Synovial Fluid Analysis and Functions

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Questions and Answers

What is the primary purpose of synovial fluid analysis?

  • To diagnose the cause of joint inflammation (correct)
  • To measure joint flexibility
  • To assess bone density
  • To evaluate muscle strength

What is the significance of synovial fluid in joints?

  • It lubricates the joints for ease of movements (correct)
  • It aids in nutrient absorption in bones
  • It provides structural support to the joint
  • It serves as a blood supply to the cartilage

What does an accumulation of synovial fluid typically indicate?

  • Joint tissue problems or inflammation (correct)
  • Nutrient deficiency in diet
  • Healthy joint function
  • Excessive exercise

Which of the following is true about the articular cartilage in the joint?

<p>It is avascular and contains no blood vessels (B)</p> Signup and view all the answers

Which of the following fluids closely resembles the viscosity of synovial fluid?

<p>Egg white (D)</p> Signup and view all the answers

What condition is collectively described when there is pain and stiffness due to damage in the synovial membrane?

<p>Arthritis (C)</p> Signup and view all the answers

Which joints typically contain synovial fluid?

<p>All movable joints (C)</p> Signup and view all the answers

What is the predominant cell type in the differential count of white blood cells?

<p>Neutrophils (A)</p> Signup and view all the answers

Which type of fluid is most frequently used for diluting white blood cells counts?

<p>NSS with methylene blue (C)</p> Signup and view all the answers

Eosinophils are elevated in which of the following conditions?

<p>Metastatic Carcinoma (A)</p> Signup and view all the answers

What is the role of hyaluronidase in the context of cell count analysis?

<p>To reduce viscosity of fluid samples (A)</p> Signup and view all the answers

Which white blood cell type is most likely to increase due to autoimmune conditions?

<p>Monocytes (A)</p> Signup and view all the answers

What is the primary function of synovial fluid during physical activities?

<p>To act as a lubricant and shock absorber (D)</p> Signup and view all the answers

What type of proteins are excluded during the nonselective filtration of synovial fluid?

<p>High-molecular-weight proteins (D)</p> Signup and view all the answers

Which method is typically used for the collection of synovial fluid?

<p>Arthrocentesis (C)</p> Signup and view all the answers

What is the typical behavior of normal synovial fluid in relation to clotting?

<p>Normal synovial fluid does not clot (D)</p> Signup and view all the answers

What might prompt a doctor to analyze synovial fluid?

<p>Accumulate of synovial fluid in a joint (A)</p> Signup and view all the answers

Which of the following statements about joint compression is correct?

<p>Joint compression is reduced by synovial fluid (D)</p> Signup and view all the answers

What condition may indicate clotting in synovial fluid?

<p>Diseased joints (C)</p> Signup and view all the answers

During which types of activities is the shock-absorbing function of synovial fluid especially important?

<p>Walking and jogging (C)</p> Signup and view all the answers

In what scenario would a patient likely undergo arthrocentesis?

<p>To remove excess synovial fluid for analysis (C)</p> Signup and view all the answers

What is the main purpose of performing arthrocentesis?

<p>To aspirate synovial fluid from the joint (A)</p> Signup and view all the answers

What volume of synovial fluid is considered normal in a healthy joint?

<p>Less than 3.5 mL (D)</p> Signup and view all the answers

What is a potential characteristic of synovial fluid in cases of inflammation?

<p>More than 25 mL in volume (C)</p> Signup and view all the answers

During arthrocentesis, what type of anesthesia is usually used?

<p>No anesthesia (D)</p> Signup and view all the answers

Which of the following describes turbid synovial fluid?

<p>It contains white blood cells, crystals, or fibrin (A)</p> Signup and view all the answers

Which of these is NOT a characteristic of normal synovial fluid?

<p>Presence of crystals (B)</p> Signup and view all the answers

What appearance might synovial fluid have if it has crystals present?

<p>Opaque and milky (B)</p> Signup and view all the answers

What is the insertion point of a needle during arthrocentesis?

<p>Between the joints (C)</p> Signup and view all the answers

What visual characteristic of synovial fluid indicates ochronosis?

<p>Ground pepper-like (D)</p> Signup and view all the answers

What is the alternative name for arthrocentesis?

<p>Joint aspiration (A)</p> Signup and view all the answers

What is a major consequence of calcium pyrophosphate dihydrate (CPPD) accumulation in the joints?

<p>Pseudogout (D)</p> Signup and view all the answers

What effect does powdered anticoagulants have on fluid analysis?

<p>It may interfere with crystal identification. (D)</p> Signup and view all the answers

Which anticoagulant is preferred when analyzing joint fluid to avoid interference?

<p>Sodium heparin (A)</p> Signup and view all the answers

What appearance of the joint fluid may indicate the presence of ochronotic shards?

<p>Ground pepper appearance (C)</p> Signup and view all the answers

What does the oily or shimmery appearance of joint fluid often result from?

