Bài giảng Phân tích dịch màng bụng, màng phổi màng tim

PHAN TICH DICH MANG BUNG,
MANG PHOI & MANG TIM

TS. Nguyễn Hữu Tùng


|. Serous Fluid (Dich mang)
1. Definition
o
o

gq

ce
pericardium

Cavity: Pericardial, pleural, peritoneal
Serous membrane:
Perietal membrane
- Visceral membrane

Parietal pleural

Pleural cavity
with serous fluid

o

Serous fluid

Visceral pleural

Diaphragm

Front

Right

Peritoneum

Left
spine

Back

Retroperitoneum


|. Serous Fluid

2. Formation
Parietal

Visceral

pleura
Chest

\

wall

o

Serous

fluids

ultrafiltrates
no

are

of

additional

formed

plasma,

,

as

with

material

\

pleura

Pleural

\

space

yf

|

|

Lung

Systemic
_

contributed by the mesothelial
cells that line the membranes.

o

Production and reabsorption
are subject to hydrostatic and
colloidal pressures from the
capillaries
that
serve

the
cavities
and
the
capillary

permeability

———
b
pressure }

|

—
pressure

+30

Intrapleural
pressure

_

—-11

-

Intrapleural

pressure

+З>

+10-—©

Lymphatic system


‘Table 13-1
on ae

Pleural Effusion?

| Pathologic Causes
of Effusions

1. Increased capillary hydrostatic pressure
Congestive heart failure
Salt and fluid retention
2. Decreased oncotic pressure
Nephrotic syndrome

Hepatic cirrhosis
Malnutrition

Protein-losing enteropathy
3. Increased capillary permeability
Microbial infections
Membrane inflammations

Malignancy

4. Lymphatic obstruction
Malignant tumors, lymphomas
Infection and inflammation

Thoracic duct injury


3. Specimen Collection and Handling

o

Method: Needle aspiration

o Volume
o

Sample care and Caution


4. Transudate and Exudate

sr); (2&-9e
ŒZ

Laboratory Differentiation of Transudates
and Exudates

Appearance

Transudate

Exudate

Clear

Cloudy

Fluid:serum protein ratio

<0.5

>0.5

Fluid:serum LD ratio

<06

>0.6

WEC count

<1000/uL.

> 1000/pL

Spontancous clotting

No

Possible

Pleural fluid cholesterol

<45-60 mg/dL

>45-60 mg/dL

Pleural fluid:serum cholesterol ratio

<0.3

>0.3

Pleural fluid:bilirubin ratio

<06

>0.6

>1.1

<1.1

Serum-ascites albumin gradient


5. General Laboratory procedures

Serous fluid examination:

Transudate and Exudate
Cell count

Chemistry
¢ Microbiology
Cytology


ll. Pleural Fluid

1.

Pleural Fluid

2.

Pleural Effusion

3.

Examination of Pleural fluid


3. Examination of Pleural fluid

3.1. Appearance
.

_ Table 13-3

~

SU

Correlation of Pleural Fluid Appearance and

DR

Appearance

Disease

Clear, pale yellow

Normal

Turbid, white

Microbial infection

Bloody

Hemothorax
Hemorthagic effusion, pulmonary embolis, tuberculosis,

(tuberculosis)

malignancy

Brown

Rupture of amoebic
liver abscess

Black

Aspergillous

Viscous

Malignant mesothelioma (increased hyaluronic acid)


3. Examination of Pleural fluid

3.2. Hematology test

t3

(2/22
ve

Mesothelial cells

Plasma cells

Malignant cells

Significance of Cells

Seen in Pleural Fluid

Normal and reactive forms have no

Tuberculosis

Primary adenocarcinoma
and smallcell carcinoma


3. Examination of Pleural fluid

3.3. Chemistry test

Â

Glucose

ô

pH

Â

Adenosine deaminase

Â

Amylase

Â

Triglyceride


_ Table 1327.

Significance of Chemical

Testing of Pleural Fluid

Test

Significance

Glucose

Decreased in rheumatoid inflammation
Decreased in purulent infection

Lactate

Elevated in bacterial infection

Triglyceride

Elevated in chylous effusions

pH

Decreased in pneumonia not responding to antibiotics
Markedly decreased with esophageal
rupture

ADA

Elevated in tuberculosis and malignancy

Amylase

Elevated in pancreatitis, esophageal
rupture, and malignancy


3. Examination of Pleural fluid

3.4. Microbiologic and Serologic Tests


PLEURAL FLUID TESTING ALGORITHM
Fluid protein and LD
‘

Fluid: serum protein >0.5
Fluid: serum LD >0.6

Appearance

Fluid LD > 2/3 upper normal serum value

Milky
Any positive

Ị

Ỉ

Yos

Hematocrit | | Triglycerides

Transudate
Glucose

ADA
WBC/Diff
Amylase
pH

TT}
|

ADA >40U/L

WBC/Diff

Amylase

ll. Pericardial Fluid