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45 Cards in this Set
- Front
- Back
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body fluid analysis
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useful to distinguish among causes of infection, inflammation, trauma and malignancy in body
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CSF
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-originates from choroid plexus
-surrounds the brain and spinal cord -constituents: most CSF constituents do not equal concentrations in plasma; regulated by BBB |
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CSF functions
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1. provides nutrition to brain
2. removes metabolic byproducts 3. protects against mechanical injury to brain |
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CSF specimen collection
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1. lumbar puncture (L3, L4 (around sup aspect of iliac crest) or L5 interspace)
2. 4 sterile collection tubes tube 1 (chem tests) tube 2 (microbio tests) tube 3 (cell counts) tube 4 (cytology) |
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CSF examination
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Fluid examination
Physical Microscopic Chemical Microbiologic -avoid delay in specimen processing -handle specimens with extreme care **look at references ranges |
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CSF opening pressure
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-expect 5-10 mm H2O drop in P for each 1 ml fluid removed
-increasing P's seen in: 1. hlding breath 2. tense muscles 3. bacterial or TB meningitis 4. encephalitis 5. neurosyphilis -decreased P seen in: 1. trauma 2. CSF leak |
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CSF physical exam
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-color (xanthochromia-there is a color to it): yellow (bilirubin); Pink/red (blood)
-clarity (0-4+) 1. white cloudy (wbc > 200/ul)- infx with bacteria, protein, WBC 2. red cloudy (RBC > 400)- blood |
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.Traumatic tap
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-amt of blood in tubes #1-4 diminshes
-colorless or pink supernatent |
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Subarachnoid hemorrhage
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-equal concentration of blood in all 4 tubes
-xanthochromic supernatant |
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CSF cell counts
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- total cell count
-WBCs -RBCs -Eosinophils (orangy granules) -malignant cells |
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CSF- chemical exam
PROTEIN |
-usually kept out by BBB
-causes of increased CSF protein level: not good 1. increased perm of BBB 2. inc CNS protein synthesis 3. tumor obstruction to flow 4. contamination with peripheral bl. -causes of decreased CSF protein level: rapid CSF loss |
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CSF- chem exam
GLUCOSE |
-50-80% of bl glucose level
Elevated levels: 1. hyperglycemia Decreased levels: not good 1. hypoglycemia 2, bacterial, fungal, protozoan infxs 3. metastatic or primary infxs 4. CNS leukemia |
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CSF microbiologic exam
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1. gram stain
2. acid fast stain 3. india ink stain 4. culture and sensitivity 5. antigen testing: ex. S.pneumoniae (faster, more $$, most useful for empiric tx, tx of close contacts and partially treated pts!) |
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typical CSF fluid findings in bacterial meningitis (deadliest)
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1. opening P: elevated
2. WBC count: > or equal to 1,000 per mm^3 3. Cell differential: predominance of PMNs 4. Protein: mild to marked elevation 5. CSF-to-serum glucose ratio: nml to marked decrease (look at chart) |
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contraindications for lumbar puncture
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1. Cardiorespiratory compromise
2. Cerebral herniation 3. Increased intracranial pressure |
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Synovial fluid
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Formed in all synovial joints
Ultrafiltration of plasma Secretion by synovium Functions Lubricates joints Supplies nutrients to chondrocytes Constituents Most constituents similar to plasma |
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synovial fluid specimen collection
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1. arthrocentesis
2. divide specimen from sterile collection tube (3-10mL) -sterile specimien -heparinized specimen -plain tube - |
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synovial fluid examination
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-Analyze specimens immediately
-Handle specimens with extreme care -Obtain fasting blood samples (look at reference ranges) |
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synovial fluid color
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1. green (purulent infx)
2. red/brown (blood) 3. milky white (TB, Lupus) |
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synovial fluid clarity
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0-4+
1. white cloudy: cells +/- prot 2. red cloudy: traumatic tap or hemorrhage 3. yellow cloudy: bacteria or inflammation |
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synovial fluid examination
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1. Microscopic examination
RBC WBC Crystals (uric acid) 2. Chemistry examination GLUCOSE +/- protein and uric acid 3. Microbiologic examination Gram stain (look at table) Culture |
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Synovial fluid; Septic (infx in the joint)
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1. possible auto-ABs present
2. cloudy, yellow-green fluid 3. poor viscosity 4. WBCs 10,000 to 200,000 5. neutrophils > 90% 6. decreased glucose 7. positive culture |
