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Analysis of Urine and Other Body Fluids: Serous Fluids, Study notes of Bioorganic Chemistry

An in-depth analysis of serous fluids, their normal formation, and the causes of their effusion. It discusses the differentiation between transudate and exudate, hemothorax, hemorrhagic exudate, chylous, and pseudochylous effusion. The document also covers the methods of collection and chemical tests on ascitic fluid, as well as the analysis of amniotic fluid and its functions, volume, macroscopic analysis, and specimen collection.

Typology: Study notes

2023/2024

Uploaded on 03/13/2024

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ANALYSIS OF URINE AND
OTHER BODY FLUIDS LECTURE
TOPIC: SEROUS FLUIDS
JOSE ENRICO M. SUMAYA, RMT
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ANALYSIS OF URINE AND

OTHER BODY FLUIDS LECTURE

TOPIC: SEROUS FLUIDS

JOSE ENRICO M. SUMAYA, RMT

INTENDED LEARNING OUTCOMES

At the end of the discussion, the students should be able to:

  • Describe the normal formation of serous fluids.
  • Describe the different causes of serous effusion.
  • Differentiate transudate from an exudate, including etiology, appearance,

and laboratory tests.

  • Differentiate a hemothorax from a hemorrhagic exudate.
  • Differentiate chylous from a pseudochylous effusion.
  • Discuss the different method of collection in serous fluid.
  • Perform different chemical tests on ascitic fluid, and state their significance

SEROUS FLUIDS

SEROUS FLUIDS

EFFUSION

  • Accumulation of fluid between the membranes due to disruption of the

mechanisms of serous fluid formation and reabsorption, as well as damages

to the membrane

  • May be classified as ____________, and _______________

SEROUS FLUIDS

EXUDATE

  • Excessive fluid formed due to the direct damage to the membrane of a

particular cavity

  • Examples: Infection, inflammation, malignancy, vasodilation, leaking of fluid,

pleuritis, and lymphoma,

TRANSUDATES VS. EXUDATES

SPECIMEN COLLECTION

METHODS OF COLLECTION

  • Pleural fluid: _________________
  • Pericardial fluid: ________________
  • Peritoneal fluid: _________________

Normal Volumes

  • Pleural fluid: _________________
  • Pericardial fluid: ________________
  • Peritoneal fluid: _________________

Normal Appearance

  • Clear to pale yellow

Specimen is distributed in the

following tubes:

  • EDTA- Cell counts and differential
  • Sterile Heparin or SPS- Microbiology

and cytology

  • Plain/Heparin tubes- Chemistry

(samples for pH must be maintained

anaerobically in ice)

PLEURAL FLUID

BLOODY PLEURAL FLUID

BLOODY PLEURAL FLUID

Due to: HEMOTHORAX HEMORRAGHIC EFFUSION

Distribution

of blood

Uneven (traumatic tap) Even

Hematocrit Pleural fluid Hct is > ½ of

Whole Blood Hct

There is only increased

blood not pleural fluid

Pleural fluid Hct is < ½ of

Whole Blood Hct

Increased both blood and

pleural fluid

PLEURAL FLUID

Additional:

Neutrophils - increased in

pneumonia

Eosinophils - increased in

pneumothorax, hemothorax,

allergic reactions, parasitic

infections

SEROLOGIC TESTING

  • Serologic testing of pleural fluid is used to differentiate effusions of

immunologic origin from noninflammatory processes. Tests for antinuclear

antibody (ANA) and rheumatoid factor (RF) are the most frequently

performed.

  • Detection of the tumor markers carcinoembryonic antigen (CEA), CA 125

(metastatic uterine cancer) , CA 15.3 and CA 549 (breast cancer), and CYFRA

21 - 1 (lung cancer) provide valuable diagnostic information in effusions of

malignant origin.

PERICARDIAL FLUID

PERITONEAL FLUID (ASCITIC FLUID)

kate aubrey liu / BSMT III-2^1

AMNIOTIC FLUID

 Fluid present in the amnion , a membranous sac which surrounds the fetus  This membranous sac is metabolically active, resulting to constant exchanges of water and chemicals in the amniotic fluid, fetus, and maternal circulation  The placenta is the ultimate source of amniotic fluid water and solutes FUNCTIONS  Cushion for the fetus  Stabilizes temperature  Allows fetal movement  Proper lung development VOLUME  The volume of amniotic fluid is significantly contributed by fetal urine and lung fluid  Normal Volume: 800-1200 mL ( 3rd trimester)  During 1st trimester, 35 mL of amniotic fluid is derived primarily from the maternal circulationfetal urine is the major contributor of amniotic fluid volume after the 1 st^ trimester of pregnancy MACROSCOPIC ANALYSIS POLYHYDRAMNIOS  Increased amniotic fluid volume (>1200 mL)  Causes:  Decreased fetal swallowing of urine  Neural tube disorders/defects  Fetal structural anomalies  Cardiac arrhythmias  Congenital infections,  Chromosomal abnormalities OLIGOHYDRAMNIOS  Decreased amniotic fluid volume (<800 mL)  Causes:  Increased fetal swallowing of urineMembrane leakageUrinary tract deformities  Congenital malformations  Premature rupture of amniotic membranes  Umbilical cord compression resulting in  decelerated heart rate and fetal death SPECIMEN COLLECTION  Method of collection: amniocentesis (paired with ultrasound para di lumagpas sa bata yung needle)  Up to 30 mL collected in sterile syringe  2 nd^ trimester amniocentesis is used for: assessing genetic defects (e.g. T21, T15, T18)  3 rd^ trimester amniocentesis is used for: assessing fetal lung maturity (FLM), and Fetal Hemolytic Disease (HDFN)  Quadruple screening tests prior to performing amniocentesis:  Alpha fetoprotein  Human chorionic gonadotrophin  Unconjugated estriol (UE4)  Inhibin A SPECIMEN HANDLINGTest for FLM : Ice on delivery, kept frozen/iced or refrigerated. Filtration prevents loss of phospholipids  Test for Cytogenetic Studies : Kept at room temperature or at 37 degrees Celsius to preserve the viability of analytes  Test for HDN : Protected from light because bilirubin, which is prone to photooxidation, is used to determine HDN OTHER TEST TO IDENTIFY A FLUID AS AN AMNIOTIC FLUID: FERN TEST  Detects ruptured membranes  Also used to diagnose pregnancy  There is a fern crystal formation due to increased sodium chloride + protein + exposure to air = fern crystal formation Procedure:  Specimen (vaginal fluid)→ Slide→ Air dry  (+) Fern line crystals [Amniotic fluid with (+) Protein and (+)NaCl]

ANALYSIS OF URINE AND OTHER BODY FLUIDS LEC

LESSON 4 - Amnniotic Fluid