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Fluid Analysis - Coggle Diagram

- - - - inc hydrostatic P
        
        = too much fl/P
      - exudation - inc vascu permea
        
        = pipes are leaking - inflamm
      - visceral organ/ves rupture
        
        = something's burst
      - dec plasma oncotic P
        
        = not enough prot
      - dec lymphatic drainage
        
        = pipes are clogged
- - - - run thru hematology analyzer
      - don't do if chunky or have bact
      - provides TNCC, HCT (calc), and RBC count
    - - hemocytometer
      - PCV (counted)
  - - - direct preps
      - verify that manual/automated TNCC agree w/ smear
      - ruptured c, clots and clumping can artificially dec TNCC
    - - automated diff = unreliable
      - 100-200 c on direct preps
      - cell morph
    - - proteinaceous, blood contamin, orgm, etc
    - - lg mononuclear (LMN)
        
        M0
        
        mesothelial c
        
        arranged individ and in clusters
        
        often appear reactive
        
        inc #
        
        prominent glycocalyx-eosinophilic fringe
        
        atypia?
        
        difficult to differen reactive mesothelium from carcinoma or mesothelioma
      - sm mononuclear c
        
        sm and intermed lymphocytes
      - neutros
        
        nondegener vs degener
        
        toxic change vs degener
        
        toxic change
        
        loc: blood
        
        appearance
        
        inc cytoplasmic basophilia
        
        cytoplasmic vacuoliz
        
        Dohle bodies
        
        toxic granules
        
        signif: inc produc/inflamm
        
        degener neutros
        
        loc: tis/fl
        
        signif: rapid c death
        
        appearance
        
        swollen, pale nucleus
        
        loss of nuclear seg
        
        look for infec agents!
      - others
        
        eos, mast c, plasma c, neoplastic c, others
      - consider degree of blood contamin
  - - - supernatant if cloudy or turbid
      - estimate
      - affected by lipemia, hemolysis, icterus
    - - transudate < 2.5 g/dL
      - modif transudate > 2.5 g/dL; 2.5-3.0
      - exudate > 3.0 g/dL
  - - - std
      - PCR for Ag recep rearrangement (PARR)
        
        lymphoid neoplasia vs reactivity
    - - ICC and IHC w/ cell block
    - - hematopoietic neoplasia
  - - - make 1+ slide immediately and send along w/ fl to pathologist
        
        prevents in vitro artifacts
        
        cellu degener
        
        bact overgrowth
        
        phagocytosis
      - technique
        
        blood smear
        
        line prep
        
        squash prep
    - - for smpl w/ low cellu
      - sediment smears
        
        centrifuge sim to urine smpl
      - cytocentrifuge/cytospin
        
        usually ref labs
        
        can do in-house (salad spinner)
    - - air dry slides rapidly
      - DO NOT heat fix
      - stain 1+ slide in-house but NOT all
        
        Diff-Quick stain
        
        cons - chromatin and mast c granules
        
        stain maint
        
        sep containers for cytology/hematology and "ears and "rears"
        
        change regularly
      - keep slides away from formalin
  - - - inc w/ inc cell count, lipid, other
    - - sepsis, neoplasia, feces, urine
- - - - SA: very sm amts
      - LA: enough to collect and analyze
        
        eq: pleural and peritoneal
        
        bov: peritoneal
    - - clear, colorless, light yellow
  - - - mech: excess diffusion of plasma water into body cavity due to changes in oncotic or hydrostatic fl in capill
      - dec plasma oncotic P
        
        inc hydrostatic P
        
        presinusoidal portal hypertension - portosys shunts, thrombosis, fl overload, cirrhosis
        
        impaired clearance of fl
        
        lymphatic obstruc - lymphangiectasia, LN dz
        
        early cardiac failure
        
        hypoALB (< 1.5 g/dL)
        
        dec produc
        
        inc loss
      - init eval
        
        appearance
        
        clear, colorless to pale yellow
        
        TP: < 2.5 g/dL
        
        TNCC
        
        <1000 cells/uL for SA
        
        <5000 cells/uL for LA
        
        norm lubricant in health
        
        inc amts are patho
        
        EXCEPT post-op
      - cytology
        
        mononuclear c predom - typ lg > sm
        
        few non-degener neutros
        
        neutro % may be higher in
        
        LA
        
        chronicity - irritation
        
        inc reactive mesothelium
        
        infec orgm typ absent
    - - def
        
        transudate that has been modif by addn of prot or c
        
        often high prot transudate
        
        mech
        
        lymphatic/vascu obstruc
        
        inc hydrostatic P
      - analysis
        
        TP: > 2.5 g/dL (2.5-3.0 g/dL)
        
        TNCC
        
        SA: 1000-5000 cells/uL
        
        LA: 5000-10000 cells/uL
        
        appearance
        
        light yellow/clear to slightly cloudy/milky
        
        cytologic eval
        
        variable - sim to transudate
      - causes
        
        congestive heart failure
        
        neoplasia
        
        thrombosis
        
        organ torsion
        
        diaphragmatic hernia
        
        long standing transudates
    - - causes
        
        infec (septic)
        
        bact, fungal, protozoal, rarely viral (FIP)
        
