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47 Cards in this Set
- Front
- Back
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CSF Color Changes in Pathologis Bleeds- After Centrifugations
Pink Yellow to Orange |
Pink - oxyHb from ruptured RBC, first occurs 2-4 after bleed, peaks in 24-36hrs, subsides in 4-8 days
Yellow to orange - (Xanthochromia) sign of pathologic bleed, due to oxyHb breakdown to bilirubin, appears at 12hrs, pks at 2-4 days, subsides at 2-4wks |
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Increased CSF protein (IgG)
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Increased permeability - acute inflammation
Increased CNS plasma cell production - demyelinating disorders (MS) |
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CSF Index
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Indications for demyelinating disease
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Increased values = demyelinating ds
Decreased = acute inflammation [CSF IgG x serum albumin]/[CSF albumin x serum IgG] Normal : < /= 0.85 |
increased CSF IgG, Increase CSF index (>0.85), oligoclonal bands, increased MBP (active disease)
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Diseases with Decreased CSF Glucose
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Diseases with Normal CSF levels
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Normal = 66% of serum (50-75 mg/dL
Decreased (<40) - bacteria, fungal, metastatic disease to meninges, mumps, herpes simplex, lymphocytic choriomeningitis |
viral meningitis, neurosyphilis, demyelinating disease, cerebral abscess
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CSF WBC
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Normal : 0-5 mononuclear cells/m3
Neutrophils are NOT normally present in CSF |
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Increased CSF WBC
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Bacterial Meningitis:
Total WBC Differential CSF glucose CSF Protein |
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Bacterial Meningits - Neutrophils predominate
Viral - Neutros 1st 24hrs then Lymphocytes Fungal - Mononuclear (lymphs and monocytes) Parasites - Mixed, (eosinophils suggest helminth infx.) |
Total WBC>1000
Differential>90% Neutrophils CSF glucose<40mg/dL CSF Protein>150mg/dL |
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Viral Meningitis
Total WBC Differential CSF glucose CSF Protein |
Fungal
Total WBC Differential CSF glucose CSF Protein |
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Total WBC<1000
Differential: Lymphocytes CSF glucose usually normal CSF Protein: 50-100mg/dL |
Total WBC<500
Differential: Lymphocytes/monocytes CSF glucose<40mg/dL CSF Protein>150mg/dL |
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Multiple Sclerosis
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Most Common Demyelinated disease, female 2:1 ~20-40yrs old
CD8 destrol myelin, Abs to MBP Acute relapse and remission of sensory and motor sympt. |
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Multiple Sclerosis Lab Findings
Total WBC Differential CSF glucose CSF Protein |
Total WBC: increased (Tcells)
CSF glucose : Normal CSF Protein: increased IgG to MBP Oligoclonal bands Increased CSF Index |
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Pleural Effusions:
Increased hydrostatic pressure in visceral pleura |
Congestive Heart Failure
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Pleural Effusions: Decreased oncotic pressure
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Nephrotic Syndrome
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Pleural Effusions: Obstruction of lymphatic drainage from visceral pleura
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Lung cancer
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Pleural Effusions: Increased vessel permeability of visceral pleural capillaries
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pneumonia, pulmonary infarction
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Pleural Effusions: Metastesis to the pleura
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Metastatic Breast cancer
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Types of Pleural Effusion
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1.Transudates - changes in starling forces
2.Exudates - protein and cell, increased vessel permeability in acute inflammation 3.Chylous Fluid - interuption of thoracic duct (malignancy is most common) high PF Chylomicrons diagnostic 4.Psuedochylous Fluid - inflammation with necrotic debri, PF Cholesterol increased, most common Rheumatoid Lung disease |
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PF Transudates vs Exudates
a.PFprotein/serum protein b.PF LDH/serum LDH c.PF LDH d. pH |
Transudate - a.<0.5, b. <0.6, c.<200U/L, pH>7.4
Exudate- a. >0.5, b. >0.6, c. > 200U/L, d. pH<7.4 |
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PF Exudate:
Neutrophils |
Empyema from pneumonia
pulmonary infarction |
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PF Exudate:
Lymphocytes |
TB is most common
Lymph blockage by tumor Viral pneumonia Metastatic leukemia or lymphoma |
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PF Exudate:
Eosinophils |
Hemothorac
Pneumothorax Resolving Bacterial pneumonia Mesothelioma (malignant mesothelial cells are also present) |
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Causes of Increased PF amylase
