Chapter 10: Pleural, Pericardial, and Peritoneal Fluid Analysis

What does the serous membrane cover?

• lungs

• heart

• abdominal organs

• internal surfaces of body cavity wall

• capillary and lymph vessels 

What lines the internal surfaces of body cavities

• thin layer of connective tissue

• mesothelial cells

Serous cavity

• fluid-filled space between these membranes 

Pleural cavity

• encloses the lungs

Pericardial cavity

• encloses the heart

Peritoneal cavity

• encloses abdominal organs 

what is the purpose of fluid in cavities?

• lubrication between the two membranes

What controls fluid formation

• permeability of capilaries in parietal membrane 

• hydrostatic pressure in capillaries 

• oncotic pressure produced by plasma proteins in capilaries 

• absorption of fluid in lymphatic system 

How is hydrostatic pressure created

• blood pressure 

• forces plasma ultrafiltrate to form inside cavity 

what force opposes filtration and hydrostatic pressure?

• oncotic pressure

Effusion

• accumulation of fluid in a body cavity 

• indicates an abnormal or pathologic process 

what can occur as a result of increased hydrostatic pressure?

• congestive heart failure

• fluid retention 

What can occur as a result of increased capilary permeability 

• inflammation

• infection

• malignancy

what does lymph obstruction cause?

• tumors

• lymphomas

• infections

• inflammation 

Paracentisis

• percutaneous puncture of a body cavity for aspiration of fluid

Thoracentesis

• pleural fluid

Pericardiocentesis

• pericardial fluid

Peritoneocentesis

• peritoneal fluid 

Ascitis

• effusion in peritoneal cavity 

How does collection work for pleural fluid

• invasive surgical procedure

• needs multiple sterile tubes 

  • with cell counts

  • without anticoagulants 

• collect a blood sample as well 

Transudate

• results from systemic disease

• cause an increase in hydrostatic pressure or a decrease in oncotic pressure

• noninflammatory 

Exudate

• result from inflammatory processes

• increase permeability or capillary endothelium or a decrease in absorption by lymph system 

  • further testing is needed 

  • i could result from infections, neoplasms, trauma, or inflammatory conditions

How are plueral fluids classified?

• transudate

• exudate 

what is the typical appearance of transudates

• clear, pale yellow

• viscosity similar to serum 

• do not clot 

  • lack fibrinogen 

what is the typical appearance of exudates

• cloudy

• various colors

  • yellow,green, pink to red

• shimmer or sheen 

• can form clots 

what is the typical appearance of milky fluids

• large number of WBC, chyle, and or lipids

• milky after centrifuge indicates chyle

  • emulsion of lymph and chylomicrons 

Microscopic evaluation looks at when when evaluatrng pleural fluid?

• total cell count 

• RBC and WBC counts

• differential cell count

• cytology studies

• identification of crystals

• gram stain 

• cytologic examination for malignant cells 

WBC count less than 1000 cells/uL indicates what

• transudates

WBC count greater than 1000/uL indicate what?

• exudates

WBC typically indicate what?

• infection

what does it mean if RBC are present

• bloody taps or a disease process 

If a traumatic tap occurs, how can youy tell?

• RBC decrease later in collection tubes

• small clots may form 

What will indicate hemorrhagic effusion 

• blood homogeneously distributed 

• no clotting

Neutrophils

• predominate in most exudates of pleural and peritoneal fluid

Lymphocytes

• pleural effusion from TB, neoplasms, systemic disease

what causes peritoneal transudates and excludates

• decrease in lymphatic absorption 

what differential cells are there 

• neutrophils, lymphocytes, monocytic/macrophage, macrophage vs mesothelial cell

What other cells could be present in a differential cell count?

• monocytes

• macrophages

• eosinophils

• plasma cells

• mesothelial cells

• malignant cells 

Chemistry tests do what?

• differentiating fluid as transudate or exudate

• helps in establishing cause of fluid accumulation 

What chemical tests can be done

• total protein

• pH

• lactate dehydrogenase

• carcinoembryonic antigen 

• glucose

• lipids

• amylase

if fluid/serum protein ratio is less than 0.5 what does that mean?

• transudate

• normal fluid protein 

if fluid/serum protein ratio is greater than 0.5 what does that mean?

• exudate 

• increased fluid protein 

If fluid serum lactate dehydrogenase ratio is less than 0.6 what does that mean?

• transudate

• normal fluid LDH

If fluid serum lactate dehydrogenase ratio is greater than 0.6 what does that mean?

• exudate

• increased fluid LDH

What happens if serous fluid is <60 mg/dl or if the difference between serum and fluid glucose is >30 mg/dL

• fluid is exudate

what is high pleural or peritoneal fluid amylase associated with? 

• pancreatitis

• esophageal rupture

• gastric duodenal perforation 

• metastatic disease

What does it mean if lipids are >110 mg/dL triglyceride

• chylous effusion 

what does an abnormally low pH mean

• pleural exudates caused by pneumonia or lung abscess 

If pH is less than 7.3 while on antibiotics what has to happen?

• placement of drainage tubes  in order to resolve the effusion 

what is a carcinoembroytic antigen (CEA)

• tumor marker

chylous effusions

• caused by obstruction/damage to lymphatic system 

what indicates chylorus effusion

• trig > 110 mg/dl 

• trig: < 50 mg/dl rules it out 

• chylomicrons should be present 

what causes cloudy paracentesis fluid

• large number of WBC, other cells, chyle, and liids 

what indicates chyle in cloudy paracentesis fluid

• emulsion of lymph and chylomicrons 

• milky after centrifugation 

chylomicrons

• lipid transport

pseudochlyrous

• low triglycerides and no chylomicrons 

how do you differentiatre chronic effusions from chylous effusion

• chylous will have higher lipid content 

  • >110 mg/dl 

gram stain

• used to ID bacteria

Acid fast stain

• used to identify TB

Pleural Microbiology

• staphylococci s

• pneumonia

• h. influenzae 

Pericardial microbiology

• streptococci

• enterococci 

• staphylococci 

Peritoneal microbiology

• e. coli

• enterobacteria 

Results that indicate transudate fluid

WBC: <1000 cells/ul

neutrophils: absent

protein: normal 

Pf/Ps: <0.5 

LDH: normal 

LDHf/LDHs: <0.6

glucose: normal

Results that indicate exudate fluid

WBC: >1000 cells/ul

Neutrophils: increased

protein: increased

Pf/Ps: >0.5

LDH: increased

LDHf/LDHs: >0.6

Glucose: <60 mg/dl