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155 Cards in this Set
- Front
- Back
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Permeability barriers for cerebrospinal fluid
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capillary endothelial cell tight junctions, choiroid plexus epithelial cells, enzymes
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Substances that cannot normally enter CSF from blood
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large molecules, polar/non-lipid substances, charged molecules
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Diffusion mechanisms for molecules entering and leaving CSF
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simple diffusion: no energy required, no carrier protein
carrier-mediated diffusion: no energy required but uses a carrier protein active transport: requires energy and a carrier protein |
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How does the brain trap glucose within the CSF to maintain a downward concentration gradient?
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Hexokinase
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What are ependymal cells?
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The cells lining the ventricles
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What is a hematoidin crystal?
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bright yellow diamond-shaped crystal of hemosiderin
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What is transudation?
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Accumulation of fluid caused by alteration of pressure differences between the cavity and plasma
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What can cause transudation?
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hypertension, increased venous hydrostatic pressure in congestive heart failure, decreased plasma protein
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What is exudation?
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An accumulation of fluids caused by vascular permeability to protein most commonly due to inflammation
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What can cause exudation?
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leaky cell membranes (tumors), extended inflammation
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What is a chylous effusion?
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leakage of the lymphatic fluid into the peritoneal space
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What is characteristically present in chylous effusion?
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chylomicrons, triglycerides
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(T/F) The peritoneal cavity usually contains a great deal of fluid
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False, the peritoneal cavity usually contains minimal fluid
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What is analyzed in a peritoneal fluid sample?
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Color, clarity, RBCs, WBCs, glucose, protein, amylase, ammonia, alkaline phosphatase, LD, microbes, tumors, other substances
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3 types of peritonitis
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spontaneous, secondary, dialysis
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Spontaneous peritonitis usually occurs when:
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fluid ascites accumulates in the peritoneal cavity because of chronic liver disease
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Secondary peritonitis occurs when:
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bacteria or enzymes enter the peritoneum from a perforation in the gastrointestinal tract
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Transudates have _____ protein content, while exudates have _____ protein content
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low, high
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Peritoneal fluid LD >60% of plasma LD indicates what type of body fluid?
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exudate
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Chloesterol >60 mg/dL indicates a(n) ________ (transudate/exudate).
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exudate
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High ratio of triglyercide:cholesterol in peritoneal fluid indicates what?
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chylous effusion
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In peritoneal fluid, an absolute neutrophil count of ________ indicates inflammation
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>250/microliter
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An increase in lymphocytes and macrophages in peritoneal fluid may indicate what?
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viral infection, malignancy, autoimmune disease
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A low pH (<7.32) of peritoneal fluid may indicate what?
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infection
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Markedly low glucose concentration in peritoneal fluid occurs in:
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severe infections, malignancies, rheumatoid arthritis
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Is synovial fluid a transudate or an exudate?
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A transudate
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What is hyaluronic acid? What produces this substance in synovial fluid?
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high molecular weight glycosaminoglycan that is synthesized by type B synovial lining cells
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Normal synovial fluid is characterized by:
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clear, colorless appearance, inability to form fibrin clot, contains less than 200 WBC/microliter, production of a mucinous clot upon the addition of acetic acid
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Laboratory procedures performed on synovial fluid
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gross appearance, viscosity, RBC count, WBC count, WBC differential, microscopic examination for crystals, protein, glucose, gram's stain, culture
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What bacteria is most commonly responsible for septic arthritis?
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Staphylococcus aureus
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Urate crystals in synovial fluid appear:
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thin, needle-shaped, strong, bright
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What is purpose of the choroid plexus epithelial cells?
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to limit movement between blood and cerebrospinal fluid
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Describe enzymatic activity in the blood/brain barrier
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enzymes in endothelial cells convert permeable substances to non-permeable substances
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Describe the types of substances that cannot permeate the blood brain barrier
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large molecules (proteins, peptides, nucleotides)
polar non-lipid soluble substances (without a specific transport system) charged molecules |
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Describe the types of substances that can permeate the blood brain barrier
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gases, lipid soluble substances, water, nutrients, transmitter precursors
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How does simple diffusion move substances across the blood brain barrier? What type of molecule is usually moved?
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down a concentration gradient with no energy or carrier protein required
Usually lipid soluble substances |
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How does carrier-mediate diffusion move substances across the blood brain barrier?
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down a concentration gradient facilitated by a carrier molecule with no energy required
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T/F Carrier-mediated diffusion may be limited by availability of carrier molecules
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True, carrier molecules may be saturated
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How does active transport move substances across the blood brain barrier?
