4 - Table Flashcards by Arriane Cyrel (MTI)

must be assessed for preterm delivery tests determine the total surfactant in the fetal alveoli

Fetal Lung Maturity

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normally appears in mature lungs and allows alveoli to remain open throughout the normal cycle of inhal and exhalation

Surfactants

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most frequent complication of early delivery Caused by lack of lung surfactants

Respiratory Distress syndrome

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reference method

Lecithin/Sphingomyelin Ratio

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: maintains alveolar stability

Lecithin

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primary component

Lecithin

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: serves as the control or basis for lecithin increase

Sphingomyelin

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Lecithin/Sphingomyelin Normal ratio:

2:1

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Up to 26th week of gestation:

Lecithin < Sphingomyelin

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36th week of gestation:

Lecithin = Sphingomyelin

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After 36th week of gestation:

Lecithin > Sphingomyelin

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L/S Ratio < 1.6:

Respiratory Distress syndrome

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Lung surfactant that may be assayed in place of L/S Ratio

Phosphatidylglycerol/
Phosphatidylinositol

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Production similar to lecithin except for diabetic mothers (delayed)

Phosphatidylglycerol/
Phosphatidylinositol

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Assayed using thin-layer chromatography or Amniostat-FLM

Phosphatidylglycerol/
Phosphatidylinositol

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uses antisera specific for phosphatidylglycerol

Amniostat-FLM

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shaking amniotic fluid with 95% ethanol for 15 seconds

Foam/Shake Test

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(+) Result: presence of continuous bubbles around the outside edge for 15 minutes

Foam/Shake Test

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Semiquantitative measure of the amount of surfactants present

Foam Stability Index

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Procedure: amniotic fluid + increasing amount of 95% ethanol

Foam Stability Index

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Foam Stability Index Value of (?): indicates fetal lung maturity

≥ 47

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Foam Stability Index Value of (?): immature lungs

< 47

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Measures the change in (?) which decreases in the presence of phospholipids

Microviscosity

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Principle: Fluorescence polarization

Microviscosity

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Presence of (?) decreases the microviscosity of amniotic fluid

phospholipids

Microviscosity : Internal Standard

Albumin

Microviscosity Value of (?): indicates fetal lung maturity

≥ 55

are lamellated phospholipids that represent storage form of surfactant

Lamellar bodies

The number of lamellar bodies present in the amniotic fluid correlates with the amount of phospholipid present in the fetal lungs=

RESISTANCE PULSE COUNTING

Lamellar Bodies=FETAL LUNG MATURITY

32,000/MI

+ lamellar bodies increases (?) of amniotic fluid

- Infection of Mother and fetus

TESTS FOR FETAL DISTRESS

- Bilirubin analysis

TESTS FOR FETAL DISTRESS

- Alfafetoprotein(AFP) Test

TESTS FOR FETAL DISTRESS

- Acetylicholinesterase level

TESTS FOR FETAL DISTRESS

- Creatinine concentration

TESTS FOR FETAL AGE

Used for the evaluation of hemolytic disease of the newborn caused by Rh or ABO incompatibilities

Bilirubin Analysis

: bilirubin decreases

Normal pregnancy

: bilirubin increases as a result of fetal red cell destruction

HDN

Principle: optical density of bilirubin (peak @ 450 nm) plotted on a Liley graph

Bilirubin Analysis

Performed for the detection of neural tube defects

Alpha-fetoprotein

Produced by the fetal liver and are present in amniotic fluid and maternal serum

Alpha-fetoprotein

Alpha-fetoprotein : highest AFP concentration

12th to 15th week of gestation

Alpha-fetoprotein : After 15th week of gestation

AFP concentration declines

Alpha-fetoprotein: indicates abnormal result

MoM > 2.0

Used as a confirmatory test for an elevated AFP

Acetylcholinesterase Level

Precaution: sample should not be contaminated with blood

Acetylcholinesterase Level

Increases as the baby nears term and concentration is 1.5 to 2.0 mg/dl prior to 36th week of gestation

Creatinine Concentration

Measured by Jaffe’s reaction

Creatinine Concentration

Creatinine Concentration level that indicates that the pregnancy is over 36 weeks

>2.0 mg/dl

serum-like fluids formed as ultrafiltrates of plasma which provide lubrication if the cavities where they are found

SEROUS FLUIDS

Primary causes of effusions include:

increased hydrostatic pressure (congestive heart failure) decreased oncotic pressure (hypoproteinemia) increased capillary permeability (inflammation and infection) absorption of fluid into the lymphatic system