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Acute pancreatitis - left sided effusion
Boerhaave's Syndrome - rupture of the esophagus |
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Rheumatoid Lung Disease
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Characteristic decrease in PF Glucose
increased PF cholesterol |
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Increased Maximal Acid Output (MAO)
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Zollinger-Ellison Syndrome and Duodenal Ulcer
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Blood In Stool
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90% of all bleeds are upper GI
1.Melena - Dark tarry stools 2.Hematochezia bright red blood in stool 3. Blood Coating stool |
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Melena
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Dark tarry stool, upper GI
proximal to Ligament of Treitz Peptic Ulcer is most common cause (and for hematemesis) |
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Hematochezia
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Bright red blood in stool
Colonic bleeding below ileocecal valve (90%) Sigmoid diverticulosis is most common |
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Blood Coating stool
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Internal Hemorrhoids most common
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Leukocytes in Stool
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1. Invasive diarrhea and acute inflammation
2. Noninvasive causes - Pseudomembrane colitis - Clostridium difficile or ulcerative colitis |
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Stool pH<6.0
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Lactase deficiency, common in Native American, Asian, Black Americans. Anaerobe convert lactose to lactate and H2 gas.
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Causes of Malabsorption
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Pancreatic insufficiency
Bile salt/acid deficiency Small Bowel disease |
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Pancreatic Insufficiency
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Most often due to Chronic Pancreatitis due to: ROH (adults) and CysticFib(kids). Diminished Lipase, and trypsin. Carb metab is not affected
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Bile Salt deficiency
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1. Production defect - Cirrhosis
2. Blockage - primary biliary cirrhosis, stone in common bile duct 3. Bacterial Overgrowth 4.Binding of Salts - Cholestyramine 5.Terminal Ileal disease - prevents recycling - Crohn's and resection of Ileum. |
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Small Bowel Diseas
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1. Inability to resorb micelles Celiac disease, Whipple's ds
2. Lymphatic Obstruction - Whipple's and Abetalipoproteinemia |
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Ascites - Peritoneal Effusion
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Cirrosis is most common cause via
1. High hydrostatic pressure 2. Low Oncotic Pressure 3. Increased lymph formation |
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Metastasis to Peritoneum
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Surface derived Ovarian cancer
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Meig's Syndrome
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Benign fibroma of the of Ovary, ascites, right-sided pleural effusion
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Spontaneous Peritonitis
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Ascites due to Cirrhosis or Nephrotic Syndrome
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Spontaneous Bacterial peritonitis
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15% of patients with ascities due to cirrhosis or nephrotic syndrome
Adults - E.coli Children - Strep.pneumoniae Fever, Rebound Tenderness, Peritoneal Exudate |
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Reiter's Syndrome
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Increased Synovial WBC
Reiter's Cells - Monocytes with phagocytosed Neutrophils HLA-B27 positive arthritis with Urethritis due Chlamydia trachomatis |
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Ragocytes
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Present in Rheumatoid Arthritis
Neutraphiles containing granules of phagocytosed Rheumatoid factor |
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Rheumatoid Factor
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Complexed IgM against Fc of IgG
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Calcium pyrophosphate dihydrate crystals (CPPD)
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Triclinic (Rhomboid) Crystals specific for CPPD
Blue and Positive Birefringence Pseudogout in Knee, radiographic |
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Monosodium Urate Crystals
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Monoclinic (needle) Crystals
Yellow and Negative birefringence Sign of Gouty Arthritis |
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Pseudogout (chondrocalcinosis)
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Degenerative joint disease
usually the knee CDDP crystal on Radiograph Crystals phagocytosed by neutrophils show Positive birefringence |
