Cavitary Effusion Flashcards
(108 cards)
1
Q
What are cavities line by?
A
Mesothelial cells
2
Q
What does the small amounts of clear serous fluid in animals do?
A
Acts as lubricant and medium of transport for electrolytes and other substances
3
Q
What is serous fluid removed by?
A
Lymphatic system
4
Q
What is the composition of fluid in health determined by?
A
Permeability of capillaries
5
Q
What is serous fluid permeable to?
A
H2O Electrolytes Glucose Urea Creatinine
6
Q
What is the cellular composition of serous fluid?
A
No erythrocytes
Low numbers of nucleated cells
7
Q
What does it mean if pleural and peritoneal fluid is collected?
A
There is an effusion
8
Q
What is accumulation of fluid or the fluid that is accumulated??
A
Effusion
9
Q
What is fluid accumulated in the cavity, typically peritoneal?
A
Ascites
10
Q
What is the passage of fluid or solute through a membrane due to changes in hydraulic or oncotic pressure gradients?
A
Transudation
11
Q
What is effusion produced by changes in mechanical factors?
A
Transudate
12
Q
What is pressure of a fluid at rest?
A
Hydrostatic pressure
13
Q
What is pressure of a fluid in motion?
A
Hydraulic pressure
14
Q
What is exuding or oozing out through pores?
A
Exudation
15
Q
What is effusion produced by increase vascular permeability to plasma proteins?
A
Exudate
16
Q
What is the escape/loss of blood?
A
Hemorrhage
17
Q
What is the escape/loss of lymph from lymph vessels?
A
Lymphorrhage
18
Q
What is a transudate that has been modified by addition of protein and/or cells?
A
Modified transudate
19
Q
What makes up the colloidal particles concentration?
A
Mainly albumin and other proteins
20
Q
What does colloidal osmotic pressure vary by?
A
Tissue: 30% of the plasma in muscle interstitium, 70% of the plasma in lungs
21
Q
What is Starling’s law?
A
Capillaries - intersitium forces
Pressure gradient = Δhydraulic - Δoncotic
22
Q
What is arterial pressure?
A
Hydraulic difference > oncotic
Fluid leaves the vessel
23
Q
What is venous pressure?
A
Hydraulic difference < oncotic
Fluid enters the vessel
24
Q
How does fluid that enters the intersitium return?
A
Via permeabl venous capillaries
25
When does effusion accumulate?
Increased fluid into cavity
| Decreased removal of fluid from cavity
26
What does the composition of fluid provide?
Evidence for the type of pathologic process
27
What causes transudates?
Excess diffusion of water from the vascular space
Pleural effusion
Portal hypertension
28
What can transudation from the liver create?
Protein rich fluid
29
What is pleural effusion primarily caused by?
Increased hydraulic pressure in alveolar capillaries
30
What does pleural effusion mostly remain?
Lungs
31
When do protein-poor transudates tend to form?
When there is marked hypoproteinemia
32
What are the most common causes of protein-poor transudates in dogs?
Hepatic cirrhosis
| PLN
33
What are the 2 major factors of protein-poor transudates?
Decreased plasma oncotic pressure
| Increased hydraulic pressure
34
What causes protein-rich transudates?
Increased plasma hydraulic pressure in liver or lungs because of venous congestion
35
What are the most common disorders that cause protein-rich transudates?
Congestive heart failure
| Portal venous hypertension
36
What causes exudates?
Infectious or noninfectious agents
Septic (bacterial, fungal, viral, or protozoal)
Noninfectious Inflammation: increased vascular permeability
37
What is the most common cells in most exudates?
Neutrophils
38
What kind of exudate is associated with FIP?
High [protein] exudates
| Protein types are very similar to the plasma
39
When is effusion considered hemorrhagic effusion?
When the primary reason for effusion is hemorrhage
40
What is the decision threshold for hemorrhagic classification?
Many factors affecting hematocrit
Sometimes there are hemorrhage and other processes
If effusion's Hct >3%, hemorrhage is contributing to the effusion
41
What are the pathologic states associated with lymphorrhagic effusions?
Traumatic: physical damage
Nontraumatic: lymph stasis, lymphatic hypertension, defective lymphatic valve function, increased permeability of lymphatic vessels
42
What are many chylous pleural effusions caused by?
Obstruction of thoracic duct or cranial vena cava
43
What is a cause of lymphorrhagic effusions?
Blockage of lymphatic vessels by neoplastic cells
44
What are the 2 major groups lymphorrhagic effusions are classified into?
Chylous (chylomicron-rich)
| Nonchylous
45
What causes chylous effusions?
Chylomicron-rich lymph leaks from vessels and enters the cavity
46
What does chylous effusion indicate?
Damage to the lymphatic vessels between the SI and thoracic vena cava
47
What is chylothorax common in?
Cats
48
What disorders can cause chylous effusions?
```
Neoplasms
Cardiomyopathy
Heart failure
Lung lobe torsion
Infections
```
49
What do almost all chylous effusions look like?
Milky-white to pink-white fluids
50
What are pseudochylous effusions?
Grossly similar appearance to chylous effusions
| Have a high cholesterol content due to degeneration of cell membranes in the body cavity
51
What is uroperitoneum?
Leakage of urine from bladder, ureter, urethra, or kidney
52
What does uroperitoneum initiate?
Inflammatory response
53
What is the nucleated cell count like with uroperitoneum?