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against a concentration gradient by carrier molecules with energy required
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Active transport usually moves substances _______ (in/out) of the CNS
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Out
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What happens in organs other than the brain when glucose supply is low?
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Other organs decrease glucose utilization to maintain adequate supply of glucose to the brain
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Which organ in the body has an obligatory requirement for glucose?
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the brain
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Hexokinase has what activity in the brain?
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Traps glucose in the brain to maintain a concentration gradient for glucose diffusion into the CNS
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What enzyme in the glycolytic pathway has a unique isoenzyme in neurons that may be used a specific marker for nerve cells?
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Enolase (neuron specific enolase)
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What is significant about 2-deoxyglucose?
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It may be used as a marker to correlate changes in neural activity with changes in glucose utilization as it is trapped by hexokinase in the brain.
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What pathway provides D-ribose for the synthesis of DNA and RNA?
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pentose phosphate shunt
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Pentose phosphate shunts provides _____ for lipid synthesis
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NADPH
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What purposes do amino acids serve in the CNS?
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peptide/protein synthesis, precursors for transmitters, neurotransmitters
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What 11 types of proteins are specific for neural/glial cells?
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specific structural proteins
specific cell surface proteins (direct neural connections) contractile proteins neurotubular protein glial fibrillary protein enzymes for transmitter synthesis/degradation transmitter receptors membrane transporters ion channels growth factors synaptic vesicle protein |
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Where are ependymal cells found?
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in the lining of the ventricles or choroid plexus
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What type of cell that can be found in the CSF has nuclei that are round to oval with a definitive smooth nuclear membrane and evenly/finely distributed chromatin but no nucleoli?
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Ependymal cells
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T/F Neutrophils in the CSF look dramatically different from neutrophils in the blood
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False, they usually look identical but occasionally granulation disappears and pseudo-hypersegmentation is observed
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Why are nucleoli sometimes visible in lymphocytes in the CSF?
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The cells are "flattened" out during cytocentrifugation
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T/F Lymphocytes in the CSF look dramatically different from lymphocytes in the blood
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False, they are almost identical morphologically
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What is a leukophage?
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A macrophage containing a phagocytized white blood cell
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What is an erythrophage?
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A macrophage containing a phagocytized red blood cells (or fragments)
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What is a siderophage?
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A macrophage contained phagocytized particles of hemosiderin
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What is a hematoidin crystals?
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a bright-yellow diamond-shaped crystal of hemosiderin
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Hematoidin crystals are iron ______ (postive/negative) on the Prussian blue stain
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negative
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Are hematoidin crystals found intracellularly or extracellarly?
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Both
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Immature granulocytes in the CSF may be an indication of what?
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traumatic tap
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NRBCs are in the CSF are commonly due to what?
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Contamination by peripheral blood or bone marrow (traumatic tap)
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What must nRBCs be differentiated from in CSF?
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pyknotic WBCs
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nRBCs are ______ (rarely/commonly) found in body fluids
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rarely
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What is a Mott cell?
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A plasma cell with numerous clear cytoplasmic vacuoles containing immunoglobulins
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In what case are reactive macrophages most commonly found in CSF?
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subarachnoid hemorrhage in small children
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Reactive macrophages are very difficult to distinguish from what type of cell?
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large atypical lymphocytes
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CSF containing malignant cells will usually have what gross physical appearance?
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turbid or bloody
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T/F Malignant tumor cells in the CSF are usually seen in clusters
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True, usually in clusters of 3-5. However, they may occur singly.
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What conditions can result in a pinkish/red CSF specimen?
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subarachoid hemorrhage, intracerebral hemorrhage, infarction, traumatic tap
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Name the order of draw for lumbar puncture for 3 tubes
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Chemistry, Microbiology, Hematology
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Name the order of draw for lumbar puncture for 4 tubes
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Hematology, Chemistry, Microbiology, Hematology
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Xanthochromia in CSF may indicate what?
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hyperbilirubinemia or increased protein
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When differentiating a traumatic tap from a hemorrhage, the centrifuged CSF supernatant is clear in _______, but it is xanthochromic in _______.
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a traumatic tap, a hemorrhage
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Xanthochromia is used to refer to a pink, orange or yellow color of what body fluid's supernatant?
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CSF
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Viral infections are associated with an increase of what cell type in the CSF?
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mononuclear cells
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What conditions are associated with an increase in mononuclear cells in the CSF?
