Body fluids

where are body fluid found

between the membranes that lines body cavities

BF function

lubricant to prevent friction between closed organs

types of fluids are

Serous Fluid: (Pleural, Pericardial ,& Peritoneal), CSF: Cerebral Spinal Fluids, Synovial fluid, Amniotic Fluid, Semen, Urine

serous fluid location

closed cavities of the body in between the membrane, provides lubrication

serous fluids types

Pleural (thoracic), Peritoneal (ascites), Pericardial

two membranes lining the cavities are serous membranes

Parietal membrane (cavity wall), Visceral membrane (organs)

serous fluid formation

Ultra filtrates of plasma (no secretory processes)

serous fluid production and reabsorption

hydrostatic pressure, oncotic pressure, capillary permeability

↑hydrostatic pressure in systemic capillary

↑production and reabsorption in lymphatic system

Effusion

Increase in the amount of fluid between the membranes due to the disruption of the mechanism of serous fluid formation and reabsorption

effusion causes

↑ hydrostatic pressure (CHF), ↓ oncotic pressures (hypo proteinemia), ↑ capillary permeability (inflammation, infection), lymphatic obstruction (tumors)

serous fluid speciment collection

needle aspiration

needle aspiration at pleura

thoracentesis

needle aspiration at peritoneal

paracentesis

needle aspiration at Pericardial

pericardiocentesis

specimen type for cell counts

EDTA

specimen type for

chemistry, microbiology, cytologic tests, serology

specimen type for pH

specimen should be on ice

transudate (not always needed)

Systemic disorders that disrupt the balance in regulation of fluid filtration and reabsorption (↑in hydrostatic pressure or ↓ in oncotic pressure)

exudates (Necessary)

Direct involvement of the membranes (inflammatory process) causing ↑ capillary permeability and ↓ reabsorption of the fluid by the lymphatic system

Lab test

appearance, total protein, LD, cell count, clot formation

most reliable test

Fluid protein: serum protein (< 0.5 for transudate, >0.5 for exudate), Fluid LD: serum LD (< 0.6 for transudates, >0.6 for exudates)

Appearance of Pleural Fluid: clear, pale yellow

normal

Appearance of Pleural Fluid: turbid, white

microbial infection (ex: TB)

Appearance of Pleural Fluid: bloody

Hemothorax (trauma)

Appearance of Pleural Fluid: milky

Chylous (thoracic duct leakage) (↑ triglycerides), pseudochylous material (Chronic inflammation, ↑ cholesterol)

pleural fluid if: Neutrophil ↑

pneumonia, pancreatitis, pulmonary infarction

pleural fluid if: Lymphocytes ↑

TB, Viral infection, autoimmune disorders or malignancy

pleural fluid if: mesothelial cells (lining cell/ fried egg apperance)

normal and reactive have no clinical significance, ↓ in TB

pleural fluid if: Plasma Cell ↑

TB

pleural fluid if: malignant cells

adenocarcinoma, metastatic carcinoma

pleural fluid if: Eosinophil >10%

trauma (air or blood in pulmonary cavity)

low glucose

rheumatoid inflammation

high glucose

purulent infection

high lactase

bacterial infection

high triglyceride

chylosous effusion

decreased pH

pneumonia not responding to treatment & markedly ↓ with esophageal rupture

high Amylase

malignancy, pancreatitis, esophageal rupture

Gram stain, cultures, and acid fast stains

Staph aureus, Enterobacteriaceae, anaerobes, and Mycobacterium Tuberculosis.

serology test

to differentiate between non inflammatory and immunologic processes

Appearance of pericardial fluid: clear, pale yellow

normal transudate

Appearance of pericardial fluid: blood-streaked

infection or malignancy

Appearance of pericardial fluid: grossly bloody

cardiac puncture or anticoagulant meds

Appearance of pericardial fluid: milky

chylous and pseudochylous material

perdicardial fluid malignant cells

metastatic carcinoma

Ascites

accumulation of fluid (ascites fluid) in peritoneal cavity

Serum ascites albumin gradient:

used in differentiation between transudate and exudate of hepatic origin

Serum ascites albumin gradient =

serum albumin – fluid albumin (Gradient >1.1 (transudate), Gradient <1.1 (exudate))

