Serous Fluid, Amniotic Fluid, Fecal Analysis PDF

SEROUS FLUID, AMNIOTIC FLUID, FECAL ANALYSIS Professor: Dr. Michelle Joy M. Cauan Trans by: Cabacungan, Carag, Carig, Mendoza, Natividad, Norberte, Olmedo, Pagador Specimen Collection and Handli...

SEROUS FLUID, AMNIOTIC FLUID, FECAL ANALYSIS Professor: Dr. Michelle Joy M. Cauan Trans by: Cabacungan, Carag, Carig, Mendoza, Natividad, Norberte, Olmedo, Pagador Specimen Collection and Handling Collected by needle aspiration from respective cavities TOPIC OVERVIEW ○ Thoracentesis - pleural cavity ○ Pericardiocentesis - pericardial A. Serous Fluid ○ Paracentesis - peritoneal a. Pleural Fluid Greater than 100 mL is usually collected. b. Pericardial Fluid EDTA - cell counts and the differential. c. Peritoneal Fluid Heparin - microbiology and cytology. B. Amniotic Fluid Plain tubes or on heparin - chemistry tests C. Fecal Analysis Maintained anaerobically in ice - for testing pH Chemical tests are frequently compared with plasma chemical concentration. A. SEROUS FLUID Transudate vs Exudates Classification can provide a valuable initial diagnostic Parietal membrane - lines the cavity wall step and aid in the course of further laboratory testing Visceral membrane - covers the organs within the cavity Serous fluid TRANSUDATES EXUDATES ○ the fluid between the membranes ○ it provides lubrication between the parietal and Description Effusion that form due to a Produced by visceral membranes systemic disorder that conditions that disrupts the balance in the directly involve ○ Lubrication - necessary to prevent the friction regulation of fluid filtration the membranes between the two membranes that occurs as a result and reabsorption (e.g. of the particular of movement of the enclosed organs. changes in hydrostatic cavity (e.g. Formation pressure created by infections and Ultrafiltrates of plasma, with no additional material congestive heart failure or malignancies) contributed by the mesothelial cells that line the hypoproteinemia membranes. associated with the nephrotic syndrome Subject to hydrostatic and colloidal pressures. (not usually tested) Disruption causes effusion. Primary causes of effusions include: Appearance Clear Cloudy ○ increased hydrostatic pressure ○ decreased oncotic pressure Fluid:Serum 0.5 ○ increased capillary permeability protein ratio ○ lymphatic obstruction. Fluid:Serum LD 0.6 ratio WBC count 1000/uL Spontaneous No Possible clotting Pleural fluid 45 to 60 cholesterol mg/dL Pleural fluid: 0.3 serum cholesterol ratio Pleural fluid: 0.6 bilirubin ratio Serum-ascites >1.1 60 mg/dL or a Elevated lymphocyte counts are seen in effusions pleural fluid:serum cholesterol ratio >0.3 resulting from tuberculosis, viral infections, malignancy, provides reliable information that the fluid is an and autoimmune disorders such as rheumatoid arthritis exudate. and systemic lupus erythematosus (LE cells). 2. Pleural fluid:serum total bilirubin ratio >0.6 indicates Increased eosinophil levels (>10%) may be associated presence of exudate with trauma resulting in the presence of air or blood(pneumothorax and hemothorax) in the pleural Appearance cavity. They are also Clear and pale yellow- normal and transudate pleural seen in allergic fluids reactions and parasitic Turbidity- usually related to the presence of WBCs and infections. indicates bacterial infection, tuberculosis, or an Mesothelial cells are immunologic disorder such as rheumatoid arthritis. pleomorphic; they The presence of blood- signifies a hemothorax (traumatic resemble lymphocytes, injury), membrane damage such as occurs in plasma, and malignant malignancy, or a traumatic aspiration. cells, frequently making identification difficult. SLE in Pleural Fluid Chemistry Tests Most common are glucose (7.0), adenosine deaminase(40U/L), and amylase. Decreased glucose levels are seen with tuberculosis, rheumatoid inflammation, and purulent infections. The finding of a pH as low as low as 6.0 indicates an esophageal rupture that is allowing the influx of gastric fluid. ADA levels over 40 U/L are highly indicative of tuberculosis. They are also frequently elevated with malignancy. As with serum, elevated amylase levels are associated with pancreatitis, and amylase is often elevated first in the pleural fluid. Microbiologic Testing Microorganisms primarily associated with pleural effusions include: ○ Staphylococcus aureus, ○ Enterobacteriaceae ○ Anaerobes ○ Mycobacterium tuberculosis. Correlation of Pleural Fluid Appearance and DIsease Gram stains, cultures (both aerobic and anaerobic), acid-fast stains, and mycobacteria cultures are performed PAGE 2 BATCH TALAGHAY | Cabacungan, Carag, Carig, Mendoza, Natividad, Norberte, Olmedo, Pagador Serologic Testing Used to differentiate effusions of immunologic origin from PERITONEAL FLUID noninflammatory processes. Tests for antinuclear antibody (ANA) and rheumatoid Commonly referred to as ascitic fluid factor (RF) are the most frequently performed. In addition to the causes of transudative effusions, Detection of the tumor markers carcinoembryonic antigen hepatic disorders such as cirrhosis are frequent causes (CEA), CA 125 (metastatic uterine cancer), CA15.3 and of ascites transudate. CA 549 (breast cancer), and CYFRA 21-1 (lung cancer) Bacterial infections (peritonitis)—often as a result of provide valuable diagnostic information in effusions of intestinal perforation or a ruptured appendix— and malignant origin. malignancy are most frequent causes of exudative fluids Transudate vs Exudates Differentiation between ascitic fluid transudates and PERICARDIAL FLUID exudates is more difficult than for pleural and pericardial Normally, only a small amount (10 to 50 mL) of fluid is effusions. found between the pericardial serous membranes. The serum-ascites albumin gradient (SAAG) is Primarily the result of changes in the permeability of the recommended over the fluid:serum total protein and LD membranes due to infection (pericarditis), malignancy, ratios to detect transudates of hepatic origin. and trauma producing exudates. Fluid and serum albumin levels are measured Effusion is suspected when cardiac compression concurrently, and the fluid albumin level is then (tamponade) is noted subtracted from the serum albumin level. A difference (gradient) of 1.1 or greater suggests a Appearance transudate effusion of hepatic origin, and lower Normal and transudate pericardial fluid appears clear and gradients are associated with exudative effusions. pale yellow. Appearance: Normal peritoneal fluid is clear and pale yellow Exudates are turbid with bacterial or fungal infections Chylous or pseudochylous material may be present with trauma or blockage of lymphatic vessels. Laboratory Tests: Normal WBC counts are less than 350 cells/L, and the count increases with bacterial peritonitis and cirrhosis. Infection - an absolute neutrophil count greater than 250 cells/uL or greater than 50% of the total WBC count Lymphocytes are the predominant cell in tuberculosis Cellular Examination: Examination of ascitic exudates for the presence of malignant cells is important for the detection of tumors of primary and metastatic origin. Malignancies are most frequently of gastrointestinal, prostate, or ovarian origin. Chemical Testing Chemical examination of ascitic fluid consists primarily of glucose, amylase, and alkaline phosphatase SIgnificance of Pericardial Fluid Testing determinations. Glucose is decreased below serum levels bacterial and Laboratory Tests tubercular peritonitis and malignancy. Primarily directed at determining if the fluid is a Amylase is determined on ascitic fluid to ascertain cases transudate or an exudate and include the fluid:serum of pancreatitis, and it maybe elevated in patients with protein and lactic dehydrogenase gastrointestinal perforations. >1000 WBCs/uL with high percentage of neutrophils- An elevated alkaline phosphatase level is also highly indicate bacterial endocarditis diagnostic of intestinal perforation. PAGE 3 BATCH TALAGHAY | Cabacungan, Carag, Carig, Mendoza, Natividad, Norberte, Olmedo, Pagador  Chemical Composition Microbiology Tests: Gram stains and bacterial cultures for both aerobes Placenta- source of AF water and solutes. and anaerobes are performed when bacterial peritonitis The concentrations of creatinine, urea, and uric acid is suspected. increase, whereas glucose and protein concentrations Color and Appearance decrease. Measurement of amniotic fluid creatinine has been used B. AMNIOTIC FLUID to determine fetal age. Prior to 36 weeks’ gestation, the Product of fetal metabolism amniotic fluid creatinine level ranges between 1.5 and 2.0 Constituents that are present in the fluid provide mg/dL. It then rises above 2.0 mg/dL,thereby providing a information about the metabolic processes taking place means of determining fetal age as greater than 36 during, as well as the progress of fetal maturation. weeks. Physiology Maternal Urine vs Amniotic Fluid Present in the amnion, a Levels of creatinine and urea are much lower in amniotic membranous sac that fluid than urine. Creatinine does not exceed 3.5 mg/dL surrounds the fetus and urea does not exceed 30 mg/dL in amniotic fluid, The primary functions of the whereas values as high as high as 10 mg/dL for fluid are: creatinine and 300 mg/dL for urea may be found in urine ○ To provide a protective Presence of glucose, protein, or both-AF cushion for the fetus Fern test, a vaginal fluid specimen is spread on a glass ○ Allow fetal movement slide and allowed to completely air dry at room ○ Stabilize the temperature, then is observed microscopically. (+) fern temperature protect the fetus from extreme like crystals, AF. temperature changes ○ To permit proper lung development Specimen Collection Transabdominal amniocentesis Volume Safe procedure, particularly when performed after the Regulated by a balance between the production of fetal 14th week of gestation urine and lung fluid and the absorption from fetal 16 weeks AOG- for chromosome analysis swallowing and intramembranous flow. Later in the third trimester- fetal distress 1 L during the third trimester A maximum of 30 mL of amniotic fluid collected in sterile During the first trimester, the approximately 35 mL of AF syringes. is derived primarily from the mother Specimen Handling and Processing After the first trimester, fetal urine is the major contributor Testing for fetal lung maturity- placed in ice and to the AF volume refrigerated up to 72 hours Polyhydramnios- >1200 mL Cytogenetic studies are maintained at room temperature Oligohydramnios-