Peritoneal Fluid and Synovial

ascites

Peritoneal Fluid

• Is the accumulation of fluid between the peritoneal membranes

ascitic fluid

Peritoneal Fluid

• is used to refer to the fluid instead of peritoneal fluid

cirrhosis

Peritoneal Fluid

• is the frequent cause of ascitic transudates

Exudative fluids

Peritoneal Fluid

In peritoneal it leads to;

• Bacterial Infection/Peritonitis (intestinal perforation or ruptured appendix)

• Malignancy

peritoneal lavage

Peritoneal Fluid

• Is a sensitive test to detect intraabdominal bleeding in blunt trauma cases

>100,000/mL

Peritoneal Fluid

• RBC count can be used along with radiographic procedures to aid in determining the need for surgery

• RBC count ________are indicative of blunt trauma injuries

• Eosinophil count can be used to detect allergic reactions to the equipment used in peritoneal dialysis

serum ascites albumin gradient

Peritoneal Fluid

• Is recommended over the Fluid:Serum Total Protein and LDH Ratio to detect hepatic transudates

  • SAAG = serum albumin – fluid albumin

• Fluid and serum albumin levels are measured concurrently

>_1.1

Peritoneal Fluid

• For SAAG, a difference/gradient of ____ suggest a hepatic transudate

  • SAAG = serum albumin – fluid albumin

>500

Peritoneal Fluid

• WBC count of <500 cells/uL is normal

• WBC count of _______ cells/uL indicates bacterial peritonitis and cirrhosis

Absolute Neutrophil Count

Peritoneal Fluid

• To differentiate between bacterial peritonitis and cirrhosis, perform an?

>250

Peritoneal Fluid

• To differentiate between bacterial peritonitis and cirrhosis, perform an Absolute Neutrophil Count

• An absolute neutrophil count of ______ cells/uL or >50% of the total WBC count indicates infection

Note: Lymphocytes are the predominant cells in tuberculosis (Same with Pleural Fluid)

green

Significance of Peritoneal Fluid Testing

• Bile, gallbladder, pancreatic disorders

alkaline phosphatase

Significance of Peritoneal Fluid Testing

• Increased in gastrointestinal perforation

BUN/ creatinine

Significance of Peritoneal Fluid Testing

• Ruptured or punctured bladder

lipophages

Peritoneal Fluid Cells

• Macrophages containing fat droplets

Budding yeast

Ascitic Fluid Cells: Peritoneal Fluid

ovarian carcinoma

Ascitic Fluid Cells: Peritoneal Fluid

• Showing community borders (Cytoplasmic molding) , nuclear irregularity and hyperchromatic nucleoli

adenocarcinoma

Ascitic Fluid Cells: Peritoneal Fluid

• Prostate showing cytoplasmic vacuoles, community borders, and hyperchromatic nucleoli

colon carcinoma

Ascitic Fluid Cells: Peritoneal Fluid

• Containing mucin vacuoles and nuclear irregularities

psammoma bodies

Ascitic Fluid Cells: Peritoneal Fluid\

• exhibiting concentric striations

  • cells that have calcium deposits

synovial fluid

• Often referred to as “Joint Fluid”

• A viscous liquid found in the cavities of the movable joints (diarthroses)

• An ultrafiltrate of plasma, most of its constituents have concentrations similar to plasma values

hyaluronic acid

Synovial Fluid

• The synovial membrane contains specialized cells called synoviocytes, which secrete a mucopolysaccharide containing ___________, which polymerizes and contributes to the viscosity of synovial fluid

arthritis

Synovial Fluid

• is the collective term for any damage to the articular membranes that produces pain and stiffness in the joints

Arthrocentesis

Synovial Fluid

• Is the medical procedure done to collect synovial fluid via needle aspiration

heparin

Synovial Fluid

• Normal synovial fluid does not clot, but a diseased joint may contain fibrinogen and will clot, therefore collection is often done with a syringe that has been moistened with ?