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Serous fluid
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-fluids contained in closed cavities of body
-cushoins organs -ultrafiltrate of plasma -rate of formation and reabsoprtion should be in balance |
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serous fluid: forces of control
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1. permeability of parietal membrane capillaries
2. hydrostatic P within caps 3. oncotic P produced by plasma proteins within caps 4. absoprtion of fluid by lymph system |
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Pleural fluid
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-surrounds lungs and lines thoracic cavity
-accumulation = effusion -specimen collection via thoracentesis |
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peritoneal fluid
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-fluid in peritoneal space
-accumulation = acites -specimen collected via abdominal paracentesis |
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serous fluid examination
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-Analyze specimens immediately
-Handle specimens with extreme care -Obtain fasting blood samples for LDH (looking to see if its high, b/ when there is a lot of cell turnover there is a high LDH), albumin and total protein |
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serous fluid physical and chemistry examination
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1. physcial:
-color and clarity 2. chemistry: -glucose -total protein -LDH -albumin -amylase -tumor markers |
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thoracentesis
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Midscapula line about 1 mm below where the fluid is
Needle: near upper border of lower rib -max: 1 L -can get a pneumothorax if not done properly |
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abdominal paracentesis
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-in LLQ
-about 1/3 from umbilicus to ASIS -max you can take out is 4L |
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synovial fluid examination
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1. Microscopic examination
RBC WBC Crystals (uric acid) 2. Chemistry examination GLUCOSE +/- protein and uric acid 3. Microbiologic examination Gram stain (look at table) Culture |
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Synovial fluid; Septic (infx in the joint)
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1. possible auto-ABs present
2. cloudy, yellow-green fluid 3. poor viscosity 4. WBCs 10,000 to 200,000 5. neutrophils > 90% 6. decreased glucose 7. positive culture |
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Serous fluid
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-fluids contained in closed cavities of body
-cushoins organs -ultrafiltrate of plasma -rate of formation and reabsoprtion should be in balance |
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serous fluid: forces of control
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1. permeability of parietal membrane capillaries
2. hydrostatic P within caps 3. oncotic P produced by plasma proteins within caps 4. absoprtion of fluid by lymph system |
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Pleural fluid
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-surrounds lungs and lines thoracic cavity
-accumulation = effusion -specimen collection via thoracentesis |
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peritoneal fluid
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-fluid in peritoneal space
-accumulation = acites -specimen collected via abdominal paracentesis |
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serous fluid examination
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-Analyze specimens immediately
-Handle specimens with extreme care -Obtain fasting blood samples for LDH (looking to see if its high, b/ when there is a lot of cell turnover there is a high LDH), albumin and total protein |
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serous fluid physical and chemistry examination
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1. physcial:
-color and clarity 2. chemistry: -glucose -total protein -LDH -albumin -amylase -tumor markers |
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thoracentesis
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Midscapula line about 1 mm below where the fluid is
Needle: near upper border of lower rib -max: 1 L -can get a pneumothorax if not done properly |
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abdominal paracentesis
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-in LLQ
-about 1/3 from umbilicus to ASIS -max you can take out is 4L |
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serous fluid microscopic and microbio exam
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1. microscopic
-total cell count -cytologic examination 2. microbiologic -gram stain -acid fast stain -culture -antigen testing |
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classifications of effusions
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-look at chart
Transudative fluid: passive fluid accumulation Exudative fluid: active mechanism of fluid accumulation |
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serum-ascities albumin gradient
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[albumin]serum - [albumin]ascites
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high serum-ascites albumin gradient
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> or equal to 1.1 g/dL
1. cirrhosis; alcoholic hepatitis 2. cardiac disease 3. massive liver metastases 4. fulminant hepatic failure 5. hepatic outflow block 6. portal vein thrombosis -due to portal hypertension |
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low serum-ascites albumin gradient
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< 1.1 g/dL
1. peritoneal carcinomatosis 2. tuberculous peritonitis 3. pancreatic duck leak 4. biliary leak 5. nephrotic syndrome 6. serositis |
