Body Fluids (lec 1) Flashcards by Wendy Pitts

Effusion is?

Transudate?

Exudate?

Abn fluid in cavity

Trans:
result of pressure diff b/w compartments,
blood filt across intact vascular wall,
(U) from system dz (CHF, etc)

Exu:
results from inflamm/vascular wall damage,
(U) from infect, malig, inflamm dz

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Total Fluid Protein tells us?

Fluid:Serum Protein tells us?

types of fluid

FP
< 3 = transu
> 3 = exu

F:S P
< 0.5 = transu
> 0.5 = exu

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Lactate DH Fluid:Serum tells us?

types of fluid

< 0.6 = transu
> 0.6 = exu

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Glucose level tells us?

transu (transu glu same as plasma glu)
or
exu (exu glu < plasma glu)

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Appearance of transu?

WBC count/type?

clear, thin

< 300
mononuclear

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Appearance of exu?

WBC count/type?

cloudy, thick

> 500
neutrophils

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Amylase tells us?

diag of pancreatitis, bowel perf, metastases

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Triglycerides tell us?

confirm chylous (fat/lymph from sm intest) effusion

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pH of pleural fluid tells us?

parapneumo effusion

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Carcinoembryonic Antigen (CEA) tells us?

CEA-producing tumor

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Types of cells in normal serous fluid? (4)

lymphocytes
monocytes
macrophages
mesothelial lining

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Nonmalig cells from disease states? (3)

neutrophils (inflamm/infect),
eosinophils (hypersens, malig, MI, infect),
RBCs (hemorr, malig)

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Exudates requires what further testing? (4)

Cytology (for malig)
Culture (for infect)
Cell count/diff
Chemistry

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Exudative Pleural Effusion values:

Specif Gravity?

Fluid Protein?

Fluid:Serum Protein?

Fluid:Serum LDH?

SG > 1.016

FP > 3

F:S P > 0.5

LDH > 0.6

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Hemothorax:

RBCs?

Hct?

RBC > 100k

Hct of fluid ≥ 50% of peripheral blood

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Hemothorax caused by? (3)

Trauma
Malig
PE

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Empyema is?

WBC count?

if >50% neutro = ?

if >50% lympho = ?

if eosino = ?

pus in pleural space

WBC > 50k

if >50% neutro = inflam/infect

if >50% lympho = neoplasm, TB

if eosino = collagen-vasc dz, drug-induced pleuritis, neoplasm, TB

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Add’l Pleural Effusion tests:

pH?

Glucose?

Amylase?

Triglycerides?

pH < 7.2 = infect, neopl, RA, esoph rupture

Glu < 60 = infect, neopl, RA

Amylase = pancreatitis, esoph rupture

Trigly = chylous effusion from trauma, neopl or obstructed lymph

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PE cause what effusions?

transu or exu

Exu Pleural Effusions caused by? (2)

1) parapneumo from bacterial PNA, lung abscess, bronchiectasis
2) Malignancy (U) lung, breast, lymphoma

Pericardial fluid obtained how?

Subxiphoid Needle Aspiration:
Echo-guided (preferred)
Alligator clip EKG (emergent)

Peritoneal fluid (Ascites) obtained how?

4 quad abdom tap

Ascites labs/significance?

same as pleural fluid

Post trauma -> r/o intraabdominal bleed

Tenderness -> r/o peritonitis

Malignant -> check cytology

Infection -> G-stain, acid-fast, C/S, biopsy

Ascites method of classification?

Serum:Acites Albumin Gradient (SAAG) =

serum albumin - ascitic fluid albumin

SAAG tells us?

> 1.1 = transudate ascites from portal HTN < 1.1 = exudate ascites from non-portal HTN (e.g. malig, infection)

Ascites cell counts tell us?

(most useful test) WBC < 500 = uncomplicated cirrhosis WBC count ↑ w/ inflamm (e.g. infect, TB, CA)

Spontaneous Bacterial Peritonitis caused by? Presentation? Tx?

cirrhosis, ascites No obvious source of infect, Abrupt fever/chills, abd pain, Rebound tender, Fluid WBC > 500 w/ neutro > 50% Abx, NO surgery

Synovial Fluid Categories? (4)

Group I = non-inflamm (OA) Group II = mild inflamm (SLE, scleroderma) Group III = severe inflamm (gout, RA) Group IV = infection (bacterial, TB)

Next tests for septic synovial? Tx?

(URGENT CONDITION) G-stain Cx Abx

Birefringence is?

polarized light test for crystals shine on dark background = crystal direction of shine determined (+ or -)

Crystal properties for Gout?

monoNa+ urate strong negative bifringence, needle-shaped

Crystal properties for Pseudogout?

Ca2+ pyrophosphate weakly positive bifringence rhomboid

Cerebrospinal Fluid collected how?

lumbar puncture | L3-4 or 4-5

CSF analysis detects what dzs?

Hemorr Infect Malig

CSF analyzed for?

Chemistry: protein, glu, immuno Micro: G/Acid-stains, C/S Hemato: count, diff Plasma prot/glu drawn for comparison

CSF Glucose tells us?

N = 2/3 of plasma glu, 50-80 mg/dl High = hyperglycemia Low = bact meningitis, fungal inf

CSF Protein tells us?

N = 20-50 mg/dl High = bleed, hemolysis, infect Oligoclonal bands = multiple sclerosis Myelin basic proteins = MS and other demyelinating dz

CSF RBCs tell us?

Present = cerebral hemorr or traumatic tap Spin CSF: If xanthochromic supernatant = hemorr If clear = traum tap

CSF WBCs tell us: Normal? ↑ neutrophils? ↑ lymphocytes? Eosinophils? Plasma cells?

N = 1-5 mononuclear cells ↑ neutro = bact meningitis ↑ lympho = virus, fungus, TB Eosino = parasitic, fungus Plasma cells = MS, chronic inflamm

Meningitis presentation?

HA N/V Photophobia (P) altered mental status

Blood Cultures used when? Best time to draw?

assess for bacteremia during episode of fever/chills

Intermittent/Transient Bacteremia possible when?

during manipulation of infected tissue (e.g. dental procedures) at onset of infection

Continuous Bacteremia likely when?

endovascular infection (e.g. endocarditis)

Blood Culture collected how?

drawn by syringe from at least 2 diff sites NOT thru existing catheter inject into BC media bottles (O2 and

Blood Cx results tell us?

If growth in both Cxs = indicative of bacteremia If one Cx set + = (P) contamination (esp if N skin flora) Or (P) true + if strep A, pneumo, h. flu, pseudo, candidia