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viral infection, cerebral abscess, acute leukemia, lymphoma, intracranial vein thrombosis, cerebral tumor, multiple sclerosis
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Reference range for CSF protein
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10-45 mg/dL
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Reference range for CSF glucose
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40-70 mg/dL
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Normal physical appearance of CSF
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clear/colorless
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Normal RBC count for CSF
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< 5/microliter
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Normal WBC count for CSF
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< 5/microliter
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Low glucose levels in CSF are associated with what conditions?
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bacterial meningitis, cryptococcal meningitis, malignant involvement of the meninges, sarcoidosis
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Viral infections of the CSF are associated with _____ glucose levels
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normal
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Increased CSF glucose reflects what condition?
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serum hyperglycemia
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CSF glucose is usually 2/3 of _______ glucose.
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serum
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An increased CSF ______ is an early sign of bacterial and cryptococcal infection
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lactate
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Lactate levels in the CSF remain normal in what type of infection?
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viral
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What conditions other than bacterial infection can cause increased lactate levels in the CSF?
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severe cerebral hypoxia, genetic lactic acidosis
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What results in the formation of a transudate?
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Accumulation of fluid caused by alternation of pressure differences between the cavity and plasma
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What conditions can result in transudate formation?
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hypertension, congestive heart failure, decreased plasma proteins, cirrhosis, nephrotic syndrome
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What results in the formation of an exudate?
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Accumulation of fluids caused by vascular permeability to protein most commonly due to inflammation
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What is chylous effusion?
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leakage of lymphatic fluid into the peritoneal space
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Describe the appearance of chylous effusion.
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cloudy, almost white, turbid due to presence of chylomicrons and triglycerides
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Most common causes of viral gastroenteritis
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Norwalk virus and Rotavirus
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What population does Rotavirus normally affect?
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Children
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Norwalk virus usually causes institutional diarrhea with peak frequency during the ______.
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winter
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Contributing factors to toxic megacolon include what drugs?
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laxatives, cathartics, opiates, anticholinergic medications
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A low level of this serum analyte can contribute to toxic megacolon
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potassium
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What physical properties of peritoneal fluid are analyzed in the laboratory?
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color, clarity
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What microscopic properties of peritoneal fluid are analyzed in the laboratory?
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RBCs, WBCs, microorganisms, tumor cells
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What chemical properties of peritoneal fluid are analyzed in the laboratory?
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glucose, protein, amylase, ammonia, LD, alkaline phosphatase
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Spontaneous peritonitis is usually associated with what type of disease?
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chronic liver disease resulting in fluid ascites in the peritoneal cavity (bacterial infection is involved)
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Describe the cause of secondary peritonitis
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entry of bacteria or enzymes into the peritoneum from the gastrointestinal tract
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Name a few possible etiologies of secondary peritonitis
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ruptured appendix, perforation of bowel, pancreatitis
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Transudates have ____ protein content, while exudates have _____ protein content
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low, high
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What level of protein in a body fluid indicates an exudate?
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>50% plasma protein or >3.0 g/dL
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When is a body fluid LD level is invalid ?
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hemolyzed sample or traumatic tap
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If the peritoneal fluid concentration of LD is greater than 60% of plasma LD, what type of fluid do you probably have?
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An exudate
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Cholesterol levels >60mg/dL indicates a(n) _________ (transudate/exudate).
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exudate
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The ratio of triglyceride:cholesterol in lymphatic fluid is approximately _____.
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10:1
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A high triglyceride:cholesterol ratio indicates a _______, rather than an exudate.
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chylous effusion
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What absolute neutrophil count in peritoneal fluid indicates inflammation?
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>250/microliter
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A low pH (<7.32) in peritoneal fluid may indicate what?
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infection or malignancy
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Ratio of peritoneal amylase to plasma amylase of 1.5:1 or greater may indicate what condition?
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pancreatitis
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Markedly low glucose concentrations in the peritoneal fluid indicate what possible conditions?
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Rheumatoid arthritis, malignancy, severe infection
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Synovial fluid is a(n) ______ (transudate/exudate)
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transudate
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What type of molecule is hyaluronic acid?
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a high molecular weight glycosaminoglycan
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What cell synthesizes hyaluronic acid in the synovial fluid?
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type B synovial lining cells
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What are the functions of the synovial fluid?
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To lubricate the joint space and transport nutrients to the articular cartilage
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Describe the physical characteristics of normal synovial fluid
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Clear, colorless or straw colored, viscous
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What type of clot does normal synovial fluid produce with the addition of acetic acid?
