L04. Chapter 13 - Serous Fluids PDF

6/26/2024 Serous Fluids Chapter 13 Preamble PowerPoints are a general overview and are provided to help students take notes over the video lecture ONLY. PowerPoints DO NOT cover the details needed for the Unit exam Each student is responsible for READING the TEXTBOOK for details to a...

6/26/2024 Serous Fluids Chapter 13 Preamble PowerPoints are a general overview and are provided to help students take notes over the video lecture ONLY. PowerPoints DO NOT cover the details needed for the Unit exam Each student is responsible for READING the TEXTBOOK for details to answer the UNIT OBJECTIVES Unit Objectives are your study guide (not this PowerPoint) Test questions cover the details of UNIT OBJECTIVES found only in your Textbook! 1  6/26/2024 Serous Membranes Closed cavity in the body Pleural – thoracic area - lung Pericardial - heart Peritoneal – peritoneal cavity – liver, stomach, Intestine, bladder, & ovaries 2 membranes Line the cavity (parietal membrane) Membrane around the organ (visceral membrane) Fluid in between the membranes Serous fluid Lubricates-prevent friction Small amounts are present - production = reabsorption are constant rate Formation Another ultrafiltrate of plasma –nothing comes from the mesothelial cells Hydrostatic pressure Parietal & Visceral capillaries enter through the membrane ↑ oncotic pressure allowing fluid back into the capillaries ---------------------------------------- Oncotic pressure (colloidal pressure) Normal conditions serum protein are the same in the capillaries Build up or accumulation of fluid = EFFUSION 2  6/26/2024 Pathological Causes of Effusions Box 13 – 1 Increased capillary hydrostatic pressure Congestive heart failure 2 forms of effusions Salt and fluid retention 1. Transudate- systemic disorder Disrupting the balance of fluid filtration & Decreased oncotic pressure Nephrotic syndrome reabsorption Hepatic cirrhosis Change in hydrostatic pressure Malnutrition 2. Exudate- conditions that involve the Protein-losing enteropathy membranes Increased capillary permeability Infections & malignancies Microbial infections Membrane inflammations Test that help to differentiate between the Malignancy fluids Lymphatic obstruction total protein (TP) Malignant tumors, lymphomas Lactic dehydrogenase (LDH) Infection & inflammation Cell count Thoracic duct injuury Differentiate from bloot ratio for total protein and LDH Refer to TABLE 13-1 Specimen collection and handling Sterile technique – with a needle aspirate Fluid Procedure Pleural Thoracentesis Pericardial Paracentesis Peritoneal Paracentesis Cell count in EDTA tube Serum or heparin tube Sterile tube for culture 3  6/26/2024 Differentiation of transudates and exudates Transudate Exudate Appearance Clear Cloudy Fluid : serum protein ratio 0.5 Fluid : serum LD ratio 0.6 White blood cell count 1000/µL Spontaneous clotting No Possible Pleural fluid cholesterol 45 to 60 mg/dL Pleural fluid : serum 0.3 cholesterol ratio Pleural fluid : bilirubin ratio 0.6 Serum-ascites albumin >1.1 1,000 /uL WBC or nucleated cells >100,000 / uL RBC Differential - examine for lymphocytes, neutrophils, monocytes, normal and malignant tissue cell, suspicious cells should be referred to the pathologist 4  6/26/2024 Pleural Fluid Normal = pale yellow / clear Fluid between the parietal pleural Turbid = WBCs – inflammation, infection membrane(pleural cavity) and the Blood = hemothorax – traumatic injury, visceral membrane (covering lungs) malignancy determine hemothorax and Can be transudate or exudate hemorrhage- run a hematocrit >50% - Another chemistry test due to injury. A membrane disease would have a low hematocrit. Cholesterol serum to pleural Milky = chylous material (↑ triglycerides) >60 mg/dL = pseudochylous (↑ cholesterol) Serum / pleural ratio >0.3 Bilirubin serum to pleural Serum / pleural ratio >0.6 Glucose – helpful in rheumatoid arthritis Hematology Test Macrophages, neutrophils, lymphocytes, eosinophil, mesothelial, plasma cells, & malignant cells 64 – 80% macrophages Same in 18 – 30% lymphocytes pericardial & 1 – 2% neutrophils peritoneal 5  6/26/2024 ↑ neutrophils – infection, pancreatitis and pulmonary infarct. (b) Monocytes – macrophage, histocytes (a) Lymphocytes – small, large & reactive , increased in tuberculosis, viral infection, malignancy, autoimmune disease (c ) Eosinophil - >10% trauma to pleural cavity, allergic reactions & parasite Lining cells = Mesothelial. Can be pleomorphic. Reactive = clusters, varying amounts of cytoplasm, eccentric nuclei and multinucleated (may look like a malignant cells) reactive normal Malignant cells Large, ugly, dark, molding, no borders (cell walls) Irregular adenocarcinoma Small or oat cell carcinoma Metastatic breast cancer Only reported as suspicious cells refer to cytology Confirmed with special staining and flow cytometry 6  6/26/2024 Chemistry test on pleural fluid Most common test glucose, pH, total protein, adenosine deaminase, triglyceride & amylase ↓ glucose (,60 mg/dL) = tuberculosis, rheumatoid inflammation, malignant effusion, esophageal rupture pH 1000 = bacterial endocarditis 8  6/26/2024 Lab test Cell counts Chemistry – lactic dehydrogenase (LD) Markers levels for tumor Cultures – routine bacterial, fungal, acid-fast bacteria Peritoneal Fluid Accumulation of fluid in peritoneal membrane = ascites Calling it ascites fluid Sometimes after the procedure = paracentesis fluid Causes Hepatic disorders (cirrhosis) Bacterial infection in intestine (peritonitis) Peritoneal Lavage Diagnostic procedure to determine an intra-abdominal bleed Normal saline injected into cavity and withdrawn and cell count performed 9  6/26/2024 Peritoneal Fluid Transudate vs Exudate More difficult than other fluids Serum-ascites albumin gradient (SAAG) preferred over total protein and LD ratio Serum and fluid albumin levels are measured; fluid level is subtracted from serum level; difference (gradient) > than 1.1 is a transudate (hepatic origin) Serum albumin 3.8 – fluid albumin 1.2 = 2.6 = hepatic transudate Appearance Pale yellow / clear Turbid – bacterial infection Green / dark brown - bile Cellular Examination Normal nucleated cell 250 cell /uL or 50% of total WBC = Peritonitis or cirrhosis Cells: WBCs, mesothelial cells, macrophages (lipophages), malignant cells from various organs Yeast, Toxoplasmosis gondii 10  6/26/2024 Additional testing of Peritoneal Fluid Chemistry Microbiology & Serology Gram stains and aerobic and Glucose: below plasma levels = anaerobic cultures peritonitis and malignancy ↑ Amylase: pancrea s, Anaerobic cultures: inoculate gastrointestinal perforation blood culture bottle at bedside ↑ Alkaline phosphatase: Acid-fast smear, adenosine intestinal perforation deaminase and culture for TB ↑ BUN, crea nine: ruptured Tumor markers bladder, accidental perforation CEA CA 125 Presence of CA 125 antigen with a negative CEA suggests the source is from the ovaries, fallopian tubes, or endometrium Presence of CEA antigen suggests source is gastrointestinal Postamble READ the TEXTBOOK for the details to answer the UNIT OBJECTIVES. USE THE UNIT OBJECTIVES AS A STUDY GUIDE All test questions come from detailed material found in the TEXTBOOK (Not this PowerPoint) and relate back to the Unit Objectives 11