Two Membranes of Serous Cavities:

( Parietal Membrane ( Visceral Membrane

: lines the cavity

( Parietal Membrane

: forms a sac around the organs

( Visceral Membrane

If an alteration in the hydrostatic and oncotic pressure in the capillaries of the cavities happens, there will be an increase in fluid volume known as an

EFFUSION

accumulation of serous fluid

EFFUSION

: serous effusions that result from disturbance of the fluid production and regulation between serous membranes

TRANSUDATE

: purulent effusions that form in any body cavity as a result of an inflammatory process

EXUDATE

Force that pushes fluid out of blood capillaries

INCREASED HYDROSTATIC PRESSURE

Force that pushes fluid into blood capillaries

DECREASED ONCOTIC PRESSURE

Chronic/Congenital Heart Failure

INCREASED HYDROSTATIC PRESSURE

Salt and fluid retention

INCREASED HYDROSTATIC PRESSURE

Nephrotic syndrome

DECREASED ONCOTIC PRESSURE

↑ protein – proteinuria ↓ albumin – hypoalbuminemia

DECREASED ONCOTIC PRESSURE

edema – swelling

DECREASED ONCOTIC PRESSURE

Hepatic cirrhosis

DECREASED ONCOTIC PRESSURE

Malnutrition

DECREASED ONCOTIC PRESSURE

Protein-losing enteropathy

DECREASED ONCOTIC PRESSURE

Appearance TRANSUDATE EXUDATE

Clear Cloudy

Fluid:serum protein ratio TRANSUDATE EXUDATE

<0.5 >0.5

Fluid:serum LD ratio TRANSUDATE EXUDATE

<0.6 >0.6

WBC count TRANSUDATE EXUDATE

<1,000/µL >1,000/µL

RBC count TRANSUDATE EXUDATE

Low >100,000/µL

Spontaneous clotting TRANSUDATE EXUDATE

No Possible

Pleural fluid cholesterol TRANSUDATE EXUDATE

<45 to 60 mg/dL >45 to 60 mg/dL

Pleural fluid: serum cholesterol ratio TRANSUDATE EXUDATE

<0.3 >0.3

Pleural fluid: bilirubin ratio TRANSUDATE EXUDATE

<0.6 >0.6

Serum-ascites albumin gradient (SAAG) TRANSUDATE EXUDATE

>1.1 <1.1

: pleural fluid collection

Thoracentesis

: pericardial fluid collection

Pericardiocentesis

: peritoneal fluid collection

Paracentesis

SEROUS FLUIDS Maintained at (?) and transported as soon as possible

room temperature

Only serous fluid for cytology may be (?) – affects viability of specimen

refrigerated (4 to 8OC)

LABORATORY TESTS FOR SEROUS FLUIDS

Physical Examination Cell count and differential count Chemistry Microbiology Cytology

: appearance, volume, spontaneous clotting

Physical Examination

: protein, cholesterol, LD, fluid-to-blood ratios

Chemistry

: Gram stain, acid fast satin, fungal stain, culture and sensitivity

Microbiology

Present within the synovial cavities found in free-moving joints

SYNOVIAL FLUIDS

A viscous liquid found in the cavities of diarthroses

SYNOVIAL FLUIDS

Formed as an ultrafiltrate of plasma-HYALURONIC ACID

SYNOVIAL FLUIDS

Mucoidal substance

HYALURONIC ACID

SYNOVIAL FLUIDS Functions:

Reduces friction between bones during movement Provides nutrients ta articular cartilage Lessens the shock of joint compression

: needle aspiration of fluid from joints

Arthrocentesis

SYNOVIAL FLUIDS powdered anticoagulants should never be used

Oxalate, lithium heparin, and powdered EDTA

May produce artifacts that may interfere with crystal analysis

Oxalate, lithium heparin, and powdered EDTA

synovial fluid specimens should be processed (?) to avoid alteration of chemical constituents, cell lysis, micro detection and identification

STAT

Glucose testing: fasting for 6 hours

SYNOVIAL FLUIDS

To establish an equilibrium between plasma and joint glucose levels

Glucose testing

Determines the integrity of the hyaluronic acid-protein complex

MUCIN CLOT TEST

Normal synovial fluid:

tight ropy clot upon the addition of HAc

MUCIN CLOT TEST Reagent:

