morphological appearance of the cell present
3 causes of lymph node enlargement
reactive lymphadenitis, metastatic malignancy, lymphoma
causes of reactive lymphadenopathy (5)
HIV mononucleosis SLE RA syphilis
causes of granulomatous lymphadenitis
TB cat scratch disease leprosy silica lymphoma sarcoid
breast adenocarcinoma cytology
diffuse cell pattern
proliferation spheres
stomach adenocarcinoma cytology
signet ring cells
dispersed single cells
lung adenocarcinoma cytology
highly vacuolated
papillary groups
dense cytoplasm
Colorectal Adenocarcinoma cytology
tall columnar cells
nuclear palisading
features of air dried slide samples
cytoplasmic features visible
metachromasia
features of fixed slide samples
features of fixed slide samples
transparent
nuclear detail and keratinisation
hyperchromasia
hyperchromasia
abundant DNA, extremely dark staining