gram stain and culture

Required Tube Types for Synovial Fluid Tests

• Sterile heparinized or SPS

cell counts

Required Tube Types for Synovial Fluid Tests

• Heparin or liquid EDTA

Note: Since Synovial is viscous, don’t use regular diluting fluids like glacial acetic acid, but you need to use NSS 0.9% to dilute

glucose analysis

Required Tube Types for Synovial Fluid Tests

• Sodium Fluoride

1 hour

Synovial Fluid: Technical Tip

• To prevent falsely decreased values caused by glycolysis, specimens should be analyzed within _____ or preserved with Sodium Fluoride

<3.5 mL

Normal Synovial Fluid Values

• Volume?

4-6 cm

Normal Synovial Fluid Values

• its Viscosity is able to form a string _____ long (2.3 Inches)

• If very viscous; pre -treat with

  • 1 drop of 0.05 % hyaluronidase in phosphate buffer per mL of fluid and incubate at 37*C for 5 min

noninflammatory

Classifications and Pathologic Significance of Join disorders (Synovial)

• Degenerative joint disorders

• Osteoarthritis

infammatory

Classifications and Pathologic Significance of Join disorders (Synovial)

septic

Classifications and Pathologic Significance of Join disorders (Synovial)

• Microbial infection

hemorrhagic

Classifications and Pathologic Significance of Join disorders (Synovial)

noninflammatory

Laboratory Findings in Joint Disorders(Synovial)

Note: You will notice, all other than this have a poor viscosity.

inflammatory : immunologic origin

Laboratory Findings in Joint Disorders

• Poorly viscous, because diseases affects the production and polymerization of hyaluronic acid

ropes/mucin clot test

Test for Hyaluronic Acid

• Note: Not routinely performed because all forms of arthritis decrease viscosity and little diagnostic information is obtained

inflammatory : crystal induced origin

Laboratory Findings in Joint Disorders

septic

Laboratory Findings in Joint Disorders

hemorrhagic

Laboratory Findings in Joint Disorders

macrophages, synovial lining cell

Cells and Inclusions Seen in Synovial Fluid

• Normal significance

Reiter cell

Cells and Inclusions Seen in Synovial Fluid

• Reactive arthritis (Infection in another part of the body)

rice bodies

Cells and Inclusions Seen in Synovial Fluid

• Tuberculosis

• Septic and RH

fat droplets

Cells and Inclusions Seen in Synovial Fluid

• Traumatic injury

• Chronic Inflammation

hemosiderin

Cells and Inclusions Seen in Synovial Fluid

• Pigmented villonodular synovitis

Monosodium urate and calcium pyrophosphate

Characteristics of Synovial Fluid Crystals

• Commonly seen crystals in synovial fluid

monosodium urate

Characteristics of Synovial Fluid Crystals

• Usually seen in cytoplasm

• Shape: Needles

• Compensated Polarized light: (-) Bifringence

• Significance: Gout

Attached photo are just other types lang

calcium pyrophosphate

Characteristics of Synovial Fluid Crystals

• Usually seen in vacuoles

• Shape: Rhomboid square, rods

• Compensated Polarized light: (+) Bifringence

• Significance: Pseudogout (e.g athletes)

Attached photo are just other types lang

lyme disease

Laboratory Section : Synovial Fluid

SEROLOGY

• Most test are performed on serum, synovial fluid is used as a confirmatory measure for cases that difficult to diagnose

• Arthritis is a frequent complication of ________, therefore demonstrating antibodies against Borrelia burgdorferi can confirm the cause.

Attached Photo is for Microbiology

glucose

Laboratory Section : Synovial Fluid

CHEMISTRY

• Most frequently tested is _________ (8 hours fasting), because markedly decreased ________levels indicate inflammatory (group II) or septic (group III) disorders

Attached Photo is for Microbiology