Serous Fluid PDF

SEROUS FLUID MISCELLANEOUS BODY FLUID  Serous fluid  Fluid between membranes › Provides lubrication (prevents friction) during movements › Normally in small amount  FORMATION  Ultrafiltrate of plasma, w/ no additional material contributed by the mesothelial cells. ...

SEROUS FLUID MISCELLANEOUS BODY FLUID  Serous fluid  Fluid between membranes › Provides lubrication (prevents friction) during movements › Normally in small amount  FORMATION  Ultrafiltrate of plasma, w/ no additional material contributed by the mesothelial cells.  Production & reabsorption are subject to hydrostatic & colloidal pressures from the capillaries that serve the cavities & the capillary permeability  FORMATION  Under normal condition, colloidal pressure in the capillaries are the same in both sides  Hydrostatic pressure in both capillaries causes fluid to enter between membranes  Filtration of plasma ultrafiltrate results in increased oncotic pressure – reabsorption back to capillaries EFFUSION – disruption of the mechanisms of serous fluid formation & reabsorption causes an increase in fluid between membranes  TRANSUDATES AND EXUDATES TRANSUDATES  Effusions that form because of a systemic disorder that disrupts the balance in the regulation of fluid filtration & reabsorption – such as changes in hydrostatic pressure  Ex. Hypoproteinemia, Congestive Heart Failure, & Nephrotic Syndrome  TRANSUDATES AND EXUDATES EXUDATES  produces by condition that directly involves the membranes of the particular cavity, including infections & malignancies  Ex. Infection, Inflammation, & Malignancy  TRANSUDATE EXUDATE Appearance Clear, pale yellow Cloudy WBC Count 1000/uL 30 g/L Fluid:Serum Protein Ratio 0.5 Fluid:Serum LD Ratio 0.6 Pleural Fluid Cholesterol 45-60 mg/dL Pleural Fluid:Serum Cholesterol 0.3 Ratio Pleural Fluid:Bilirubin Ratio 0.6 Serum-Ascites Albumin >1.1 100,000/uL  Cell counts can be performed manually by using a Neubauer counting chamber or by electronic cell counters General Laboratory Procedures  Manual cell counts = include a count of all nucleated cells  Electronic counters = Inclusion of tissue cells & debris in the count must be considered, & care must be taken to prevent the blocking of tubing w/ debris General Laboratory Procedures  Differential cell counts = routinely performed on serous fluids, preferably on Wright’s- stained, cytocentrifuged spx or on slides prepared from the sediment of centrifuged spx › examined not only for WBCs, but also for normal & malignant tissue cells.  PLEURAL FLUID  Obtained from the pleural cavity, located between the parietal pleural membrane lining the chest wall & the visceral pleural membrane covering the lungs.  Effusions – either transudative or exudative  Additional Pleural Fluid tests  Pleural fluid cholesterol - >60mg/dl  Fluid:serum cholesterol ratio- >0.3  Fluid:serum bilirubin ratio – 0.6 or more EXUDATE PLEURAL FLUID APPEARANCE  PLEURAL FLUID APPEARANCE  Turbidity = WBCs & indicates bacterial infection, tuberculosis, or an immunologic disorder such as rheumatoid arthritis  Presence of blood = signify a hemothorax (traumatic injury), membrane damage such as occurs in malignancy, or a traumatic aspiration  PLEURAL FLUID APPEARANCE  Hemothorax vs. Hemorrhagic exudate/effusion › Run hematocrit on the fluid › Hemothorax = Hct is >50% of the whole blood hct, because the effusion comes from the inpouring of blood from the injury; Uneven distribution of blood › chronic membrane disease effusion (contains both blood & increased pleural fluid) = resulting in a much lower hct; Even distribution of blood  Hemothorax or Hemorrhagic Effusion?  Pleural fluid HCT of 29% and Whole blood HCT of 54%.  Whole blood HCT is 38% and Pleural fluid HCT is 18%  Pleural fluid HCT of 25% and Whole blood HCT of 50%.  