<p>Radiographic contrast media (B)</p> Signup and view all the answers

What is a potential consequence of the degeneration of synovium in joints affected by CPPD?

<p>Production of pigmented cartilages (D)</p> Signup and view all the answers

Which of the following is true about glucose analysis in joint fluid?

<p>Sodium fluoride helps to preserve glucose levels. (B)</p> Signup and view all the answers

Which of the following describes the normal viscosity of joint fluid?

<p>High viscosity and elastic (A)</p> Signup and view all the answers

What is a significant aspect to check when performing fluid analysis of synovial fluid?

<p>Crystals that may be present (A)</p> Signup and view all the answers

What can cause inflammation in the joints affected by crystal accumulation?

<p>Crystal accumulation (D)</p> Signup and view all the answers

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Flashcards

What is synovial fluid?

Synovial fluid is a thick, lubricating fluid found in the joints of the human body. It helps reduce friction and allows for smooth movement.

Why do we analyze synovial fluid?

Joint fluid analysis, also known as synovial fluid analysis, is a test performed to diagnose the cause of joint inflammation.

What is articular cartilage?

Articular cartilage is the smooth tissue covering the ends of bones within a joint. It is avascular, meaning it lacks blood vessels.

What does an excess of synovial fluid indicate?

An accumulation of synovial fluid in a joint can be a sign of joint inflammation or damage to the joint tissues.

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Why is synovial fluid called "synovial"?

Synovial fluid is called synovial because the word "synovium" comes from the Latin word for "egg".

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What happens when the synovial membrane is damaged?

Damage or inflammation of the synovial membrane, which surrounds the joint, can cause pain and stiffness, collectively known as arthritis.

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What is the primary function of synovial fluid?

The main function of synovial fluid is to lubricate the joints, reducing friction and allowing smooth movement.

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Synovial Fluid Filtration

The process of filtering out large molecules, primarily proteins, from synovial fluid.

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Synovial Fluid

The fluid that lubricates and cushions joints, found in the joint cavity.

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Arthrocentesis

A procedure to extract fluid from a joint, often used to analyze synovial fluid for conditions like infection or inflammation.

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Shock Absorption in Synovial Fluid

The ability of synovial fluid to absorb shock and reduce stress on joints during movement.

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Normal Synovial Fluid Clotting

The normal characteristic of synovial fluid - it does not form clots.

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Diseased Synovial Fluid Clotting

When synovial fluid clots, indicating a potential problem in the joint, such as infection or inflammation.

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Synovial Fluid Analysis

The reason why doctors may request synovial fluid analysis - to diagnose and treat joint problems.

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Analysis of Synovial Fluid

The process of analyzing synovial fluid to identify the cause of joint pain, swelling, or other problems.

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Synovial Fluid

The fluid that lubricates and cushions joints. It is filtered to remove large proteins.

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Synovial Fluid Volume

When synovial fluid is aspirated, it can help identify the cause of joint inflammation based on its volume.

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Synovial Fluid Clarity: Normal

Normal synovial fluid is clear and transparent.

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Synovial Fluid Clarity: Turbid

Synovial fluid can become cloudy due to the presence of white blood cells, crystals, fibrin, or rice bodies.

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Synovial Fluid Clarity: Opaque, Milky

Synovial fluid can appear opaque and milky due to crystals.

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Synovial Fluid Clarity: Ground Pepper

Synovial fluid with a ground pepper appearance indicates ochronosis.

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Synovial Fluid Clarity: Oily, Shimmering

Synovial fluid with an oily and shimmering appearance indicates rheumatoid arthritis.

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Normal Synovial Fluid Volume

Normally, the joint contains a small amount of synovial fluid.

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Inflammation and Synovial Fluid Volume

A significant increase in synovial fluid volume usually indicates inflammation.

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Arthrocentesis Procedure

Arthrocentesis involves inserting a needle into the joint, usually without anesthesia.

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Neutrophil in Synovial Fluid

This blood cell is frequently found in synovial fluid and is associated with early rheumatoid arthritis as well as other inflammatory conditions. Its presence often indicates inflammation and can inhibit clot formation.

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Hyaluronidase in Synovial Fluid Analysis

Synovial fluid is a viscous fluid found in the joints. In cases of severe viscosity, this enzyme can be added to the sample to break down hyaluronic acid and make analysis easier.

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Synovial Fluid Cell Count

The cell count reveals the number of white blood cells (WBCs) in the synovial fluid. It helps assess the degree of inflammation and infection.

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Synovial Fluid Differential Count

This test determines the different types of white blood cells found in synovial fluid, giving a deeper understanding of the nature of the inflammation.

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Monocyte Count in Synovial Fluid

A high monocyte count in synovial fluid is a characteristic of viral arthritis, serum sickness, and systemic lupus erythematosus (SLE). It suggests an immune-mediated inflammation.

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What is CPPD?