2 to 5% HAc

MUCIN CLOT TEST Reporting: Good: Fair: Low: Poor:

solid clot soft clot friable clot no clot

Same proteins with that of plasma except fibrinogen, β2-macroglobulin and α2- macroglobulin

Protein Determination

Normal value: 1 to 3 g/dL

Protein Determination

↑: ankylosing spondylitis, arthritis, arthropathies (Crohn’s disease), gout, psoriasis, Reiter syndrome and ulcerative colitis

Protein Determination

Normal value: 10mg/dL lower than serum

Glucose Determination

↓: infectious joint disorders

Glucose Determination

Diagnosis of gout

Uric Acid Determination

Normal value: 6 to 8 mg/dL

Uric Acid Determination

Results from anaerobic glycolysis in the synovium

Lactic Acid Determination

For rapid differentiation or inflammatory septic arthritis

Lactic Acid Determination

Normal value: <25 mg/dL

Lactic Acid Determination

↑ (as high as 1000 mg/dL): septic arthritis

Lactic Acid Determination

Performed immediately, otherwise refrigerate specimen

Total WBC Count

Clear specimens: no dilution needed

Total WBC Count

Total WBC Count Turbid/Bloody:

NSS + methylene blue

Total WBC Count to promote RBC lysis:

+ hypotonic saline or saline with saponin

Total WBC Count Very viscous specimen:

+ hyaluronidase to 0.5 ml of fluid + 0.05% hyaluronidase in PO4 buffer/ml of fluid incubate for 5 min at 37oC

Total WBC Count Counting chamber:

Neubauer

Normally absent in synovial fluid

CRYSTALS IN SYNOVIAL FLUID

CRYSTALS IN SYNOVIAL FLUID Formation may be due to:

(1) decreased renal excretion (produced elevated blood levels of crystalizing chemical) (2) degeneration of cartilage and bone (3) injection of medication

Common crystals formed

Monosodium urate/uric acid Calcium pyrophosphate

needle-like appearance seen in gout

Monosodium urate/uric acid

Appears yellow in compensated polarized light indicating negative birefringence

Monosodium urate/uric acid

needle-like appearance or in rods seen in Pseudogout

Calcium pyrophosphate

Appears blue in compensated polarized light indicating positive birefringence

Calcium pyrophosphate

Needle-like

Monosodium urate

(-) birefringence

Monosodium urate Cholesterol Calcium oxalate

Gout

Monosodium urate

Rhombic squares or rods

Calcium pyrophosphate

(+) birefringence

Calcium pyrophosphate

Pseudogout

Calcium pyrophosphate

Notched, rhombic plates

Cholesterol

Chronic effusion

Cholesterol

Flat, variableshaped plates

Corticosteroid

May exhibit positive and negative birefringence

Corticosteroid

Injections

Corticosteroid

Envelope-like

Calcium oxalate

Renal dialysis

Calcium oxalate

Small particles

Calcium phosphate

No birefringence

Calcium phosphate

Osteoarthritis

Calcium phosphate

stimulates parietal cells to produce HCI

GASTRIN

For intestinal absorption of Vit.B12

INTRINSIC FACTOR

Pepsinogen ->

Pepsin

– catalyzes protein digestion

PEPSIN

GASTRIC Patient Preparation:

12-hour fasting/15-hour fasting no medication 24 hours prior to collection should not swallow excessive amount of saliva should be resting and relaxed

gastric tube inserted in the stomach (buccal/nasal cavity)

1. TUBE/INTUBATION METHOD

Oral administration of ion-exchange resin with azure blue dye → free HCl acts on the complex → azure blue is released from the complex and reabsorbed → excreted as part of urine

2. TUBELESS METHOD/DIAGNEX BLUE METHOD

requires fasting for 12 or 15 hours

3. BASAL GASTRIC SECRETION

total gastric secretion reflects

Basal Acid Output (BAO)

BAO:

0 to 6 mEq/hr

4. MAXIMAL GASTRIC SECRETION requires stimulation

HISTAMINE PENTAGASTRIN HISTALOG (BETAZOLE)

Primarily involves qualitative and quantitative measurement of gastric acidity

GASTRIC JUICE CHEMICAL EXAMINATION

: measures free HCl, loosely combined HCl, acid salts and organic acids

Total Acidity

—normal acidity Hyperchlorhydia—duodenal and peptic ulcer

Euchlorhydia

—carcinoma of the stomach, gastric syphilis, chronic gastritis

Hypochlorhydia

—pernicious anemia, advanced gastric cancer, pellagra

Achlorhydia

—complete absence of HCl

Achylia