PLEURAL FLUID APPEARANCE  Milky pleural fluid = presence of chylous material (thoracic duct leakage) or pseudochylous material (chronic inflammatory conditions) PLEURAL FLUID APPEARANCE  PLEURAL FLUID APPEARANCE  Chylousmaterial = contains a high conc. of triglycerides  Pseudochylous material = higher conc. of cholesterol  PLEURAL FLUID APPEARANCE  Sudan III staining: › chylous material = strongly positive › pseudochylous effusions = contain cholesterol crystals  PLEURAL FLUID HEMATOLOGY TEST  Diff. Count – most significant hematology test performed on serous fluid Primary cells: 1. Neutrophil 2. Lymphocytes 3. Eosinophils 4. Mesothelial cells 5. Plasma cells 6. Malignant cells  PLEURAL FLUID HEMATOLOGY TEST  Macrophages = 64% to 80%  Lymphocytes = (18% to 30%) &  Neutrophils = (1% to 2%) ; increased indicates bacterial infection,(pneumonia, pancreatitis) & pulmonary infarction › These same cells are also found in pericardial and peritoneal fluids  PLEURAL FLUID HEMATOLOGY TEST  Lymphocytes = normally present in both transudates & exudates in a variety of forms, including small, large, & reactive  Elevated lymphocyte = effusions resulting from tuberculosis, viral infections, malignancy, & autoimmune disorders (rheumatoid arthritis & SLE  PLEURAL FLUID HEMATOLOGY TEST  Increased eosinophil levels (>10%) - trauma resulting in the presence of air or blood (pneumothorax & hemothorax) in the pleural cavity › also seen in allergic reactions & parasitic infections PLEURAL FLUID HEMATOLOGY TEST PLEURAL FLUID HEMATOLOGY TEST  Pleural Fluid Chemistry Test 1. Glucose 2. pH 3. Adenosine deaminase (ADA) 4. Amylase 5. Triglyceride - chylous Glucose: Tuberculosis Rheumatoid decreased inflammation Purulent infection  decreased - 1000 WBCs/uL w/ neutro= bacterial endocarditis 4. Cytologic examination – presence of malignancies =metastatic lung or breast carcinoma  Pericardial Fluid Laboratory Testing 5. Bacterial culture & gram stain = endocarditis (Haemophilus, Streptococcus, Staphylococcus, Adenovirus, Coxsackievirus) 6. Effusions of tubercular origin = increasing as a result of AIDS  Test for AFS& adenosine deaminase PERITONEAL FLUID  PERITONEAL FLUID Ascites – accumulation of fluid between the peritoneal membranes - fluid = ascitic fluid rather than peritoneal fluid - frequently caused of ascite : 1. hepatic disorders (cirrhosis) = transudates 2. Bacterial infection (Peritonitis) – intestinal perforation or ruptured appendix exudates 3. Malignancy  PERITONEAL FLUID  PERITONEAL LAVAGE – sensitive test to detect intra-abdominal bleeding in blunt trauma cases, & RBC count results along w/ radiographic procedures (determine the need for surgery) › RBC counts >100,000/uL – indicative of blunt trauma injuries  PERITONEAL FLUID (peritoneal dialysis)  Cell counts & differentials = infection  Eosinophil counts = allergic rx’ns to the equipment or introduction of air into the peritoneal cavity  PERITONEAL FLUID Transudates Vs. Exudates - more difficult to differentiate than for pleural & pericardial effusions - serum-ascites albumin gradient (SAAG) – recommended over the fluid: serum total protein & LD ratios to detect transudates of hepatic origin  PERITONEAL FLUID Transudates vs. Exudates - Fluid & serum albumin levels are measured concurrently, & the fluid albumin level is then subtracted from the serum albumin level - difference (gradient) of 1.1 or greater = transudate effusion of hepatic origin, & - lower gradients = associated w/ exudative effusions PERITONEAL FLUID sa thoracic duct (Quac)  PERITONEAL FLUID Laboratory Tests  Normal WBC 250 cells/μL or >50% of the total WBC count = bacterial peritonitis  Lymphocytes - predominant cell in tuberculosis  PERITONEAL FLUID Laboratory Tests  PERITONEAL FLUID Cellular examinations  Malignancies origin : gastrointestinal, prostate, or ovarian  Other cells present : leukocytes, abundant mesothelial cells, & macrophages, including lipophages  PERITONEAL FLUID Cellular examinations  Microorganisms (bacteria, yeast, & Toxoplasma gondii may also be present  Malignant cells of ovarian, prostatic, & colonic origin, often containing mucin- filled vacuoles, are frequently seen  Psammoma bodies containing concentric striations of collagen-like material = benign conditions & are also associated w/ ovarian & thyroid malignancies  PERITONEAL FLUID Laboratory Tests  Chemical Testing › Glucose, › amylase, and › alkaline phosphatase  PERITONEAL FLUID Laboratory Tests  Bilirubin = leakage of bile into the peritoneum is suspected following trauma or surgery; primarily conjugated bilirubin  Amylase or lipase = determine pancreatitis or damage to the pancreas  PERITONEAL FLUID Microbiology Tests  Gram stains & bacterial cultures for both aerobes & anaerobes = bacterial peritonitis is suspected  blood culture bottles increases the recovery of anaerobic organisms  AFS, adenosine deaminase, & cultures = tuberculosis  PERITONEAL FLUID Serologic Tests  CEA & CA 125 = for identifying the primary source of tumors producing ascitic exudates › presence of CA 125 Ag w/ a negative CEA = ovaries, fallopian tubes, or endometrium PERITONEAL FLUID