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Serous fluids


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What are causes of ASCITIC TRANSUDATES?
-Increased HP - Cong. heart failure
-Decreased COP - hepatic cirrhosis, nephrotic syndrome.
What are causes of ASCITIC EXUDATES?
-Metabolic disease (uremia) -Decreased lymphatic resorption
What's the procedure for getting ascitic fluid?
What are most peritoneal effusions related to?
Alcoholic liver cirrhosis.
How is protein in ascitic fluid evaluated?
what is SAAG?
serum-ascities albumin gradient;

Serum alb - fluid alb = SAAG
How is the SAAG evaluated?
Elevated is higher than 1.1 g/dL
Decreasd is lower than 1.1
What causes an elevated SAAG?
Portal hypertension from alcoholic cirrhosis.
What causes a decreased SAAG?
Hi-protein effusions;
When do cell counts become important when evaluating peritoneal fluid?
When the SAAG is High. Alcoholic cirrhosis can be uncomplicated, or Complicated.
What complication can result from alcoholic cirrhosis?
Spontaneous Bactrial Peritonitis
What distinguishes SBP
A PMN count of >250/uL
Name 5 other tests for peritoneal fluid:
1. Amylase/lipase
2. Peritoneal lavage
3. Alkaline phosphatase
4. BUN/Creat
5. CEA and CA-125
M"oving onto pleural fluid
What are causes of pleural TRANSUDATES?
same as ascitic;
-High HP from CHF
-Low COP from NS, cirrhosis.
What are causes of pleural EXUDATES?
-GI disease
-Systemic disease - SLE/RA
-Decrsd lymphatic resorption.
What are SPECIAL APPEARANCES of various pleural effusions?
What does cloudy pleural fluid mean?
Probably WBCs and/or bacteria.
What does bloody pleural fluid mean? (3 things)
-Traumatic tap
What does milky pleural fluid mean? (2 things)
What causes:
-Chylous fluid
Chylous: from dmg to the thoracic duct of lymphatics.
Pseudochylous: assoc w/ Rh. Arth
What are other tests that can/should be done on Pleural fluid?
-CEA and CA-125.
What information does the pH give about pleural fluid?
-Intubation -> if over 7.3, don't.
-Esophageal damage - acidic.
What is the Amylase/lipase useful for?
Evaluating/looking for esophageal damage. If salivary amylase is present in the pleural fluid, that's bad.
What info does CEA and CA-125 give about pleural fluid?
Whether it's malignant or not.
-45% of pleural fluids are!
Moving on to PERICARDIAL
What are 3 causes of pericardial exudates?
-Myocardial infarct
-Neoplasms of lung/breast
What are indications for a pericardial tap?
to rule out infection
to rule out neoplasm.
What do hemosiderin crystals tell?
that there's been RBC ingestion.
What is an LE cell?
a neutrophil with ingested material.

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