AUBF 24: SEROUS FLUID

Pleural fluid

Obtained from the pleural cavity, located between the parietal pleural membrane lining the chest wall and the visceral pleural membrane covering the lungs

Pleural fluid cholesterol, serum cholesterol ratio, serum total bilirubin ratio

Tests to analyze pleural fluid

60 mg/dL - exudate

Pleural fluid cholesterol

0.3 - exudate

Pleural fluid serum cholesterol ratio

0.6 - exudate

Fluid serum total bilirubin ratio

Clear, pale yellow

Appearance of normal fluid

Turbid, white

Appearance of the fluid when there is presence of WBC, bacterial infection, tuberculosis, immunologic disorder (rheumatoid arthritis)

Bloody

Appearance of the fluid when there is hemothorax (traumatic injury), malignancy, hemorrhagic effusion, pulmonary embolus, tuberculosis

Milky

Appearance of the fluid when chylous material from thoracic duct has a leakage, pseudochylous material from chronic inflammation

Brown

Appearance of the fluid when there is a rupture of amoebic liver abscess

Black

Appearance of the fluid when there is Aspergillus infection

Viscous

Malignant mesothelioma (increased hyaluronic acid)

Hematocrit

Used to differentiate between hemothorax and hemorrhagic exudate

Chylous material

Contains high concentration of triglycerides

Pseudochylous material

High concentration of cholesterol

Sudan III

Staining positive for chylous material

Cholesterol

Pseudochylous effusions contains ___ crystals

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Caused by thoracic duct damage

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Caused by chronic inflammation or lymphatic obstruction

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Appears milky/white

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Appears milky/green tinge

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Predominantly contains lymphocytes

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Contains mixed cells

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Absent cholesterol crystals

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Present cholesterol crystals

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Triglycerides of >110 mg/dL

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Triglycerides of <50 mg/dL

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Sudan III Staining whows strongly positive

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Sudan III Staining shows negative/weakly positive

Transudates

Effusion formed because of a systemic disorder that disrupts the balance in the regulation of fluid filtration and reabsorption

Hydrostatic pressure

Changes in ____ created by congestive heart failure or the hypoproteinemia associated with the nephrotic syndrome is an example of a transudate

Exudates

Formed by conditions that directly involve the membranes of the particular cavity

Initial diagnostic, aid

Classifying whether transudate or exudate can provide valuable ___ step and ___ in further testing

Transudate

Transudate/ exudate: It is not necessary to test this fluid

Protein and lactic dehydrogenase blood ratio

Most reliable differentiation between transudate and exudate fluids

Transudate

Transudate/ exudate: Clear

Exudate

Transudate/ exudate: Cloudy

Transudate

Serum protein ration: <0.5

Exudate

Serum protein ration: >0.5

Transudate

Serum LD ratio: <0.6

Exudate

Serum LD ratio: >0.6

Transudate

WBC count: <1000/uL

Exudate

WBC count: >1000/uL

Transudate

No spontaneous clotting

Exudate

Possible spontaneous clotting

Transudate

Pleural fluid cholesterol: <45 to 60 mg/dL

Exudate

Pleural fluid cholesterol: >45 to 60 mg/dL

Transudate

Pleural fluid serum cholesterol ratio: <0.3

Exudate

Pleural fluid serum cholesterol ratio: >0.3

Transudate

Pleural fluid bilirubin ratio: <0.6

Exudate

Pleural fluid bilirubin ratio: >0.6

Transudate

Serum ascites albumin gradient: >1.1

Exudate

Serum ascites albumin gradient: <1.1

C

The primary purpose of serous fluid is to: a. Remove waste products b. Lower capillary pressure c. Lubricate serous membranes d. Nourish serous membranes

D

The membrane that lines the wall of a cavity is the: a. Visceral b. Peritoneal c. Pleural d. Parietal

A

During normal production of serous fluid, the slight excess of fluid is: a. Absorbed by the lymphatic system b. Absorbed through the visceral capillaries c. Stored in the mesothelial cells d. Metabolized by the mesothelial cells

D

Production of serous fluid is controlled by: a. Capillary oncotic pressure b. Capillary hydrostatic pressure c. Capillary permeability d. All of the above

C

An increase in the amount of serous fluid is called a/an: a. Exudate b. Transudate c. Effusion d. Malignancy

D

Pleural fluid is collected by: a. Pleurocentesis b. Paracentesis c. Pericentesis d. Thoracentesis

BAAABAB

Place the inappropriate letter in front of the following statements describing transudates and exudates a. Transudate b. Exudate

____ caused by increased hydrostatic pressure ____ caused by increased capillary permeability ____ caused by decreased oncotic pressure ____ caused by congestive heart failure ____ malignancy related ____ tuberculosis related ____endocarditis related

