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Unit 2 Clin Med Lab > L6: Transudative vs Exudative > Flashcards

L6: Transudative vs Exudative Flashcards

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1
Q

Does pulmonary embolism cause transudative or exudative effusion?

A

Can cause EITHER transudative or exudative effusion

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2
Q

most common causes of transudative pleural effusion

A

CHF
cirrhosis
nephrotic syndrome

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3
Q

most common causes of exudative pleural effusion

A

1st: Parapneumonic effusion
2nd: Malignancy
Autoimmune: lupus, rheumatoid arthritis
Hemothorax
Chylous effusion

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4
Q

Parapneumonic effusion

A

secondary to bacterial pneumonia, lung abscess, bronchiectasis

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5
Q

Malignancies most likely to cause exudative pleural effusion

A

lung/breast cancer, lymphoma

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6
Q

Hemothorax

A

pleural fluid has RBCs>100,000 cells/uL serousanginous appearance due to trauma, malignancy, pulmonary embolism

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7
Q

Chylous effusion

A

thoracic lymphatic duct disruption/impairment due to trauma, malignancy with lymphoma → cloudy milky effusion with triglycerides and lipids

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8
Q

Chylous effusion can occur in 2 sites

A

pleural fluid

peritoneal fluid

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9
Q

Light’s Criteria Rule for exudative pleural effusion

A
  1. Pleural fluid protein/serum protein ratio >.5
  2. Pleural fluid LDH/serum LDH ratio >.6
  3. Pleural fluid LDH > 2/3rds of upper limits of laboratory’s normal serum LDH

Any 1 of these three criteria: exudative

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10
Q

Transudative vs exudative pleural effusion: Total protein levels

A

Transudative: <3 g/dl
Exudative: > 3g/dl

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11
Q

Transudative vs exudative pleural effusion: protein fluid/protein serum ratio

A

Transudative: .5

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12
Q

Transudative vs exudative pleural effusion: Color

A

Transudative: clear, thin fluid
Exudative: cloudy, thick, viscous

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13
Q

Transudative vs exudative pleural effusion: WBC

A

Transudative: <300 cell/uL
Exudative: >500 cells/uL

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14
Q

Transudative vs exudative pleural effusion: LDH fluid/LDH serum ratio

A

Transudative: .6

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15
Q

Transudative vs exudative pleural effusion: fluid glucose vs serum glucose

A

Transudative: fluid glucose=serum glucose
Exudative: fluid glucose < serum glucose, or <60 mg/dl

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16
Q

Transudative vs exudative pleural effusion: pH

A

Transudative: 7.4-7.5
Exudative: 7.3-7.4

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17
Q

Transudative vs exudative pleural effusion: fluid amylase vs serum amylase

A

Transudative: fluid amylase=serum amylase
Exudative: fluid amylase > serum amylase

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18
Q

Peritoneal fluid aka

A

ascites

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19
Q

Causes of ascites

A

Portal hypertension: Hepatic cirrhosis (most cases), alcoholic hepatitis, acute liver failure

Malignancy (10%): most commonly ovarian

Heart failure, TB or fungal infection, hemodialysis-associated, pancreatic disease, nephrotic syndrome, severe malnutrition, myxedema (due to hypothyroidism)

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20
Q

severe hypothyroidism can cause

A

myxedema (severe edema)

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21
Q

Spontaneous bacterial peritonitis

A

Occurs in patients with cirrhosis+ascites

Infection likely originates in bowel→ abrupt onset of fevers, chills, abdominal pain, rebound tenderness

Exudative effusion

High mortality: important to recognize, treat

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22
Q

Transudative vs exudative peritoneal fluid:

Total protein levels

A

Transudative: <3g/dl
Exudative: >3g/dl

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23
Q

Transudative vs exudative peritoneal fluid:

Protein fluid/protein serum ratio

A

Transudative: .5

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24
Q

Transudative vs exudative peritoneal fluid:

Color

A

Transudative: thin, clear
Exudative: cloudy, thick, viscous

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25
Transudative vs exudative peritoneal fluid: | WBC
Transudative: <300 cells/uL Exudative: >500 cells/uL
26
Transudative vs exudative peritoneal fluid: | LDH fluid/LDH serum ratio
Transudative: .6
27
Transudative vs exudative peritoneal fluid: | Glucose
Transudative: fluid glucose=serum glucose Exudative: fluid glucose < serum glucose, or <60 mg/dl
28
Transudative vs exudative peritoneal fluid: | Serum:ascitic fluid albumin gradient
Transudative: >1.1 g/dL Exudative: <1.1 g/dL
29
SAAG=
Serum:ascitic fluid albumin gradient
30
Causes of pericardial effusion
Acute pericarditis (viral, bacterial, TB, idiopathic) autoimmune disease post-MI post cardiac surgery sharp/blunt chest trauma, cardiac diagnostics/interventional procedures malignancy (esp. metastatic) mediastinal radiation renal failure myxedema aortic dissection extending into the pericardium
31
How to tell if pericardial effusion is transudative or exudative
*Protein, LDH, glucose, RBC, WBC do not reliably differentiate an exudate from a transudate*
32
Rapid/acute pericardial effusion
small effusions 200-300 ml
33
Chronic pericardial effusion
larger effusions, >300 ml or so
34
When to suspect pericardial effusion
All cases of acute pericarditis Unexplained, new cardiomegaly on CXR without pulmonary congestion Unexplained persistent fever Fever + disease process which could involve the pericardium
35
Meningitis
Altered mental status + nuchal rigidity + fever Often rapid onset, patients are quite ill Requires rapid assessment and treatment → high mortality and long term morbidity
36
Encephalitis
brain infection
37
CSF
Between pia and arachnoid mater (subarachnoid space) | Blood brain barrier allows only lipid-soluble very small molecules to pass
38
Pleural fluid normal values
50 ml, clear/serous/light yellow RBCs: none WBCs: <300/ml <50 ml
39
Peritoneal fluid normal values
Clear, serous, light RBCs: none WBCs: <300/ml <50 ml
40
Pericardial fluid normal values
Clear, straw colored RBCs: none WBCs: none
41
CSF normal values
``` 150-200 ml Thin,clear Pressure <20 cm H2O* RBC: 0-5 cells/uL WBC: 0-5 cells/uL Protein: 15-45 mg/dL Glucose: 50-75 mg/dL (approx 2/3 serum glucose) LDH <40 units/L ```
42
Order CEA to test for
Cancer
43
Serum vs pleural fluid: compare:
Protein, glucose, amylase
44
Serum vs peritoneal fluid: compare:
Protein, glucose, LDH, albumin
45
Method of choice for pericardial fluid imaging
Ultrasound
46
What to order if your patient has pericardial fluid
Troponin, ESR, CRP ANA EKG PCR
47
Test for TB in
all body fluids
48
pleural fluid pH >7.3
infection esophageal rupture neoplasm
49
Increase pleural fluid amylase
pancreatitis esophageal rupture malignancy
50
Pleural fluid eosinophilia
Parasitic infection Malignancy TB
51
Peritoneal fluid LDH fluid/LDH serum ratio >.6
bowel perforation malignancy infection
52
Peritoneal fluid: Elevated amylase
``` pancreatic bowel perforation malignancy infection esophageal rupture ```
53
Peritoneal fluid: Elevated ammonia
ruptured/strangulated bowel
54
Peritoneal fluid: Elevated bilirubin (brown effusion)
bowel/biliary perforation
55
gold standard for analyzing CSF
culture
56
Cloudy CSF
infection | elevated protein
57
Pink/red CSF
bleeding from procedure vs. subarachnoid bleeding
58
Yellow CSF
xanthochromic: lysis of RBCs
59
Increased CSF pressure
infection intra-cranial bleeding tumor hydrocephalus
60
Decreased CSF pressure
hypovolemia (dehydration, shock), chronic CSF leak, nasal fracture with dural tear
61
Large differences in opening and closing pressure
spinal cord obstruction (tumor) | screaming/breath holding in baby/child who then relaxes
62
CSF neutrophils
bacterial/tubercular meningitis, cerebral abscess, subarachnoid bleeding, tumor
63
Abnormal CSF WBCs
>5 cells/uL
64
CSF Lymphocytes
viral/TB/fungal/syphilitic meningitis. Multiple sclerosis, Guillain-Barre syndrome
65
CSF Eosinophils
parasitic meningitis, allergic reaction to radiopaque dyes
66
CSF Macrophages
tubercular/fungal meningitis, hemorrhage, brain infarction
67
Abnormal CSF RBCs
>5 cells/uL
68
abnormal WBC:RBC ratio in CSF
Ratio of 1 WBC:500 RBCs → pathologic: infection/meningitis
69
Xanthochromia in CSF
lysis of RBCs→ hemoglobin→ oxyhemoglobin → methemoglobin → bilirubin Present in >90% of patients within 12 hours of subarachnoid hemorrhage onset, but also can be present in infectious/inflammatory process
70
Increased CSF protein
``` infection/inflammatory processes meningitis encephalitis myelitis autoimmune disease +/- bleeding/hemolysis ```
71
Oligoclonal gamma globulin bands (CSF)
Multiple sclerosis
72
CSF glucose 2/3 of serum glucose
meningitis | neoplasm
73
CSF glucose is increased in
hyperglycemic atates
74
Increased CSF lactate dehydrogenase
bacterial meningitis malignancy intracranial hemorrhage
75
Increased CSF Lactic Acid
bacterial/fungal meningitis, but *not in viral*
76
Increased CSF Glutamine
hepatic encephalopathy | coma
77
Increased CSF C-reactive protein (CRP)
bacterial meningitis
78
Test CSF for
syphilis (VDRL/FTA-ABS) Cryptococcus (india ink) Toxoplasmosis (Giema/wright stain)
79
Positive latex agglutination of CSF
meningococcal meningitis
80
Traumatic puncture vs subarachnoid bleed: | CSF pressure
Traumatic puncture: normal | Subarachnoid bleed: increased
81
Traumatic puncture vs subarachnoid bleed: | Duration of bleeding
Traumatic puncture: decreases as CSF is drawn | Subarachnoid bleed: remains the same color throughout draw
82
Traumatic puncture vs subarachnoid bleed: | Repeat lumbar puncture
Traumatic puncture: no blood | Subarachnoid bleed: blood
83
Traumatic puncture vs subarachnoid bleed: | Clotting
Traumatic puncture: present | Subarachnoid bleed: absent
84
Traumatic puncture vs subarachnoid bleed: | Centrifuge
Traumatic puncture: clear fluid | Subarachnoid bleed: xanthochromia

Unit 2 Clin Med Lab (8 decks)

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