SYNOVIAL Flashcards by skug LU

Viscous liquid found in the cavities of the movable
joints (diarthroses) or synovial joints

Synovial fluid

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Bones in the synovial joints are lined with ___ and separated by a cavity containing The synovial fluid.

Bones in the synovial joints are lined with smooth
articular cartilage and separated by a cavity containing
the synovial fluid.

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Joint is enclosed in a _____lined by the
synovial membrane that is lubricated by synovial fluid.

Joint is enclosed in a fibrous joint capsule lined by the
synovial membrane that is lubricated by synovial fluid.

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Synovial membrane contains specialized cells called
.

synoviocytes

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Macrophage-like cells located in
the superficial layer of the synovial membrane
and play an important role in phagocytosis.

Type A cells

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FIbroblast-like cells with prominent
endoplasmic reticulum located in a deeper layer
of the synovial membrane and produce
hyaluronic acid, fibronectin, and collagen to
produce synovial fluid.

Type B cells

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together
reduce friction between the bones during joint
movement.

Smooth articular cartilage and synovial fluid

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provides nutrients to the articular cartilage
and lessens the shock of joint compression that occurs
during activities such as walking and jogging

Synovial fluid

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is formed as an ultrafiltrate of plasma
across the synovial membrane.

Synovial fluid

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The secrete a mucopolysaccharide
containing hyaluronic acid and a small amount of protein
(approximately one fourth of the plasma concentration)
into the fluid

synoviocytes

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contribute the noticeable
viscosity to synovial fluid.

hyaluronate molecules

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Damage to the articular membranes produces
pain and stiffness in the joints

Arthritis

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Degenerative joint disorders,
osteoarthritis

Non-inflammatory

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mmunologic disorders,
rheumatoid arthritis,
systemic lupus
erythematosus,
scleroderma, polymyositis,
ankylosing spondylitis,
rheumatic fever, Lyme
arthritis, Crystal-induced
gout, pseudogout

Inflammatory

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Microbial infection

Septic

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Traumatic injury, tumors,
hemophilia, other
coagulation disorders,
Anticoagulant overdose

Hemorrhagic

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Classification and Pathological Significance of Joint
Disorders

NON INFLAMMATORY
INFLAMMATORY
SEPTIC
HEMORRHAGIC

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Clear, yellow fluid
Good viscosity
WBCs <1000 uL
Neutrophils <30%
Similar to blood glucose

Noninflammatory

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Cloudy, yellow fluid
Poor viscosity
WBCs 2,000 to 75,000 uL
Neutrophils >50%
Decreased glucose level
Possible autoantibodies
present

INFLAMMATORY - Immunologic origin

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Cloudy or milky fluid
Low viscosity
WBCs up to 1000,000 uL
Neutrophils <70%
Decreased glucose level
Crystals present

INFLAMMATORY

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Cloudy, yellow green fluid
Variable viscosity
WBCs 50,000 to 100,000 uL
Neutrophils >75%
Decreased glucose level
Positive culture and Gram
stain

III. Septic

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Cloudy, red fluid
Low viscosity
WBCs equal to blood
Neutrophils equal to blood
Normal glucose level

Hemorrhagic

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Colorless and pale
yellow

Normal

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In arthritis the following are decreased

Production of hyaluronic acid
Polymerization of hyaluronic acid
Viscosity

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Synovial fluid is collected by needle aspiration called

arthrocentesis

Fluid is often collected in a syringe that has been moistened with .

heparin

plain, nonanticoagulated red stopper tube

Tube 1 used for chemical or immunologic analysis.

sodium heparin per mL (green stopper) EDTA) tube (lavender stopper) f

Tube 2 cell count, differential count, and crystal identification.

heparin is added (green stopper) or to a sodium polyanethol sulfonate (yellow stopper)

Tube 3 tube for microbiological studies..

should not be used because they may produce artifacts that interfere with crystal analysis.

