UNIT 10. SEROUS FLUID

• parietal membrane - lines cavities

• visceral membrane - lines organs

Pleural, Pericardial, Peritoneal Cavities are lined by 2 membranes, namely ?

Serous Fluid

__ is the body fluid responsible for lubrication in the serous membrane

• Pleural Cavity - lodges the lungs

• Pericardial Cavity - lodges the heart

• Peritoneal/Visceral Cavity - lodges the visceral organs

ENUMERATE

Body cavities

serous space

The space between the visceral and parietal membranes is called the ___.

lymphatic capillaries

The difference in pressure between the parietal and visceral capillaries creates a small excess of fluid.

This excess fluid is reabsorbed by __ within the membranes.

T

T or F

Both membranes contain blood vessels — specifically capillaries — that allow the exchange of fluids.

serous space

The ultrafiltrate of plasma naturally moves into the ___

endothelial cells

not the same

Since capillaries have ___ that act as filters, the fluid that enters the serous space comes from the blood, but its composition is ___ as that of blood because some blood components cannot pass through the endothelial barrier.

oncotic

same

The __ pressure between or in both sides of the parietal and visceral membrane are the _.

ultrafiltrate of plasma

where does serous fluid come from

Oncotic pressure

__ is the force yield by your protein in pulling back the water back to the circulation/blood vessel.

hydrostatic pressure

__ is the pressure yielded because of a natural phenomenon caused by gravity.

Hydrostatic

__ pressure is responsible for the filtration process.

Abnormal effusion

__ is the excess accumulation of fluid in the serous space.

EFFUSION

By the action of oncotic pressure the pressure that pulls back the excess fluid into the circulation and by hydrostatic pressure the pressure that brings in fluid in the cavity the volume of serous fluid remains to be constant unless there is __

Effusion

__ is the abnormal accumulation of fluid within a body cavity, usually due to inflammation, increased capillary permeability, or an imbalance between hydrostatic and oncotic pressures.

Transudate

__ are effusions that form because of a systemic disorder that disrupts the balance in the regulation of fluid filtration and reabsorption

Transudate

An effusion produced because of metabolic disruptions in the production and reabsorption of serous fluid.

Occurs when there is no inflammation or infection, but rather a disturbance in pressure balance within the capillaries.

Exudate

An effusion produced because of inflammation or infection.

This is not a metabolic problem, but rather a pathological response where fluid escapes due to increased permeability or tissue damage

congestive heart failure

hypoproteinemia associated with nephrotic syndrome.

Transudate are effusions that form because of a systemic disorder that disrupts the balance in the regulation of fluid filtration and reabsorption—such as the changes in hydrostatic pressure created by ___ or ___

Exudates

___ are produced by conditions that directly involve the membranes of the particular cavity, including inflammations/infections and malignancies.

• congestive heart failure

• salt & fluid retention

Causes of Transudates due to Increased hydrostatic pressure

• nephrotic syndrome

• hepatic cirrhosis

• malnutrition protein-losing enteropathy

• hypoproteinemia

Causes of Transudates due to Decreased oncotic pressure

protein wasting

Nephrotic Syndrome is Characterized by __.

80%

total protein, albumin, and globulin (TPAG)

In cirrhosis, about __ of hepatocytes are damaged, resulting in decreased _

Edema

__ is also a common manifestation in patients with cirrhosis or kidney problems.

• microbial infections

• membrane inflammation

• malignancy

Causes of Exudates due to Increased Capillary permeability

• malignant tumors

• lymphomas

• infection/inflammation (W. bancrofti or B. malayi)

• thoracic duct injury

Causes of Exudates due to Lymphatic obstruction

>100 ml

Main Needle Aspiration: __ is collected

needle aspiration

Fluids for laboratory examination are collected by __ from the respective cavities

• Pleural = Thoracentesis

• Pericardial = Pericardiocentesis

• Peritoneal = Paracentesis

NEEDLE ASPIRATION

• Pleural = ___

• Pericardial = ___

• Peritoneal = ___

• EDTA

• Sterile Heparinized

• SPS

• Heparin

[SESH]

ENUMERATE

Anticoagulants used in Body fluid aspiration

EDTA

Anticoagulants used in Body fluid aspiration

• Cell counts & Differential counts

Sterile Heparinized & SPS

Anticoagulants used in Body fluid aspiration

• Microbiology & Cytology

Plain tubes / Heparin

Anticoagulants used in Body fluid aspiration

• Chemistry

• transported on ice or

• maintained in anaerobic conditions

pH requirement for body fluids aspiration

< 10 ml

Normal volume of Pleural fluid

10-50 ml

Normal volume of Pericardial fluid

< 100 ml

Normal volume of Peritoneal fluid

PLEURAL FLUID TRANSUDATE

• Pleural fluid cholesterol = < 45-60 mg/dL

• Pleural fluid: serum cholesterol ratio = < 0.3

• Pleural fluid: bilirubin ratio = < 0.6

PLEURAL FLUID TRANSUDATE

• Pleural fluid cholesterol =

• Pleural fluid: serum cholesterol ratio =

• Pleural fluid: bilirubin ratio =

PLEURAL FLUID TRANSUDATE

• Pleural fluid cholesterol = > 45-60 mg/dL

• Pleural fluid: serum cholesterol ratio = > 0.3

• Pleural fluid: bilirubin ratio = > 0.6

PLEURAL FLUID EXUDATE

• Pleural fluid cholesterol =

• Pleural fluid: serum cholesterol ratio =

• Pleural fluid: bilirubin ratio =

recollect for sediment analysis

wtd if malignant cells are found on CSF?

