Serous Fluid

Question 1

•________: from the pleural cavity that surrounds the lungs

•_________: from the pericardial cavity that surrounds the heart

•________: from the peritoneal cavity that surrounds the abdominal organs

Answer 1

Pleural fluid

Pericardial fluid

Peritoneal fluid

Question 2

FORMATION
• 4 factors involved in formation:

Answer 2

• Permeability of capillaries in the parietal membrane
• Hydrostatic pressure in capillaries
• Oncotic pressure in capillaries
• Absorption of fluid by the lymphatic system

Question 3

COLLECTION
•__________: percutaneous puncture of a body cavity for fluid aspiration

(3)

Answer 3

Paracentesis

• Thoracentesis
• Pericardiocentesis
• Peritoneocentesis

Question 4

________
• Accumulation of serous fluids, which suggests a pathologic process

Answer 4

EFFUSION

Question 5

•: effusion in the peritoneal cavity

Answer 5

Ascites

Question 6

EFFUSION

• Common causes: (2)

Answer 6

• Increased capillary permeability and hydrostatic pressure

• Decreased oncotic pressure and absorption in the lymphatics

Question 7

: systemic diseases that increases hydrostatic pressure and decreases oncotic pressure; non-inflammatory

Answer 7

Transudate

Question 8

Transudate systemic diseases

Answer 8

Congestive heart failure
liver cirrhosis
nephrotic syndrome

Question 9

: inflammatory conditions that increases capillary permeability and decreases absorption in the lymphatic system

Answer 9

Exudate

Question 9

• Note: _______effusion is not classified as transudate or exudate.

Answer 9

Pericardial fluid

Question 10

• Bloody: differentiate…

Answer 10

traumatic tap and hemorrhagic effusions (hemothorax)

Question 11

• Milky: differentiate…

Answer 11

chylous from pseudochylous effusions

Question 12

• presence of WBCs, cells, lipids, or chyle

Answer 12

Cloudy serous fluids

Question 13

: malignant mesothelioma (cancer of the mesothelial cells that cover most internal organs; may be pleural or peritoneal)

Answer 13

• Viscous

Question 14

: Aspergillus infection

Answer 14

• Black

Question 15

: rupture of amoebic liver abscess

Answer 15

• Brown

Question 16

MICROSCSOPIC EXAMINATION

• Pericardial fluid: _______ indicates pericarditis

• Pleural fluid:________ indicates neoplasm or trauma

• Peritoneal fluid: a_______ with high neutrophils indicates bacterial peritonitis

Answer 16

WBC count > 1000 cells/ul

RBC count > 10,000 cells/ul

WBC count > 500 cells/ul

Question 17

• Total Cell Count
• Use_____ as diluent

Answer 17

NSS

Question 18

MICROSCOPIC EXAMINATION

• Differential Count: sample used???

• Count all_____ cells both in HPO and LPO

• LE cells (neutrophils with phagocytized homogeneous nucleus) may be seen
• Mesothelial cells
• Malignant cells

Answer 18

cytocentrifuged smear

nucleated

Question 19

• Cytologic examination: _______ of fluid when malignancy is suspected

Answer 19

10-200 ml

Question 20

• Note: Differential count is not routinely performed in______ fluid as different conditions produce the same differential count.

Answer 20

pericardial

Question 21

DIAGNOSTIC PERITONEAL LAVAGE

• Introduction of______ into the peritoneal cavity to detect abdominal injuries that have not yet resulted in fluid accumulation

• Commonly used in patients with…

• RBC counts_______ are indicative of blunt trauma injuries

Answer 21

normal saline

blunt abdominal trauma or any abdominal catastrophe

> 100,000/ml

Question 22

CHEMICAL EXAMINATION
LDH

LDH ratio: LDH of serous fluid/ LDH of serum

• Transudate:______
• Exudate:_____

Answer 22

< or equal to 0.6

> 0.6

Question 23

CHEMICAL EXAMINATION

TOTAL PROTEIN
• TP ratio: TP of serous fluid/ TP of serum

• Transudate:_____
• Exudate:____

Answer 23

< or equal to 0.5

> 0.5

Question 24

CHEMICAL EXAMINATION • Glucose • Low glucose level is clinically significant • Exudate: ______or if the difference between serum and serous fluid glucose is ______

Answer 24

< 60 mg/dl > 30 mg/dl

Question 25

•________: abnormal if the value exceeds the ULN or if 1.5 or twice the serum value • Carcinoembryonic antigen (CEA) and CA 125: malignant effusions of gastrointestinal (CEA) and ovarian (CA 125) origin

Answer 25

Amylase

Question 26

CHEMICAL EXAMINATION •_______: aids in differentiating chylous and pseudochylous effusions • Exudate:_____serous fluid to serum cholesterol ratio

Answer 26

Lipids > 0.3

Question 27

• pH • Parapneumonic effusions (exudate from pneumonia or lung abscess) • Collection: same with_______ • If______: resolved

Answer 27

ABG (anaerobic in heparinized syringe, transport with ice) > 7.3

Question 28

•________: increased in tuberculosis and malignancy

Answer 28

Adenosine deaminase

Question 29

MICROBIOLOGIC EXAMINATION (3)

Answer 29

• Gram stain • Acid-fast stain • Culture

Question 30

• Larger volume, greater chance of isolating an organism • Perform both aerobic and anaerobic culture

Answer 30

Culture