Powdered anticoagulants

tube for other tests must be centrifuged and separated to prevent cellular elements from interfering with chemical and serologic analyse

Nonanticoagulated

Technical Tip: Specimens for ___________should not be refrigerated because they can produce additional crystals that can interfere with the identification of significant crystal

crystal analysis

Glucose analysis WHAT TUBE

Sodium fluoride

Presence of WBCs, red blood cells (RBCs), synoviocytes, crystals, fat droplets, fibrin, and cellular debris in the synovial fluid.

Clarity

o Crystals present:

Miky

o Presence of WBCs o Synovial cell debris and fibrin

Turbidity

Bacterial infection COLOR

: greenish tinge

Normal viscous synovial fluid resembles

egg white.

comes from polymerization of the hyaluronic acid and is essential for the proper joints lubrication.

Synovial fluid viscosity

Arthritis ______- the fluid viscosity.

decreasing

Hyaluronate polymerization can be measured using a

Ropes, or mucin clot test.

Mucin clot test is reported in terms o

f good (solid clot), fair (soft clot), low (friable clot), and poor (no clot).

Formation of a mucin clot after adding acetic acid can be used to identify a questionable fluid as

synovial fluid

Rope or mucin clot test REAGENT

Add 2% to 5% acetic acid to S.F.

Diluting fluid FOR CELL COUNT

Diluting fluid Nss Hypotonic slaine (0.4%) Saponin “add methylene blue’ Do not use acetic acid it will clot sample

Primary cells found

Mono, macrophage, synovial TISSUE cells

Evaluation of arthritis

Crystal id

Cause of crystal formation

Metabolic disorder (goat) Decreased renal excretion Degeneration of cartilage injoints Injection of steroids

= screen presence of crystals

Direct polarization

id of crystal

Compensated polarization =

- crystal deposition in articular tissue

Gout

- inflammatory response to crystal deposition

Gouty arthritis

- primary crystal for gouty arthritis

Monosodium urate (MSU)

= pseudo gout

Calcium pyrophosphate (CPPD)

= calcified cartilage degeneration

Hydroxyapatite

notched end rhombic plates

Cholesterol crystal -

Types of arthritis

Osteoarthritis - breakdown of cartilage RA autoimmune disease + autoantibodies Gouty arthritis - inflamm due to crystal deposition crystal present Septic arthritis - bacterial infection Positive gram stain and culture

can aid in detecting tissue cells and debris.

Scattergrams

HOW MUCH NEUTRO AND LYMPHO IS PRESENT

 Neutrophils: < 25%  Lymphocytes: < 15%

 Increased neutrophils indicate a _____ condition

septic

Elevated cell count with a predominance of lymphocytes suggests a inflammation.

nonseptic

Other cell abnormalities include the presence of:

o Eosinophils o LE cells o Reiter cells o RA cells o Lipid droplets o Hemosiderin granules

(or neutrophages, vacuolated macrophages with ingested neutrophils)

Reiter cells

(or ragocytes, neutrophils with small, dark cytoplasmic granules consisting precipitated rheumatoid factor).

RA cells

may be present after crush injuries

Lipid droplets

are seen in cases of pigmented villonodular synovitis

Hemosiderin granules

VOL

< 3.5 ml

VISCOSITY

4-6 cm long

RBC count

< 2000 cells/ uL

WBC count

< 200 cells/ uL

Neutrophil

< 20 %

Lymphocyte

< 15 %

Monocyte & Macs

65 %

Glucose

< 10 mg/ ml than blood

Lactate

< 250mg/ dl

Total protein

< 3 g/ dl

Increased levels are found in patients with inflammatory and hemorrhagic disorders

Total Protein

Elevation of in cases of gout

Elevation of serum uric acid in cases of gout

Increased in septic arthritis caused by gram-positive cocci and gram-negative bacilli Except in arthritis caused by Neisseria gonorrhea

Lactate

Increased levels are found in patients with inflammatory and hemorrhagic disorders

TOTAL PROTEIN

SYNOVIAL Flashcards

(80 cards)