Clear & pale yellow

Normal appearance of Pleural fluid

• Microbial infection (Tuberculosis)

• immune disorder (Rheumatoid Arthritis)

Turbid white appearance of Pleural fluid

transudate

Transudate or Exudate?

Exudate

fibrinogen

Specimen clotting in exudates is due to the presence of __

• Transudate = Clear, water-like

• Exudate = Cloudy, pus-like

SPX APPERANCE

• Transudate =

• Exudate =

WBC

Cloudy, pus-like appearance of exudate is due to increased ___

1. Hematology - EDTA

2. Microbiology - SPS

3. Chemistry - Heparin/Plain

Order of Department priority for serous fluid analysis

cytology

Histopathology

If the hematology section finds malignant cells during differential count, a __ exam is requested, then to the _ section for further examination.

Differential Count (Wright Stain, Cytocentrifuged Specimen)

• Examines not only WBCs but also normal and malignant cells

• The purpose is to examine not only WBCs, but also other nucleated cells present in the specimen.

Manual (Neubauer Counting Chamber)

• Count all nucleated cells, inclusion tissue cells, and debris

• including degenerated or depressed cells.

Electronic Counters

Used to prevent debris interference during cell counting

• Hemothorax (Traumatic injury)

• Hemorrhagic Exudate (Malignancy)

• Traumatic Tap

ENUMERATE

Causes of blood pleural fluid

Hemothorax (Traumatic injury)

• PF Hct > 50% of WB Hct

• effusion from blood due to injury

Hemorrhagic Exudate (Malignancy)

• PF Hct < WB Hct

• blood less than pleural fluid

Traumatic Tap

Cause of streaked & uneven pleural fluid

Rupture of amoebic liver abscess (E. histolytica)

cause of brown pleural fluid

Aspergillus infection

cause of black pleural fluid

Malignant mesothelioma (presence of hyaluronic acid)

cause of viscous pleural fluid

Hemothorax

• Caused by traumatic injury—a blood vessel is damaged, allowing blood to enter the pleural fluid.

• Uneven blood distribution across collected specimen tubes

• 1st tube: Dark red (high blood content)

• 2nd tube: Pink (less blood)

• 3rd tube: Light-colored (further diluted)

HEMOTHORAX

• 1st tube:

• 2nd tube:

• 3rd tube:

Hemorrhagic

• Caused by active bleeding within the pleural cavity.

• Even blood distribution across all tubes — all remain red regardless of how many are collected

Chylous Effusion

• Caused by damage to the thoracic duct

• Triglyceride level: High

• Cholesterol level: Low

Pseudochylous Effusion

• Caused by chronic inflammation or lymphatic obstruction.

• Triglyceride level: Low

• Cholesterol level: High

Chylous effusion

Pseudochylous effusion

macrophage

Lymphocytes

Neutrophils

Eosinophils

Mesothelial Cells

Membranes lining the serous cavities consist of a single layer of these cells.

Normal cells: small or large, round, with round nuclei and uniform dark purple cytoplasm

Reactive Mesothelial Cells

Found in clusters, multinucleated, with eccentric nuclei, resembling malignant cells.

tuberculosis

Lack of mesothelial cells with plasma cells indicates ___.

Malignant Cells

Show nuclear and cytoplasmic irregularities and hyperchromatic nucleoli.

pneumonia

malignancy

Malignant cells in pleural fluid is increased in __ and _.

Triglyceride

Glucose

↓ (Decreased) in tuberculosis, rheumatoid inflammation, and infections

Lactate

↑ (Increased) in bacterial infections

pneumonia

need for tube drainage

< pH 7.2 would suggest ?

• gastric fluid issues

• esophageal rupture

≤ pH 6.0 would suggest ?

malignancy

≥ pH 7.4 (alkaline) may be related to __

• acidosis

• advanced infection

pH 0.30 lower than blood pH indicates ?

ADA (Adenosine Deaminase)

> 40 U/L

High __ levels may indicate malignancy or tuberculosis.

Pleural Fluid & Salivary Amylase

Tested for assessment of pancreatitis, Esophageal rupture and malignancy

• >1.1 = Transudate

• <1.1 = Exudate

Serum-Ascites Albumin Gradient (SAAG)

• >1.1 =

• <1.1 =

PERITONEAL LAVAGE

Sensitive test to detect intra-abdominal bleeding in blunt trauma cases

RBC count >100,000/mL

parameter used as an indication of Blunt trauma injuries

bile

Green/Dark-brown Peritoneal fluid indicates the presence of __

bacterial peritonitis or cirrhosis

>500 cells/µL in peritoneal fluid indicates

Ascitic exudates

show malignant cells, Lipophages, Toxoplasma gondii

Psammoma bodies

seen in benign conditions & w/ Ovarian & Thyroid malignancies

GIT malignancy, colorectal cancer

CEA in peritoneal fluid

ovaries, fallopian tubes, endometrium cancers

(+) CA125, (-) CEA

Pancreatitis, GIT perforation

Increased amylase & lipase in peritoneal fluid

GIT perforation

Increased ALP in peritoneal fluid