Low because of the relatively large amount of urine entering the body
54
What will the leakage of bile cause?
Low-moderate grade inflammation --> exudate
55
What does the leakage of gastric/intestinal contents cause?
Inflammation and exudate
56
What can causes cavitary effusions to accumulate?
Abdominal neoplasia
Heart failure
Urine or bile
57
What samples should be collected for pleural and peritoneal fluids?
EDTA to inhibit fibrin clot formation
| Sterile for microbiologic testing
58
What does it mean if fluid is clear/hazy?
Cellularity probably low, concentration method is needed
59
What does it mean if fluid is cloudy/opaque?
Concentration method is probably not needed
60
What will fluid look like if it's supernatant contains bilirubin?
Yellow-orange
61
What will fluid looks like if it's supernatant contains Hgb?
Pink-red-brown
62
What will fluid look like if it's supernatant contains stercobilinogen?
Brown
63
What will fluid look like if it's supernatant contains chorophyll?
Green
64
What will fluid look like if it's supernatant contains lipoproteins/chylomicrons?
White/creamy
65
What does it mean if the supernatant has color?
Pigment solutes in the fluid
66
What does it mean if the sediment has color?
Pigments in the cells or particles
67
What physical analysis is used for pleural and peritoneal effusion?
Refractometric estimates of [total protein]
| Refractometric estimates of specific gravity
68
What does total nucleated cell concentration measure?
Fluids that contain leukocytes, mesothelial cells, potentially other cells
69
What kind of fluid is present if TNCC is at its lowest values (<1,000/ul)?
Protein-poor transudates
70
What kind of fluid is present if TNCC is at its greatest values (>100,000/ul)?
Exudates and neoplastic lymphoid effusions
71
What is the most important part of the fluid analysis if the fluid is not clear and colorless?
Microscopic exam
72
What are the major aspects of microscopic exams?
Percentages of each nucleated cell
Diagnostic features of cells
Nucleated cell differential count
Extracellular structures
73
What cells are routinely identified on microscopic exams of fluid?
```
Neutrophils
Lymphocytes
Mesothelial cells
Macrophages
Mononuclear cells
Erythrocytes
Platelets
```
74
What does increased neutrophils usually indicate?
Exudation
75
What can degenerate appearing neutrophils occur without?
Sepsis
76
What may nondegenerate neutrophils occur with?
Sepsis
77
What should you look for if degenerate neutrophils are present?
Organisms
78
What may lymphocytes of fluid have features of when stimualted?
Reactive lymphocytes, plasmacytoid lymphocyte, or plasma cells
79
What is the structural function of mesothelial cells?
Involved in inflammatory response
80
What becomes more prominent the longer blood is in the cavity?
Erythophages, siderophages, and other macrophages
81
What happens when there is recurring or persistent low-grade hemorrhage (neoplasm)?
Properties of both acute (high Hct) and chronic (siderophages) hemorrhagic effusion are present
82
What does the presence of platelets suggest?
Ongoing or very recent hemorrhage or blood contamination
83
What does the presence of clots in the sample indicate?
Fibrinogen was in the sample and could be because of exudation, hemorrhage, or blood contamination
84
What will the analysis should if there is a suspicion that they effusion is chylous?
TG will be higher in fluid than in the serum
Cholesterol:TG ratio will be low
TG >100 mg/dL
85
What will urea and creatinine be like if there is recent urine in the cavity?
They will be greater than in plasma
86
What electrolytes are freely diffusible through most capillary walls?
Na, Cl, K
87
Where are the concentrations of Na, Cl, and K nearly the same?
In plasma, interstitial fluids, and most effusions
88
What is the exception to the concentrations of Na, Cl, and K?
Uroperitoneum has low Na and Cl and high K compared to plasma
89
What is L-lactate a product of?
Anaerobic glycolysis, which is increased in hypoxia
90
What is L-lactate increased in?
Peritoneal fludis
91
Is glucose lower in dogs and cats with bacterial effusions of nonbacterial effusions?
Bacterial effusions
92
What do protein concentrations in effusions represent?
Proteins that leaked through the capillary wall
93
What does increased lipase in fluid indicate?
Acute pancreatitis
94
When is septic used to describe exudates?
When bacteria was found in the microscopic exam of an exudate
95
What is bacterial exudate like?
Few to numerous leukocytes, often degenerate, TP >2 g/dL
96
What is intestinal content like?
Not many neutrophils
97
What are effusions with neoplastic lymphocytes like?
>10um nuclei, high cellular activity
98
What may carcinomas and adenocarcinomas do?
Exfoliate cells into effusion
99
Do metastatic sarcomas exfoliate or cause effusions?
Not typically
100
True or False: metastatic mast cell neoplasias may exfoliate cells into fluid
True
101
Will have hemangioma or hemangiosarcome have neoplastic cells in effusions?
Rarely
102
Will metastatic melanomas exfoliate neoplastic cells?
Yes
103
What can mesotheliomas produce?
Effusions with numerous anaplastic cells
104
What are the most common causes of lymphocyte rich effusions?
Lymphoid neoplasia
| Accumulation of lymph
105
What are pericardial effusions associated with?
Neoplasia and infection, often idiopathic
106
What do pericardial effusions frequently have features of?
Hemorrhagic effusion
107
What is amniotic fluid like?
Clear and watery
108
What are the cells present in amniotic fluid?
Numerous nucleated or anucleate cornified squamous epithelial cells
