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Is it normal to have small amounts of fluid in the body cavities?
yes - in chest and abdomen
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What is the small amounts of fluid in the body cavities for?
lubricates organs so they can move easily
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Where does the small amount of fluid in body cavities originate from?
capillaries found throughout tissue
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What are the two main types of pressure that affect the fluid in body cavities?
- capillary hydrostatic pressure
- colloid osmotic pressure
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What is capillary hydrostatic pressure?
pushes fluid out of the vessels into the tissue
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What is the capillary hyrodstatic pressure driven by?
- the blood pressure
- the higher the blood pressure, the more fluid that is being pushed out
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What is colloid osmotic pressure?
draws fluid back in
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What is colloid osmotic pressure due to?
albumin
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What is albumin?
main plasma protein that maintains fluid balance in the vessels
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What would happen if we didn't have colloid osmotic pressure?
the capillary hydrostatic pressure would cause the abdomen to fill up like a balloon
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What is effusion?
increase fluid in a body cavity
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What is effusion usually due to?
an underlying disorder
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Any process that impairs absorption, alters capillary pressure, or alters albumin causes what?
effusion
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What are two main diagnositc reasons for effusion?
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What are the different classifications of effusion?
- transudate
- modified transudate
- exudate
- hemorrhagic effusion
- chylous effusion
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What are the clinical conditions that cause effusion?
- ascites
- hydrothorax
- hemothorax
- chylothorax
- pyothorax
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What is ascites?
increase in fluid in the abdomen
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What is hydrothorax?
water in the thorax
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What is hemothorax?
blood in the thorax
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What is chylothorax?
chyle in the thorax
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What is pyothorax?
puss in the thorax
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What is centesis?
collecting fluid sample
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Should we use aseptic technique when doing a centesis?
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If we want to culture a centesis what do we need to remember to do?
collect that sample first as a separate sample
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What do we use to do a centesis?
needle or catheter
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What type of catheter should we use to do a centesis?
peritoneal dialysis catheter
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What is the main problem too much fluid causes for the animal?
problems breathing
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What type of gross characteristics should we note when looking at a fluid sample?
- color
- clarity
- odor
- viscosity
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What is viscosity?
the texture of the fluid (thin, thick, etc)
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Should we perform a total protein of a fluid sample?
yes
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If the sample is bloody, what should we do?
buffy coat smear
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What is flocculent fluid?
stuff floating in the fluid
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How many smears should we make of the fluid?
at least 2
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If the fluid is clear, what should we do?
want to centrifuge it down and treat it like a urine sediment
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What kind of stain should we use?
diff quik
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What does transudate fluid look like?
looks like water - clear, colorless, thin
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Are pure transudates common?
no, they are rare
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What are most transudates due to?
low albumin
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What could cause low albumin levels?
- starvation
- not enough protein in the diet
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What is the total protein of transudate fluid?
< 2.5 gm/dl
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How many cells do we see in transudate fluid?
fewer than 1000 cells/ul
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What kind of cells will we see in transudate fluid?
- mesothelial cells
- macrophages
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Where do we find mesothelial cells?
they are cells tha tline the body cavities
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What do mesothelial cells look like?
- basophilic cytoplasm
- oval nucleus (may or may not see nucleolus)
- may see clusters of cells
- may see mitosis
- may see vacuoles
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If we catch a mesothelial cell while it is changing into a macrophage, what might it be confused with?
neoplasia
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Which is more common transudate or modified transudate fluid?
modified transudate
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What does modified transudate fluid look like?
- can be clear and colorless
- or cloudy and tinged with red
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What is modified transudate due to?
- change in vasular pressure
- usually due to an increase in osmotic pressure because of masses blocking capillary flow
- commonly seen with neoplasms
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Are masses always seen in neoplastic effusion?
no due to fluid covering the mass
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Which tumors exfoliate more readily than others ?
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Are negative neoplasic findings significant?
no, a negative finding may not always be negative
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How many of the neoplastic criteria do we need to see in order to safely say it is neoplastic?
more than 3
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What are the two main causes of modified transudate?
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What is exudate due to?
inflammation
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What does exudate fluid look like?
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What are the two types of exudates?
septic and nonseptic
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What is the total protein of exudate?
