13 Serous Fluids

7/31/2019 13 Serous Fluids

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URINALYSIS AND BODY FLUIDS(SEROUS FLUIDS)

Dr. Essam H. Aljiffri


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SEROUS FLUIDS

- The closed cavities of the body mammal; the

pleural, pericardial, and peritoneal cavities areeach liner by two membranes referred to as theserous membranes.


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SEROUS FLUIDS

- One membrane lines the cavity wall (parietalmembrane), and the other covers the organs

within the cavity (visceral membrane).

- The fluid between the membranes which

provides lubrication as the surfaces moveagainst each other, is called serous fluid.


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SEROUS FLUIDS

- Normally only a small amount of serous fluid ispresent because production and absorption takeplace at a constant rate.


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Formation

- Serous fluids are formed as ultrafiltrates ofplasma, with no additional material contributedby the membrane cells.

- Production and reabsorption are subject tohydrostatic and colloidal (oncotic) pressures

from the capillaries serving the cavities undernormal conditions.


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Formation

- The greater hydrostatic pressure in the systemiccapillaries on the parietal side favors fluidproduction through the parietal membrane andreabsorption through the visceral membrane.


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Formation

- Fluids for laboratory examination are collected byneedle aspiration from the respective cavities.

- These aspiration procedures are referred to as:

thoracentesis (pleural)

pericardiocentesis(pericardial).

paracentesis (peritoneal).


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Formation

- Abundant fluid is usually collected; therefore,suitable specimens are available for eachsection of the laboratory.

- An anti-coagulated specimen is needed for cellcounts, a sterile tube for culture.

- Large volumes of fluid should be prepared prior

to microbiologic and cytologic examinations


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General Laboratory Procedures

- Routine fluid examination including classificationas a transudate or exudate, appearance, cellcount, differential, chemistry and microbiologyprocedures is performed in the same manner on

all serous fluids.


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General Laboratory Procedures

- Cell counts are usually performed manually usingthe Neubauer counting chamber.

- Differential counts are performed on (Wright stainedsmears).

- Any suspicious cells been on the differential shouldbe referrer to the cytology laboratory or thepathologist.


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Summary of Serous Fluid Testing

Pleural Fluid

Normal appearance: Clear, pale yellow

Turbidity: White blood cells and microorganisms

Blood: Traumatic injury, malignancy, traumatic tapMilky: Chylous or pseudochylous material

Neutrophils: Bacterial infection

Lymphocytes: Tuberculosis, malignancy

Normal glucose: Parallels serum glucose

Low glucose: Tuberculosis, rheumatoid- inflammation, malignancyLow pH: Tuberculosis, malignancy, esophageal rupture

Elevated amylase: Pancreatitis


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Pericardial Fluid


Milky: Lymphatic drainage

Turbidity: Infection, malignancy

Blood: Tuberculosis, tumor, cardiac puncture

Neutrophils: Bacterial endocarditis

Low glucose: Bacterial infection, malignancy


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Peritoneal Fluid


Turbidity: Peritonitis, cirrhosis

Blood: Trauma

Neutrophils: Peritonitis

Low glucose: Tubercular peritonitis, malignancy

Elevated amylase: Pancreatitis, gastrointestinal perforationElevated alkaline phosphatase: Intestinal perforation

Elevated urea or creatinine: Ruptured bladder


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TRANSUDATES AND EXUDATES

- Many pathologic conditions can cause a buildup(effusion) of serous fluid.

- A general classification of the cause of theeffusion can be accomplished by separating the

fluid into the category of transudate or exudate.


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- Exudates are produced by conditions that directlyinvolve the membranes of the particular cavity,

including infections, malignancies and from aninflammatory process.

- Transudates also can be thought of as resultingfrom a mechanical process,


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- A variety of laboratory tests have been used todifferentiate between transudates and exudates,

including appearance, specific gravity, totalprotein, lactic-dehydrogenase, cell counts, andspontaneous clotting.


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- As can be seen using these criteria, one wouldexpect a transudate to be a clear fluid with a

specific gravity less than 1.015, protein less than3.0 g per dl, and a lactic dehydrogenase below200 IU.


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Laboratory Differentiation of Transudates and Exudate

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Transudate Exudate

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Appearance Clear Cloudy

Specific gravity < 1.015 > 1.015

Total protein < 3.0 g/dl > 3.0 g/dl

Lactic dehydrogenase < 200 IU > 200 IU

Cell count < 1000/l > 1000/lSpontaneous clotting No Possible

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13 Serous Fluids

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