B

Fluid: serum protein and lactic dehydrogenase ratios are performed on serous fluids: a. When malignancy is suspected b. To classify transudates and exudates c. To determine the type of serous fluid d. When a traumatic tap has occurred

B

Which of the following requires the most additional testing? a. Transudates b. Exudates

C

An additional test performed on pleural fluid to classify the fluid as a transudate or exudate is the: a. WBC count b. RBC cout c. Fluid:cholesterol ratio d. Fluid-to-serum protein gradient

D

A milky-appearing pleural fluid indicates: a. Thoracic duct leakage b. Chronic inflammation c. Microbial infection d. Both A and B

D

Which of the following best represent a hemothorax? a. Blood HCT: 42 Fluid HCT:15 b. Blood HCT: 42 Fluid HCT: 10 c. Blood HCT: 30 Fluid HCT: 10 d. Blood HCT: 30 Fluid HCT: 20

D

All of the following are normal cells seen in pleural fluid except: a. Mesothelial cells b. Neutrophils c. Lymphocytes d. Mesothelioma cells

C

A differential observation of pleural fluid associated with tuberculosis is: a. Increased neutrophils b. Decreased lymphocytes c. Decreased mesothelial cells d. Increased mesothelial cells

B

All of the following are characteristics of malignant cells except: a. Cytoplasmic molding b. Absence of nucleoli c. Mucin-containing vacuoles d. Increased nucleus:cytoplasm ratio

A

A pleural fluid pH of 6.0 indicates: a. Esophageal rupture b. Mesothelioma c. Malignancy d. Rheumatoid factor

D

Plasma cells seen in pleural fluid indicates: a. Bacterial endocarditis b. Primary malignancy c. Metastatic lung malignancy d. Tuberculosis infection

B

A significant cell found in pericardial or pleural fluid that should be referred to cytology is a: a. Reactive lymphocyte b. Mesothelioma cell c. Monocyte d. Mesothelial cell

C

Another name for a peritoneal effusion is: a. Peritonitis b. Lavage c. Ascites d. Cirrhosis

B

A test performed primarily on peritoneal lavage fluid is a/an: a. WBC count b. RBC count c. Absolute neutrophil count d. Amylase

B

The recommended test for determining whether peritoneal fluid is a transudate or an exudate is the: a. Fluid:serum albumin ratio b. Serum ascites albumin gradient c. Fluid:serum lactic dehydrogenase ratio d. Absolute neutrophil count

B

Given the following results, classify this peritoneal fluid: serum albumin, 2.2 g/dL, serum protein, 6.0 g/dL, fluid albumin, 1.6 g/dL a. Transudate b. B. exudate

C

Differentiation between bacterial peritonitis and cirrhosis is done by performing a/an: a. WBC count b. differential c. Absolute neutrophil count d. Absolute lymphocyte count

B

Detection of the CA125 tumor marker in peritoneal fluid indicates: a. Colon cancer b. Ovarian cancer c. Gastric malignancy d. Prostate cancer

D

Chemical tests primarily performed on peritoneal fluid include all of the following except: a. Lactose dehydrogenase b. Glucose c. Alkalinephosphatase d. Amylase

D

Cultures of peritoneal fluid are incubated: a. Aerobically b. Anaerobically c. At 37degC and 42degC d. Both A andB

Pleural fluid

Obtained from the pleural cavity, located between the parietal pleural membrane lining the chest wall and the visceral pleural membrane covering the lungs

Pleural fluid cholesterol, serum cholesterol ratio, serum total bilirubin ratio

Tests to analyze pleural fluid

60 mg/dL - exudate

Pleural fluid cholesterol

0.3 - exudate

Pleural fluid serum cholesterol ratio

0.6 - exudate

Fluid serum total bilirubin ratio

Clear, pale yellow

Appearance of normal fluid

Turbid, white

Appearance of the fluid when there is presence of WBC, bacterial infection, tuberculosis, immunologic disorder (rheumatoid arthritis)

Bloody

Appearance of the fluid when there is hemothorax (traumatic injury), malignancy, hemorrhagic effusion, pulmonary embolus, tuberculosis

Milky

Appearance of the fluid when chylous material from thoracic duct has a leakage, pseudochylous material from chronic inflammation

Brown

Appearance of the fluid when there is a rupture of amoebic liver abscess

Black

Appearance of the fluid when there is Aspergillus infection

Viscous

Malignant mesothelioma (increased hyaluronic acid)

Hematocrit

Used to differentiate between hemothorax and hemorrhagic exudate

Chylous material

Contains high concentration of triglycerides

Pseudochylous material

High concentration of cholesterol

Sudan III

Staining positive for chylous material

Cholesterol

Pseudochylous effusions contains ___ crystals

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Caused by thoracic duct damage

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Caused by chronic inflammation or lymphatic obstruction

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Appears milky/white

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Appears milky/green tinge