        sterile inflamm
        
        pancreatitis
        
        sterile FB
        
        necrosis
        
        irritating substances
        
        neoplasia
        
        vessel leakage/injury
      - appearance
        
        gross
        
        color: any
        
        clarity: often cloudy, chunky
        
        TP: > 3.0 g/dL
        
        TNCC
        
        SA: > 5000 cell/uL
        
        LA: >10000 cells/uL
        
        cells
        
        typ neutros predom
        
        sometimes mixed (neoplastic c)
      - cytologic exam
        
        ID primary c type
        
        if inflamed - look for underlying cause - bact, fungal, bile, foreign material
        
        give your effusion a name
        
        type of neoplasia
        
        type and degree of inflamm
      - mech
        
        inc capill permea allows exudation of plasma, prot, and c (typ due to inflamm)
  - - - mech
        
        leakage of bile from biliary tract
      - causes
        
        biliary mucocele
        
        trauma
        
        cholelithiasis/cholangitis/cholecystitis/cholangiohepatitis
        
        neoplasia
        
        pancreatitis
      - phys appearance
        
        brown, green or yellow and often turbid
      - TP: typ > 3.0 g/dL
      - TNCC: typ > 5000 cells/uL
      - cytologic appearance
        
        golden, green or blue-black granular or crystalline material
        
        inflamm - usually neutrophilic
        
        white bile
      - definitive diag
        
        [fl bilirubin] > [serum bilirubin]
    - - common offenders
        
        lymphoma
        
        carcinoma
        
        other tumors less common
      - gross appearance
        
        variable: clear to turbid, light yellow to apricot
      - TP: typ > 2.5 g/dL
      - TNCC: variable
      - cytologic appearance
        
        presence of neoplastic c
        
        based on ID criteria of malig
        
        secondary process
        
        a lack of neoplastic c does NOT rule out a neoplastic effusion
    - - mech
        
        leakage of urine
      - causes
        
        trauma
        
        HBC, rupture during parturition (foals)
        
        urolithiasis/obstruc
        
        neoplasia (TCC)
        
        iatrogenic
      - TP: typ > 2.5 g/dL
      - TNCC: variable but typ <4000 cells/uL
        
        c may be poorly preserved
        
        inflamm c = mononuclear c and neutros
      - confirm diag
        
        [fl creatinine] > [serum creatinine]
        
        typ 2X serum
        
        expected serum biochem abnorm
        
        azotemia, hyperkalemia, hyponatremia, hypochloremia
        
        imaging
    - - mech
        
        accum of chyle in body cavity
      - chyle
        
        milky fl consis of chylomicrons and lymph
        
        chylomicrons: triglyceride rich emulsified fats
        
        lymph: fl containing lymphos
        
        drains from lacteals of sm intes into lymphatic sys
      - causes
        
        idiopathic (dogs and cats)
        
        cardiovascu dz (cats)
        
        neoplasia - lymphoma, thymoma
        
        heartworm
        
        lymphangiectasia - peritoneal fl (rare)
      - charac
        
        appearance
        
        milky white to pink
        
        TNCC: variable, typ > 3000 cells
        
        TP: typ > 2.5 g/dL
        
        cytologic appearance
        
        sm lymphos predom
        
        LMN and neutros inc w/ chronicity/inflamm
        
        +/- fine lipid vacuoles in bkgd and intracellu
      - definitive diag
        
        [fl trig] typ > 3X serum
        
        [fl trig] typ > 100 g/dL
    - - any body cavity or bi-cavitary
      - phys appearance
        
        clear to cloudy, straw colored, viscous, +/- fibrin strands
      - high prot w/ rela low c count
        
        TP: > 4.5 g/dL
        
        TNCC: < 5000 cells/uL but variable
      - cytologic appearance
        
        nondegener neutros/mixed
        
        bkgd: bluish-gray to pink granular due to high prot content
    - - mech
        
        leakage of blood from ves/organs
      - causes
        
        trauma
        
        coagulopathies
        
        rodenticide
        
        congenital
        
        neoplasia
        
        benign and malig (hemangiosarcoma)
        
        organ torsion or rupture - liver, spleen
        
        other
      - gross appearance
        
        red, pink, serosanguineous
      - TP: > 2.5 g/dL
      - TNCC: variable
      - PCV of fl: > 50% blood
      - cytologic eval
        
        mostly RBCs
        
        nucleated c sim to blood
        
        erythrophagocytosis (may occur in vitro)
        
        RBC brkdn products
        
        hemosiderin
        
        Fe inside M0 = siderophages
        
        hematoidin crystals
      - differen contamin vs hemorr
        
        hemorr = PCV > 50% of blood, erythrophagocytosis and RBC brkdn products
        
        blood contamin = plts present and lack of RBC brkdn products
    - - transudates, modif transudates, exudates
      - often hemorr
        
        RBCs
        
        RBC brkdn products
        
        reactive mesothelium
      - causes
        
        idiopathic pericarditis
        
        neoplasia: hemangiosarcoma, lymphoma
        
        conges heart failure (esp cats)
        
        less freq: infec, traumatic, coagulopathy, FIP
      - often need further diag
    - - eosinophilic effusions
      - other infec
        
        fungal
        
        histoplasma, blastomycosis, pythium
        
        parasitic
        
        peritoneal cestodiasis
        
        protozoa
        
        nocardia/actinomyces
        
        anaplasma and mycoplasma
- - - - inflamm dz, neoplasia, infec, lymphatic dz
  - - - trauma, collapse, weakness, respir distress, stranguria, GI signs
    - - abd/peritoneal cavity
        
        abd distension - ascites, pain, fl wave
      - pericardial sac
        
        muffled heart sounds, arrhythmias
      - pleural cavity
        
        dyspnea, tachypnea, coughing, muffled heart sounds, respir distress
    - - anemia, hypoalbuminemia, electrolyte abnorm, evidence of inflamm
    - - ECG (cardiac tamponade)