SPUTUM, BAL, SWEAT

Mixture of plasma, electrolytes, mucin, and water

Tracheobronchial secretions

Sputum is ____ water

95%

Sputum is ____ solids

5%

Most important single component of sputum viscosity

Sialic acid

Acceptable sputum specimen: ____ SEC / LPF

<10

Acceptable sputum specimen: ____ WBC / LPF

>25

Most preferred sample for sputum collection

1st morning

Sputum collection for volume measurement

24-hr sputum

Sputum collection for pediatric patients

Throat swab

Sputum collection for non-cooperative patients

Sputum indication

Sputum collection for debilitated or unconscious patients

Tracheal aspiration

Sputum preservation

Refrigerate

Sputum preservation if refrigeration is not possible

10% formalin

Patients with bronchial asthma will have?

Decreased sputum volume

Patients with acute bronchitis will have?

Decreased sputum volume

Patients with early pneumonia will have?

Decreased sputum volume

Patients in the stage of healing will have?

Decreased sputum volume

Patients with bronchiectasis will have?

Increased sputum volume

Patients with lung abscess will have?

Increased sputum volume

Patients with edema will have?

Increased sputum volume

Patients with gangrene will have?

Increased sputum volume

Patients with TB will have?

Increased sputum volume

Patients with pulmonary hemorrhage will have?

Increased sputum volume

Colorless or yellow sputum

Made up of mucus only

White or yellow sputum

Increased pus

What conditions may the patient have if the sputum color is white or yellow?

TB, bronchitis, jaundice, pneumonia

Gray sputum

Increased pus and epithelial cells

Bright green or greenish sputum

Increased bile

In what conditions can you see bright green or greenish sputum?

P. aeruginosa infection

Red or bright red sputum

Fresh blood or hemorrhage, TB, bronchiectasis

Anchovy sauce or rusty brown sputum

Old blood, pneumonia, gangrene

Prune juice sputum

Pneumonia, chronic lung cancer

Olive green or grass green sputum

Cancer

Black sputum

Dust or dirt, carbon, charcoal, anthracosis, smoking

Rusty with pus

Lobar pneumonia

Patients with S. pneumoniae infection can have this characteristic sputum

Rusty with pus

Ruty without pus

Congestive heart failure

Currant, jelly-like sputum

Klebsiella pneumoniae infection

Normal odor for sputum

Odorless

Foul or putrid sputum odor

Lung gangrene, advanced necrotizing tumors

Sweetish odor

Bronchiectasis, tuberculosis

Cheesy sputum odor

Necrosis, tumors, empyeme

Fecal sputum odor

Liver abscess, enteric Gram (-) bacterial infection

Mucoid consistency of sputum

Asthma, bronchitis

Serous or frothy consistency of sputum

Lung edema

Mucopurulent consistency of sputum

Bronchiectasis, tuberculosis with cavities

Macroscopic structures associated with bronchial asthma, bronchitis, bronchiectasis

Dittrich’s plugs

Yellow or gray material, size of a pinhead, prodcues foul odor when crushed

Dittrich’s plugs

Hard concretions in a bronchus (lung stones)

Yellow / white calcified TB structures / foreign materials

Pneumoliths or Broncholiths

Patients with Histoplasmosis and chronic tuberculosis may have these macroscopic structures

Pneumoliths / Broncholiths

Most common cause of pneumoliths / broncholiths

Histoplasmosis

Branching tree-like casts of the bronchi

Bronchial casts

Patients with lobar pneumonia, bronchitis, and diphtheria may have these macroscopic structures

Bronchial casts

Formation found in bronchiectasis, lung abscess, and gangrene

Layer formation

Layer formation: 1st layer

Frothy mucus

Layer formation: 2nd layer

Opaque, water material

Layer formation: 3rd layer

Pus, bacteria, tissues

Macroscopic structures associated with pneumoconiosis

Foreign bodies

Bronchial calculi (calcium carbonates and phosphate)

Asbestos bodies, silica particles

Foreign bodies

Macroscopic structures associated with TB

Elastic fibers

Slender fibrils with double countour and curled ends

Elastic fibers

Macroscopic structures associated with bronchial asthma only

Charcot-Leyden crystals

Colorles, hexagonal, double pyramid, often needle-like, arise from disintegration of eosinophils

Charcot-Leyden crystals

Macroscopic structures assoc. with congestive heart failure and heavy smokers

Pigmented cells

Hemosiderin-laden macrophages

Heart failure cells

Angular black granules

Carbon-laden cells

Assoc. with bronchial asthma, coiled mucus strands, “fluffball”

Curschmann’s spirals

Macroscopic structures that have no significance and are mistaken as Blastomyces

Myelin globules

Colorless globules occuring in a variety of sizes and bizarre forms

Myelin globules

Clusters of columnar epithelial cells assoc. with bronchial asthma

Creola bodies

Parasites found in sputum

ASH

E. histolytica, E. gingivalis, T. tinax, P. westermani, E. granulosus, T. canis

Bronchoalveolar lavage is an important diagnostic test for?

P. jiroveci (P. carinii)

Stain used for detecting cysts of P. jiroveci

Grocott’s methenamine silver stain

Most predominant cell in BAL

Alveolar macrophage

Alveolar macrophage percent comp in BAL

56-80%

Lymphocytes percent comp. in BAL

1-15%

Lymphocytes in BAL may be increased with what conditions?

Interstitial disease, pulmonary lymphoma, nonbacterial infections

Neutrophils percent comp. in BAL

< 3%

Neutrophils may be increased with what conditions?

Cigarette smoking, bronchopneumonia, toxin exposure

Primary granulocyte in BAL

Neutrophil

Eosinophils percent comp. in BAL

<1-2%

Eosinophil in BAL associated with what conditions?

Hypersensitivity reaction

Ciliated columnar bronchial epithelial cells percent comp. in BAL

4-17%

Sweat test is used to diagnose?

Cystic fibrosis

Cystic fibrosis aka?

Mucoviscidosis

Cystic fibrosis pattern of inheritance

Autosomal recessive

CF is associated with?

Pancreatic insufficiency, respiratory distress, intestinal obstruction

In CF, Na is?

Increased

In CF, Cl is?

Increased

Pilocarpine iontophoresis: application of _____ current

0.16 mA

Pilocarpine iontophoresis: application of current for _______

5 minutes

How is sodium tested?

Flame photometry, ion exchange electrode

How is chloride tested?

Manual or automated titration

Diagnostic for CF

>70 mEq/L

Borderline for CF

40 mEq/L