A condition that can cause pain and inflammation in the joints, similar to gout but caused by calcium pyrophosphate dihydrate crystals.

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What is pseudogout?

A type of arthritis that is caused by the buildup of calcium pyrophosphate dihydrate crystals in the joints.

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What does a 'ground pepper appearance' in joint fluid indicate?

A visual description of a joint fluid sample containing calcium pyrophosphate dihydrate crystals, resembling ground pepper.

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What are 'ochronotic shards'?

A dark, brown pigment that can accumulate in tissues, especially cartilage, leading to degeneration and ochronosis due to the breakdown of homogentisic acid.

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What is ochronotic arthropathy?

A condition characterized by the accumulation of ochronotic pigment in cartilage, leading to joint pain, stiffness, and degeneration.

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What is cell counting in joint fluid analysis?

A technique used to study joint fluid by examining its cells under a microscope, aiding in the diagnosis of conditions like inflammation, infection, or crystal deposition.

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What is a sodium fluoride tube used for?

A type of blood tube used for blood glucose analysis, containing sodium fluoride to stabilize glucose levels and prevent breakdown.

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Why should powdered anticoagulants be avoided in joint fluid analysis?

Powdered anticoagulants should be avoided when collecting joint fluid for crystal analysis because they can interfere with crystal identification.

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What type of heparin should be used for joint fluid analysis?

Lithium heparin should not be used as an anticoagulants for joint fluid analysis. Sodium heparin is the preferred anticoagulant.

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What is viscosity in joint fluid analysis?

The viscosity of joint fluid can be a clue to the presence of certain conditions. Normal synovial fluid has a high viscosity, similar to egg white.

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Study Notes

Synovial Fluid Analysis

  • Synovial fluid analysis (joint fluid analysis) helps diagnose joint inflammation.
  • Joints contain synovial fluid for lubrication and ease of movement.
  • Increased synovial fluid can indicate joint inflammation.
  • Synovial fluid is a viscous fluid similar to egg white.
  • Hyaluronic acid, produced by synoviocytes, is responsible for synovial fluid viscosity.
  • Synovial fluid is an ultrafiltrate of plasma, containing hyaluronic acid.
  • The synovium lines the synovial tendon, found in diarthrodial (movable) joints.
  • Articular cartilage is avascular.
  • Damage or inflammation in the synovial membrane causes arthritis.

Functions of Synovial Fluid

  • Lubricates joints and reduces friction.
  • Provides nutrients to articular cartilage.
  • Lessens shock during joint compression.
  • Keeps bones apart, protecting the cartilage.
  • Enhances joint movement and function.

Synovial Fluid Specimen Collection

  • Arthrocentesis (joint aspiration) is used to collect the fluid.
  • A needle is inserted into the joint cavity.
  • Normal synovial fluid does not clot.
  • Diseased joints may clot.

Synovial Fluid Analysis: Physical Examination

  • Color: Colorless to pale yellow (normal); deeper yellow indicates inflammation, greenish tinge suggests bacterial infection, red suggests blood.
  • Clarity: Transparent or clear (normal); turbid indicates cells, crystals, fibrin, or free-floating bodies.
  • Viscosity: Able to form a string 4-6 cm long (normal). Decreased viscosity may indicate disease, or presence of hyaluronidase-producing bacteria.

Synovial Fluid Analysis: Chemical Examination

  • Glucose: Normal <10 mg/dL; higher values suggest inflammation or infection.
  • Protein: Normal <3 g/dL; elevated values suggest inflammatory disorders.
  • Lactate: Normal = plasma levels; elevated indicates bacterial infection.
  • Uric acid: normal = plasma; elevated values in gout.
  • Other possible components: Lipids, enzymes (like LDH), and other substances depending on specific conditions.

Synovial Fluid Analysis: Microscopy and Crystals

  • Polarizing Microscopy: Used to identify crystals; positive (e.g., CPPD) or negative (e.g., MSU) birefringence patterns are characteristic of different crystals.
  • MSU (Monosodium Urate) crystals are needle-shaped and cause gout.
  • CPPD (Calcium pyrophosphate dihydrate) crystals are rhomboid-shaped and associated with pseudogout.
  • Other Crystals: Hydroxyapatite, basic calcium phosphate, cholesterol, calcium oxalate, corticosteroid.

Synovial Fluid Analysis: Cell Counts and Differential

  • WBC Count: High values (over 100,000/µL) suggest infection or inflammation
  • Differential count: Identify types of WBCs. Increased neutrophils suggest infection; increased monocytes and lymphocytes are associated with inflammatory processes.
  • Neutrophils are the most common inflammatory cells
  • Monocytes and macrophages also provide important inflammatory roles.

Sweat Analysis (Cystic Fibrosis)

  • Measures electrolytes (sodium and chloride) in sweat.
  • High chloride levels suggest Cystic Fibrosis.
  • A pilocarpine iontophoresis method is frequently used to induce sweat production.

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