Appearance of peritoneal fluid: clear, pale yellow

normal

Appearance of peritoneal fluid: turbid

microbial infection

Appearance of peritoneal fluid: green

gallbladder, pancreatic disorder

Appearance of peritoneal fluid: blood-streaked

trauma, infection or malignancy

Appearance of peritoneal fluid: milky

lymphatic trauma &blockage

Appearance of peritoneal fluid: peritoneal lavage

>100,000 RBC/μL (blunt trauma)

peritoneal fluid WBC <500 cells/uL

normal

peritoneal fluid WBC >500 cells/uL

bacterial peritonitis, cirrhosis

peritoneal fluid CEA

malignancy of GI tract

peritoneal fluid CA 125

malignant of ovarian origin

peritoneal fluid glucose

decrease in tubercular peritonitis, malignancy

peritoneal fluid amylase

increase in pancreatitis, GI perforation

peritoneal fluid Alkaline phosphatase (ALP)

increase GI perforation

peritoneal fluid BUN/creatinine

ruptured or punctured bladder

peritoneal fluid gram stain & culture

bacterial peritonitis

peritoneal fluid acid-fast stain and adenosine deaminase

TB

BAL definition

Saline instilled and aspirated from the distal bronchoalveolar tree

Bronchial wash vs BAL

Wash = proximal bronchioalveolar tree, BAL = distal bronchioalveolar tree with more cells

Fiber optic bronchoscope

bidirectional light to obtain image and provide light

Bronchoscope

rigid optical instrument now used for biopsy

first BAL specimen

ideal for cytologic studies (largest # of cells)

BAL done in

immunocompromised patients, interstitial lung disease, airway diseases

BAL more sensitive for

Pneumocystis carinii (Fungal Infection) and Aspergillus sp.

BAL Lymphocyte (NR: 1-10%) increased

interstitial lung disease, drug reactions, pulmonary lymphoma and nonbacterial infections

BAL eosinophils (NR: <1%) increased

asthma, hypersensitivity, pneumonitis, and eosinophilic pneumonia

BAL neutrophils (NR: 2-21%) increased

cigarette smokers and bronchopneumonia, exposure to toxins and alveolar damage

BAL macrophages (NR: 56-79%)

contain phagocytized material

lining cells

Ciliated columnar bronchial epithelial cells

Amniotic fluid formation and location

product of fetal metabolism present in amniotic sac surrounding the fetus

amniotic fluid functions

provide protective cushion, allow movement, and exchange of water and chemicals between fetus, fluid and maternal circulation

amniotic fluid 2nd trimester volume

major component is fetal urine

amniotic fluid 3rd trimester volume

maximun 1L, but will decrease prior to delivery

amniotic fluid 1st trimester volume

35mL from maternal circulation, similar to maternal plasma with some fecal cells

regulation of Amniotic fluid

fetal swallowing of amniotic fluid (AF)

hydramnios

failure to swallow, ↑ volume; cause: fetal distress due to neural tube defect

oligohydramnios

↑ fetal swallowing, ↓ volume; cause: urinary tract deformities and membrane leakage

amniotic fluid speciment collection

safe after 14 weeks of gestation

amniotic fluid speciments collection for chromasomal analysis

16 weeks

amniotic fluid screening test

trisomy (Extra chromosome) 21 (Down Syndrome) or 18 (Edwards), other

amniotic fluid is done if

maternal age is >35 because it is associated with defects

Amniocentesis can diagnosis

Down’s syndrome, Turner’s syndrome, X-linked muscular dystrophies, Congenital Adrenal Hyperplasia, Fragile X syndrome, Cystic fibrosis, Neural Tube Defects, and Erythroblastosis Fetalis (HDN)

liley’s test

assessment for fetal anemia

Liley Graph interpretation: zone 1

unaffected or only serologically affected

Liley Graph interpretation: zone 2A

mildly affected, if at all, deliver at term

Liley Graph interpretation: zone 2B

Moderately affected: deliver early and anticipate exchange transfusion

Liley Graph interpretation: zone 3

Severely affected: intrauterine transfusions indicated, deliver early

Neural tube defect (NTD)

most common birth defect

NTD indicates and cause

failure of skin to close over neural tissue, detect fetal neural tube defects (anencephaly and spina bifida)

Microviscosity ratio

>70 indicates FLM (fetal lung maturity)

Chromosomal studies for genetic disorders

Down’s syndrome, Turner’s syndrome, X-linked muscular dystrophies, Congenital Adrenal Hyperplasia, Fragile X syndrome

seminal fluid indications

infertility, post vasectomy, and forensic analysis

production of spermatozoa

seminiferous tubules of the testes