Serous fluids
Terms
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- What are causes of ASCITIC TRANSUDATES?
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-Increased HP - Cong. heart failure
-Decreased COP - hepatic cirrhosis, nephrotic syndrome. - What are causes of ASCITIC EXUDATES?
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-Infections/Neoplasms/Trauma,
-Pancreatitis
-Metabolic disease (uremia) -Decreased lymphatic resorption - What's the procedure for getting ascitic fluid?
- Paracentesis
- What are most peritoneal effusions related to?
- Alcoholic liver cirrhosis.
- How is protein in ascitic fluid evaluated?
- SAAG
- what is SAAG?
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serum-ascities albumin gradient;
Serum alb - fluid alb = SAAG
--OR USE TOTAL PROTEIN--- - How is the SAAG evaluated?
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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?
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Hi-protein effusions;
- MALIGNANCY
- NEPHROTIC SYNDROME - 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?
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Spontaneous Bactrial Peritonitis
SBP - What distinguishes SBP
- A PMN count of >250/uL
- Name 5 other tests for peritoneal fluid:
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1. Amylase/lipase
2. Peritoneal lavage
3. Alkaline phosphatase
4. BUN/Creat
5. CEA and CA-125 - M"oving onto pleural fluid
- ok
- What are causes of pleural TRANSUDATES?
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same as ascitic;
-High HP from CHF
-Low COP from NS, cirrhosis. - What are causes of pleural EXUDATES?
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-Infections/neoplasms/trauma
-GI disease
-Systemic disease - SLE/RA
-Decrsd lymphatic resorption. - What are SPECIAL APPEARANCES of various pleural effusions?
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-Cloudy
-Bloody
-Milky - What does cloudy pleural fluid mean?
- Probably WBCs and/or bacteria.
- What does bloody pleural fluid mean? (3 things)
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-Traumatic tap
-Hemothorax
-Serosanguinous - What does milky pleural fluid mean? (2 things)
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-Chylous
-Pseudochylous -
What causes:
-Chylous fluid
-Pseudochylous -
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?
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-Cholesterol
-pH
-Amylase/lipase
-CEA and CA-125. - What information does the pH give about pleural fluid?
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-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?
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Whether it's malignant or not.
-45% of pleural fluids are! - Moving on to PERICARDIAL
- ok
- What are 3 causes of pericardial exudates?
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-Infection
-Myocardial infarct
-Neoplasms of lung/breast - What are indications for a pericardial tap?
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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.