> 2.5 gm/dl
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How many cells will we see with exudate?
more than 5,000 cells/ul
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What kind of cells will we see with exudate fluid?
- mostly segs
- some macrophages and mesothelial cells
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What will we see with septic exudate?
bacteria
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Where will we see bacteria in septic exudate?
- most in segs
- free floating in sample
- occasionally in macrophages
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Should we culture septic exudate?
yes
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What will the segs look like in septic exudate fluid?
- degenerating
- will see karyolysis, karyorrhexis, pyknosis
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What are the two types of septic exudate?
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What does a cytology of nonseptic exudate look like?
- many segs (may become hypersegmented or pyknosis)
- macrophages (may see segs being phagocitized in macrophages)
- no bacteria
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What does it mean if we see eosinophils in exudate fluid?
there is parasite migration
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What type of effusion is the wet form of FIP?
nonseptic exudate
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What does the fluid of FIP look like?
yellow-green and viscous
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What is elevated in FIP?
- elevated total protein
- elevated cell counts
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What does the background of an FIP cytology look like and why? What do we often get this confused with?
- bluish granular background
- due to protein precipitate
- may be confused with bacteria
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What are some causes for nonseptic exudate?
- FIP
- gall bladder rupture (not common)
- urinary bladder rupture
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What is different in the cytology of a gall bladder rupture?
green pigment in macrophages
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If we catch the urinary bladder rupture within 24 hours after the rupture then what test can we do?
- compare the creatinine in the fluid and serum
- the creatinine in the fluid will be higher than in the serum
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What will we see in the fluid if there is a urinary bladder rupture?
crystals
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What are the three main effusions?
- transudate
- modified transudate
- exudate
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An abdomen full of blood that is not due to a trauma usually mean _____.
neoplasia
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What is hemmorhagic effusion usually due to?
internal bleeding
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What typically causes internal bleeding?
- spleen or liver rupture
- vessel ruptures/coagulopathy
- blood vessel tumor rupture
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What will we see in the cytology of hemmorhagic effusion?
erythophagocytosis (macrophages phagocytizing RBCs)
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If there platelets seen in a hemmorhagic effusion sample what does that mean?
it is fresh blood and it happened within 4 hours
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In order to look at a cytology of hemmorhagic effusion what do we need to do?
spin it down because if not then all we will see if a bunch of RBCs
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How can we tell if the blood is old or new after we spin down a sample from a hemmorhagic effusion?
- the supernant will be clear/straw colored if the blood is fresh
- the supernant will be yellow if the blood is old
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What does the fluid from chylous effusion look like?
white-pinkish and opaque
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What causes chylous effusion?
leakage from lymphatics
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Which species do we usually see chylous effusion in and why?
- cats
- cats will sometimes have a spontaneous leakage in the thoracic duct
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What is the thoracic duct?
largest lymph vessel that dumps lymph back into the systemic circulation
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What will be elevated with chylous effusion?
triglycerides (fats)
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What will we see on a cytology of chylous effusion?
many small lymphs
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What is the total protein of chylous effusion?
2 - 6.5 gm/dl
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How many cells will we see with chylous effusion?
900 - 16,650 cells/ul
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In addition to many small lymphs on a chylous effusion what other cells will we see?
segs
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What are some other diseases that we will see with chylous effusion (these are not common!)?
- cardiomyopathy
- lymphosarcoma
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What type of fluid is this?
chylous effusion
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What type of fluid is this?
chylous effusion
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- A: reactive mesothelial cell
- B: RBC
- C: segs
- D: macrophages
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What is this?
eosinophils in an effusion - not normal - due to parasite migration
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What is this?
erythrophagocytosis
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What kind of patient is this from?
FeLV cat
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What is this due to?
FIP
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What is this due to?
FIP
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Describe this fluid.
flocculent
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What kind of effusion is this from?
hemmorrhagic effusion
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What is this?
hyperplastic mesothelial cells
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What is this?
lymphosarcoma
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What is this?
lymphosarcoma
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What type of cell is this?
mesothelial cell
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What is this?
a cluster of mesothelial cells
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What cell is this and what is happening to it?
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What is this?
pyothorax
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Where did this sample come from?
thoracic effusion
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