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What are other names for bronchial wash?
- transtracheal aspiration (TTA)
- branchoalveolar lavage (BAL)
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What is bronchial wash?
a diagnostic aid for lower respiratory tract disease
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What do we use to collect a bronchial wash?
collect thru an endoscope or thru a long sterile catheter
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What type of long sterile catheter should we use for a bronchial wash?
intra catheter - has a needle in the catheter
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Why do we usually do usually do the bronchial wash while the patient is awake? Can it be done with the patient anesthetized?
- to preserve the cough reflex
- yes
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Where do we insert the catheter for a bronchial wash?
insert catheter between tracheal rings to the bifurcation
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After we have inserted the catheter for a bronchial wash, what do we do?
- inject warm saline (5 - 15ml)
- aspirate when the patient coughs
- if the patient is anesthetized, then aspirate quickly after injecting the saline
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When would we anethetize the patient when doing a bronchial wash?
when we use an endoscope
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Once we inject the saline and aspirate, where does our sample end up?
not in the syringe, but in the catheter
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What should we do with some of the sample from the bronchial wash if we suspect the patient has pneumonia?
culture
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How do we measure the length of where the catheter needs to go for large animals for a bronchial wash?
from midthorax to trachea, enter between tracheal rings
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Is the sample from the bronchial wash large or small?
small
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How do we prepare a sample for a cytology from a bronchial wash?
- smear sample onto slide
- air dry
- stain
- observe cells
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Should the sample from a bronchial wash have lots of cells or a few cells?
a few cells (acellular)
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What kind of cells will we see on a bronchial wash cytology?
- ciliated
- columnar cells
- cuboidal cells
- macrophages
- lymphocytes
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If we see squamous epithelial cells on the cytology from a bronchial cells what does it mean?
we went the wrong direction and into the pharynx
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What are some abnormal findings we would find on a cytology from a bronchial wash?
- eosinophils
- abnormal neoplastic cells
- bacteria and yeast (macrophages with yeast and hyphae)
- parasites and/or ova
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What would be the cause of having a fungal infection but unable to see any parasites on a bronchial wash cytology?
the organism may have been walled off by granulomas tissue
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What is arthrocentesis?
analysis of synovial fluid
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What do we use arthrocentesis to help diagnose?
joint disease
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What are some of the clinical signs of joint disease?
- lameness
- swelling of joint
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Should we use aseptic technique when doing arthrocentesis?
yes, shave and scrub
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What do we need in order to do an arthrocentesis?
needle and syringe
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If we need to do a culture of the synovial fluid, should we do that first?
yes
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What kind of anticoagulant can we use after collecting fluid from an arthrocentesis?
EDTA to make sure fluid does not clot
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What does normal synovial fluid look like to the naked eye and how many cells should we see on a cytology?
- clear/colorless to straw colored (pale yellow in herbivores)
- no turbidity (cloudiness)
- viscous (if it comes out like water then it is not normal) - drop should hang 2 cm from needle
- total protein < 2.5 gm/dl
- low cell count (< 3,000/ul)
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How do we tell the difference between old blood and fresh blood from an arthrocentesis?
- centrifuge the blood down and look at the supernatant
- fresh blood: clear supernatant, will see platelets
- old blood: yellow-red fluid after being centrifuged, will not see platelets
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Can we run the fluid from an arthrocentesis through a blood counting machine?
yes, some of them will count the cells and some will not
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If we can't use a blood counting machine, how do we count the cells?
- use WBC pipettes to count
- diluet using 20 cc saline, 2 drops crystal violet, and 0.2 ml Wydase
- count on a hemocytometer
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Can we estimate our cell count from synovial fluid?
yes, thats what most people do
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If we see an increase in cells from synovial fluid, is this a significant problem?
yes
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How do we do the mucin clot test of synovial fluid?
- mix 0.1 ml of 7-N glacial acetic acid to 4 ml of water
- add 1 ml synovial fluid (no EDTA) and leave for 1 hour
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What is "normal" for a mucin clot test of synovial fluid?
ropy white clump
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What does an abnormal mucin clot test look like and what is usually the cause?
- fragments
- bacterial infection is usually the cause
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What is an alternative way to do the mucin clot test?
- add a few drops of synovial fluid to 10 ml of 5% acetic acid
- let stand for 5 minutes
- if WNL then we will see a tight clot and clear fluid
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What does a normal cytology of synovial fluid look like?
- 90% of cells are mononuclear (lymphs/monos/macros)
- cells are often aligned linearly (line up)
- granular eosinophilic background due to mucin
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What does a traumatic/degenerative arthropathy look like?
- increase in mononuclear cells and large macrophages
- osteoclasts seen if there is erosion of cartilage
- fluid may be red or cloudy
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What does infectious arthritis look like?
- many cells, mostly segs
- poor mucin clot or none at all
- the sample itself may clot or see turbidity
- may find organisms
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What does CSF stand for?
cerebrospinal fluid
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Where is cerebrospinal fluid?
bathes the exterior of the brain and spinal cord
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Why do we do cerebrospinal fluid analysis?
- patient is showing CNS signs and we can't pin it on any other cause
- patient is showing neck/back pain
- suspicious of equine protozoal myeloencephalititis (EPM)
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Is CSF stable fluid?
nope
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Where can we collect CSF in small animals and large animals?
- small animals: cisterna magna (where head joins the neck)
- large animals: lumbosacral space
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Where is the CSF fluid?
in the subarachnoid space below the duramator
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What kind of needle do we use to collect CSF?
spinal needle with stylet
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When we are collecting CSF do we need to have the animal anesthetized?
we anesthetize for small animals and just use a local anesthetic for large animals
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Should we use aseptic technique when collecting CSF?
yes
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What types of practices typically do CSF pressures?
specialty practices
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What kind of disease conditions should we look for in CSF?
- bacterial
- viral
- fungal
- rickettsial
- protozoal
- parasitic
- immune-mediated
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What are the different parts of analyzing CSF?
- color
- turbidity
- protein content
- cellularity
- cell morphology
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Describe normal CSF.
- celar and colorless
- few cells - < 25 cells/ul in dogs and < 5 cells/ul in horses
- lymphocytes is typically the cell you will see
- low protein (<50 - 60 mg/dl)
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How do we measure total protein of CSF?
- we can not use a refractometer because it will not measure that low
- we can use urine dipsticks
- 1+ mild, 3+ marked
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What is the pandy test?
- crude test to detect globulins
- abnormal if globulins are present
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How do we do the pandy test?
- mix 1ml phenol to 1-2 drops of CSF
- normal - no turbidity
- turbidity - there are globulins present
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What is the time frame for counting cells of the CSF?
within 30 minutes
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What are the different methods to counting cells in the CSF?
- with a hemocytometer - count wbcs in all 9 primary squares and then multiply by 1.1
- cytocentrifuge fluid, draw circle with wax pencil on silde, fill with CSF, let settle for 25 minutes, draw off fluid, dry, stain
- micropore filter
- special sedimentation slides
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What do abnormal CSF results look like?
- increased cell count
- increase in immunoglobulins
- eosinophils
- parasites
- bacteria, other organisms
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Even if you have an animal with CNS signs can we still have normal CSF results?
yes, negative does not necessarily mean nothing is wrong
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What is the carrier of EPM?
oppossums
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What are we looking for in the CSF when testing for EPM?
looking for antibodies to sarcocystis
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