Body Cavity Effusion Analysis

Question 1

What are the cells lining the body cavities?

Answer 1

mesothelial cells

Question 2

What are the common causes of body effusions?

Answer 2

trauma

CV dz/altered starling forces

hemorrhage

neoplasia

infection/inflammation

ruptured organs

Question 3

What is the most common clinical sign associated with severe effusions?

Answer 3

dyspnea

Question 4

If you know there will be a delay in assessing the effusion sample, what should be done?

Answer 4

Make a direct smear at collection

store fluid in fridge

Question 5

If performing an estimate of the cell count in an effusion, how can it be determined?

Answer 5

Average number of cells in at least 10 representative fields is multiplied by the square of the objective used to perform the count

Question 6

What are the normal findings in a body cavity effusion for small animals?

Answer 6

minimal reactive mononuclear cells

low # of small lymphocytes & mesothelial cells

Question 7

Normal effusion cellular makeup in the horse?

Answer 7

 Low numbers of mesothelial cells
 Minimally reactive mononuclear phagocytes
 Low number of small lymphocytes
 Mature non-degenerate neutrophils often predominate

Question 8

What are the cell # present in small animal & equine exudative effusions?

Answer 8

horse >10,000

small animals >5,000

Question 9

What is a transudate?

Answer 9

Diffusion of plasma water from the vessels

Question 10

What causes transudate effusions?

Answer 10

Reduced plasma oncotic pressure

Increased hydrostatic pressure

Question 11

What clinical conditions result in transudate effusions?

Answer 11

Liver dz ( Portal hypertension
 Shunting
 Malnutrition
 Hepatic insufficiency)

Intestinal Dz (malabsorption/digestion, PLE)

Renal dz (PLN)

Iatrogenic fluid overload and dilution of plasma albumin

Question 12

With acute transudates, what is the predominant cell type in small animals? In chronic transudates? Why?

Answer 12

acute: mononuclear
chronic: NT (fluid irritates mesothelial cells that release cytokines that recruit NT)

Question 13

What causes exudate effusions?

Answer 13

inflammation results in increased vascular permeability

Question 14

Clinical conditions that result in non-septic exudates?

Answer 14

chronic modified transudates

Chemical peritonitis: uroperitoneum, bile peritonitis

FIP

Misc: sterile FB, neoplasia, pancreatitis, abscessed organs

Question 15

What question is critical to ask when assessing an exudate as being septic or not and you do not see any intracellular organisms but you do see degenerate NT?

Answer 15

did the animal receive abx?

Question 16

What is the major difference between septic & non-septic exudates?

Answer 16

septic: degenerate NT with intracell organisms

non-septic: non-degenerate NT

Question 17

What clinical condition could result in a septic exudate?

Answer 17

puncture/bite wound

perforation of the GI tract

abscessed organs

Iatrogenic

Question 18

Abdominal effusion in a horse- protein >5 mg/dL, 30,000 cells

Type?

Answer 18

septic exudate

Question 19

How large would the difference in BG and effusion glucose have to be to indicate exudate?

Answer 19

>20 mg/dL

Question 20

What is the difference in vascular permeability in transudates vs. exudates?

Answer 20

transudates: normal
exudates: increased

Question 21

Clinical conditions that result in modified transudate effusions?

Answer 21

CHF (peritoneal in dogs, pleural in cats)

thrombosis of CVC

Misc: diaphragmatic/ peritoneal/pericardial hernias, organ torsion (acute), neoplasia

Question 22

Main difference between modified transudate & transudate?

Answer 22

MT: higher protein and cells

Question 23

Main reason for modified transudates to occur?

Answer 23

increased hydrostatic pressure

Question 24

How does a chylous effusion appear grossly and cytologically?

Answer 24

gross: pale, turbid, white
cytology: lymphocytes dominant, macrophages/NT with lipid vacuoles

Question 25

What causes chylous effusions?

Answer 25

blockage of the lymphatics

Question 26

What levels of triglycerides would make you suspicious for a chylous effusion?

Answer 26

\>100 mg/dL

Question 27

Clinical conditions that result in chylous effusions?

Answer 27

lymphangiectasia: physical vs. functional obstructions physical (congenital, fungal, neoplasia, venous thrombus) functional (cardiac dz (common in cat)/HW dz) Idiopathic (dogs) diaphragmatic hernia, lung lobe torsion, thoracic duct rupture

Question 28

Where do chylous effusions typically occur?

Answer 28

thoracic cavity

Question 29

What test would you like to run on this effusion obtained from the thorax of a cat to confirm your suspicion? What is the most likely dx?

Answer 29

TG (if \>100= chylous) Cardiac dz

Question 30

What is the component of pseudochylous effusions that makes it appear chylous?

Answer 30

cholesterol from breakdown products in chronic effusions

Question 31

A foal presents with lethargic and dyspnea. An amber colored fluid is removed from the abdomen. On chemistry, the foal has a ____ & \_\_\_\_\_. What is the diagnostic test result that will confirm your suspicion of uroperitoneum?

Answer 31

hyperK & hypoNa fluid: Creatinine ration \>2:1

Question 32

A yellow/green/brown colored fluid is removed from the abdomen of a dog. The cytology indicate what likely dx? What test can confirm your suspicion?

Answer 32

Bile peritonitis Fluid:Serum bilirubin concentration \>2:1

Question 33

A feline presents with a light amber color fluid from the abdomen. TP \>5 g/dL. What is the likely dx? What on the cytology indicated that?

Answer 33

FIP granular eosinophilic background, protein crescents

Question 34

What Albumin:Globulin ratio in effusions with a total protein \>3.5 g/dL and neutrophilic and macrophagic inflammation would exclude FIP? Include FIP?

Answer 34

Exclude: \>0.8 Include: \<0.45

Question 35

Acute or chronic hemorrhage?

Answer 35

Chronic (hemosiderin breakdown products in macrophage)

Question 36

Type of effusion? Characteristics? Acute or chronic?

Answer 36

Hemorrhagic (erythrophagia & hemosiderin breakdown products, PCV 10-25% of peripheral blood) Acute (erythrophagia), chronic (hemosiderin breakdown products)

Question 37

True hemorrhage or iatrogenic? How do you know?

Answer 37

True hemorrhage (erythrophagia) iatrogenic: would have PLT

Question 38

True hemorrhage or iatrogenic?

Answer 38

Iatrogenic

Question 39

Clinical conditions that can cause hemorrhagic effusions?

Answer 39

1. Trauma 2. Acquired clotting disorder (Rodenticide) 3. Inherited clotting disorders 4. Idiopathic/benign (dogs & horses) 5. Neoplasia (hemangiosarcoma, adrenal tumors, thyroid carcinoma)

Question 40

Most common clinical condition associated with chylous and hemorrhagic effusions in dogs?

Answer 40

Idiopathic

Question 41

If you are concerned fro lymphoma vs. chylous effusion, what test can be run?

Answer 41

PPAR

Question 42

Type of effusion?

Answer 42

Neoplastic (carcinoma)

Question 43

Most common type of neoplasia seen with neoplastic effusions?

Answer 43

hemangiosarcoma adrenal tumors thyroid carcinoma mesothelioma