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a mucinous clot
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(T/F) Synovial fluid can form a fibrin clot
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False
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How many WBCs does normal synovial fluid contain?
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<200 WBC/microliter
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What laboratory procedures are normally performed on a synovial fluid sample?
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Examination of physical characteristics, cell count, WBC differential, crystal examination, protein, glucose, gram stain, culture
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What are the groups of synovial fluid classification?
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Normal, non-inflammatory (group I), inflammatory (group II), septic (group III), hemorrhagic
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Describe the characteristics of a group I synovial fluid
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Non-inflammatory: high viscosity, clear, straw to yellow, 200-2000 WBC per microliter, negative Gram stain
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Describe the characteristics of a group II synovial fluid
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Inflammatory: low viscosity, cloudy or turbid, yellow, 2,000-75,000 WBCs per microliter, negative Gram stain
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Describe the characteristics of a group III synovial fluid
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Septic: variable viscosity, opaque, variable color, >100,000 WBC per microliter, positive Gram stain
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Describe the characteristics of a hemorrhagic synovial fluid
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High viscosity, variable clarity, red color, WBC count approximately equivalent to blood, negative Gram stain
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Osteoarthritis results in what type of synovial fluid sample?
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Group I, non-inflammatory
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Rheumatoid arthritis, Reiter's syndrome and viral infections result in what type of synovial fluid sample?
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Group II, inflammatory
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Pyogenic bacterial infections result in what type of synovial fluid sample?
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Group III, septic
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What bacterium is most commonly responsible for septic arthritis?
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Staphylococcus aureus
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Hemophilia, scurvy, tumors and trauma can all results in what type of synovial fluid sample?
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Hemorrhagic
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Describe the appearance of urate crystals in synovial fluid
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thin, needle-shaped, strong, bright
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Describe the appearance of MSU crystals in synovial fluid
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needle-shaped, frequently intracellular, strongly negatively birefringent
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Describe the appearance of Calcium Pyrophosphate dihydrate crystals in synovial fluid
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Rod or rhomboid shaped, weakly positively birefringent
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Basic calcium phosphate crystals in synovial fluid are found in what conditions?
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Acute calcific periarthritis, acute arthritis, destructive arthropathy
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What type of cells line the surfaces of the pleural membranes? What is their purpose?
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Mesothelial cells, to prevent the lung from making direct contact with the chest wall and the diaphragm
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Fluid enters the pleural space through the _______ (parietal/visceral) pleura.
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parietal. The fluid exits through the visceral pleura where it is drained into the lymphatic system.
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What normally prevents excessive fluid from entering the pleural space?
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protein in circulation and balanced pressures
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What three basic mechanisms result in pleural fluid accumulation?
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increased drainage of fluid into the space(hypertension, ascites)
increased production of fluid by cells in the space (mesothelioma) decreased drainage of fluid from the space (hypoproteinemia, empyema, tumor) |
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Exudate in the pleural space may indicate what conditions?
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malignancy, pneumonia, tuberculosis
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Transudate in the pleural space may indicate what conditions?
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CHF, cirrhosis, nephrotic syndrome, hypothyroidism, Meigs syndrome
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Describe the clinical importance of isoenzymes in pleural fluid
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They may help identify the source of an exudate
LD1, LD2 - red cells (blood) LD2, LD3 - malignancy LD5 - neutrophils |
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Glucose levels in pleuritis may be low due to _________.
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rheumatoid arthritis or bacterial infection
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What conditions can cause pericardial effusion?
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infection, cardiovascular disease, neoplasm, hemorrhage, autoimmune disease
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When might a surgical pericardiectomy be recommended?
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Recurrent or chronic bacterial pericarditis
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The total protein ratio of total protein in fluid to total protein in serum can help differentiate transudates from exudates. Which type of fluid has a low ratio?
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Transudates (<0.5)
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The LD ratio of total LD in the fluid to total LD in the serum can help differentiate transudates from exudates. Which type of fluid has a low ratio?
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Transudates (<0.6)
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Seminal fluid is made up of secretions from what organs/glands?
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testes, epididymis, seminal vesicles, prostate gland
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High viscosity of seminal fluid is associated with what?
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prostate secretion problems
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Low levels of fructose in the seminal fluid indicates what?
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obstruction of the ejaculatory ducts
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Acid phosphatase in the seminal fluid assesses the function of what?
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the secretory function of the prostate
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