Please enable JavaScript.
Coggle requires JavaScript to display documents.
Amniotic fluid, Synovial fluid, Cerebrospinal Fluid, serous fluids:…
Amniotic fluid
-
Func: cushioning medium, Regulates temperature for fetus, Serve as passage of constituents such as glucose, sodium and potassium
-
-
Amniocentesis: test for congenital disease, neutral tube defect, hemolytic disease of the fetus and fetal pulmonary development.
HDFN: due to the differences in ABORh blood group system b/t maternal and fetal. appears in amniocentesis fluid and measure the incompatibility reaction.
Most commonly use method is direct spectrophotometric scan of undiluted amniotic fluid and calculate the relative bilirubin amount
Neutral tube defect: increase Alpha Feto Protein for spina bifida and anencephaly. Decrease maternal serum AFP: down syndrome and other aneuploidy states
AFP screening. the secondary method is assay for a central nervous system specific acetylcholinesterase (AChE) that offers a degree of
confirmation for amniotic fluid AFP. By enzymatic immunologic and electrophoretic inhibition.
Fetal lung maturity: sufficient phospholipids in amniotic fluid to prevent atelectasis (alveolar collapse). The alveolar epithelial cells has two types cells. Type 1 cells: form the alveolar capillary
membrane for exchange of gases. Type 2: Produce and store surfactant need for alveolar stability in the form of lamellar bodies
Lecithin: The ratio of lecithin to sphingomyelin (L/S ratio) in amniotic fluid is often measured to assess fetal lung maturity. An L/S ratio greater than 2:1 typically indicates that the fetal lungs are mature. Phosphatidylglycerol (PG): Its presence in amniotic fluid further indicates lung maturity. PG appears later in gestation compa
-
Functional assay: direct physical
measure of amniotic fluid for surfactant--bubble or shake test and foam stability index (FSI)
If enough surfactant is present a stable ring of foam bubbles remain at the air liquid interface. FSI: f 0.47mol, and L/S ratio of 2.0-2.5
Quantitative test: Tests such as phosphatidylglycerol, lecithin, and sphingomyelin. Type 2 produce phosphatidylglycerol
and lecithin to increase-- lung matures
• Phosphatidylglycerol Less than or
equal to 0.2 means possibility of respiratory
distress syndrome in neonates within 72 hrs.
Lamellar bodies like as platelets exist in the amniotic fluid. To predict fetal lung maturity. =< 15,000/μL -- fetal lung immaturity, increased risk of
neonatal respiratory distress syndrom. >= 20,000 predict maturity and decrease the risk of distress. >= 55,000 mature lung.
Fetal lung maturity: Lecithin/sphingomyelin>=2.0. Amiostat fetal lung maturity is positive. Foam stability index>= 47. Optical density ar 650nm >= 0.150, Lamellar body count > 32,000/ml.
Hemolytic disease of newbaby: bilirubin scan > 0.025.. Alpha -fetoprotein > 2.0 --neural tube disease
Synovial fluid
-
Interstitial fluid, Protein, Hyaluronic acid, Lubricin
-
Normal: colorless - straw yellow clear. Viscosity is high. wbc< 150 , <25% Neutrophils.
if noninflammatory: yellow, slightly cloudy, low viscosity, wbc< 1000, < 30% Neutrophils.
inflammatory: white, gray yellow, cloudy turbid. Absent viscosity, wbc< 100000 , > 50 %Neutrophils.
septic: white, gray, yellow green, cloudy, purulent. WBC: 50,0000-200,000. > >90% neutrophils. Glucose 20-100.
Crystal-induced: white cloudy, turbid, opaque, milky. wbc same septic. glucose 0-80.
Hemorrhagic: Sanguineous, red, brown Cloudy. < 59% neutrophils. 0-20 of glucose.
-
Calcium pyrophosphate dihydrate crystals ( (CPPD): microscope: Rhomboid square, rods --Pseudogout.
Cholesterol: notched, rhomboid plates 菱形--Chronic inflammation,extracellular
-
-
MSU negative birefringence, small joints (more LE), Hyperuricemia.
CPPD:Positive birefringence. Large joints, 1≥ joints affected
Cerebrospinal Fluid
within the subarachnoid space. Produced: choroid plexuses, at third ventricle by ependymal cells.
puncture between the third and fourth or fourth and fifth lumbar vertebra, it can measurement of intracranial pressure
Generally csf sx: Tube 1: Chemistry and Serology, 2. Microbiology, 3. Hematology., 4, others: ex cytology analysis
Traumactic tap: Heaviest in the 1st tube. Clot formation positive. during lumbar puncture, if the needle accidentally punctures a blood vessel, it can introduce blood into the CSF sample. This type of blood contamination is called a traumatic tap. Xanthochromic Supernatant: the presence of breakdown products of red blood cells, such as bilirubin. generally no present.
Subarachnoid hemorrhage: blood distribution even in all 3 tubes. No clot d/t CSF exist fibrinolytic enzymes. Xanthochromic supernatant may exist d/t old hemorrhage.
CSF also exists all proteins that in plasm but lower levels: 15-45 mg/dL. If decrease: CSF leakage. Increase: Meningitis, Hemorrhage. If albumin increase d/t Damage to the blood brain barrier. IgG and myelin basic protein: multiple sclerosis
glucose: 60-70% of plasma level. Draw plasma 2-4 hours before a lumbar puncture is to allow time for the blood and CSF to reach equilibrium. Lactate < 25 mg/dL. Indicative of anaerobic
metabolism in CSF. When only decrease glucose: Brain tumor, disorder in transport of glucose into CSF. If elevated lactate and decrease glucose: bacterial, fungal, TB meningitis.
Glutamine: 8-18 mg/dL. estimate for ammonia within the CNS. ammonia formed by -AA byproduct. Ammonia is toxic, so ammonia + glutamate= glutamine is intoxic. > 35 mg/dl-- coma
Bacterial meningitis: increase protein, WBC (neutrophils), decrease glucose, >35 lactate,
viral: increase protein, WBC ( lymphocytes), normal glucose and lactate.
TB: increase protein, WBCs, lymphocytes and monocytes. >25 lactose. decrease glucose.
Fungal: increase protein, WBCs, lymphocytes and monocytes. >25 lactose, normal or decrease glucose. Positive India ink stain.
serous fluids: between 2 serous membranes. Parietal: outside lines the cavity wall. Visceral: inside lines oragns
Pleural
-
-
Thoracentesis: sx Heparin tube: culture, EDTA: microscopy,Sodium fluorescein (NaF) tube: glucose and lactate
-
Secondary: transudate. hypoproteinemia d/t malnutrition by dcrease oncotic oressure (colloidal decrease of protein)
-
-
peritoneal
-
Ascites: Serum-ascites albumin gradient (SAAG) calculated by paracentesis. Calculation:
Ascitic fluid albumin level - Serum albumin level.
= >1.1g/dL. transudate. < 1.1 --exudate
-
-
-
Primary: exudate --metastatic ovarian, prostate, and colon cancer
Secondary: Transudative ascites-- portal hypertension. cirrhosis, congestive heart
failure, a
let blood out the vessel: capillary filtration pressure (hydrostatic pressure) + interstitial fluid pressure of tissue (colloidal osmotic pressure)
-
-
-