Pericardial Fluid

DESCRIPTION:

Pericardial fluid reduces friction within the pericardium by lubricating the epicardial surface. The fluid is similar to the
cerebrospinal fluid of the brain which also serves to cushion the organ. Problems can occur when the pericardium
becomes enflamed or fills with fluid.

SIGNIFICANCE:

 It keeps the heart fixed in its proper place within the chest cavity avoiding collision with other organs.
 It also prevents the heart from stretching too much while doing its function and also keeps it from overfilling
with blood.
 The pericardial fluid also acts as a lubricant to the heart to prevent friction with the tissues surrounding it as it
beats.

MACROSCOPIC APPEARANCE:

 Normal and transudate pericardial fluid appears clear and pale yellow
 Effusions resulting from infection and malignancy are turbid, and malignant effusions are frequently blood
streaked
 Grossly bloody effusions are associated with accidental cardiac puncture and misuse of anticoagulant
medications.
 Milky fluids representing chylous and pseudochylous effusions may also be present

TEST PERFORMED

 Primarily directed at determining whether the fluid is a transudate or an exudate and include the fluid
serum protein and lactic dehydrogenase ratios.
 WBC counts are of little clinical value, although a count of >1000 WBCs/uL with a high percentage of
neutrophils can indicate bacterial endocarditis.
 Cytologic examination of pericardial exudates for the presence of malignant cells
 Bacterial cultures and Gram stains are performed on concentrated fluids when endocarditis is suspected.
 Acid- fast stains and chemical tests for adenosine deaminase are often requested on pericardial effusions.
PERITONEAL

DESCRIPTION:

Peritoneal fluid lubricates the surface of tissue that lines the abdominal wall and pelvic cavity. It allows the
diffusion of electrolytes and other substances to and from the serosal surfaces. It covers most of the organs in
the abdomen.

SIGNIFICANCE:

 It helps determine causes of accumulation of excess fluid within the peritoneal cavity.
 It is helpful in establishing a diagnosis and determining a prognosis for many gastrointestinal disorders.
 Two sites are recommended for abdominocentesis in cattle.
 The first evaluates the right cranial abdomen and is most helpful in cases in which a localized peritonitis is
suspected secondary to perforation of an abomasal ulcer.
 The second site is located just above the udder on the right side under the fold of the flank

MACROSCOPIC APPEARANCE:

• Normal Volume: 5-20 mL

• Normal RBC count: none
• Normal WBC count: <500 cells/uL

Transudate

• Appearance: Clear, pale yellow

• Protein: <3 g/dL
• Albumin level: Low
• LD fluid/serum ratio: <0.6
• Glucose: equal to blood glucose level
• Cell count: few cells are present, usually lymphocytes
• Specific gravity: <1.015

Exudate

• Appearance: cloudy
• Protein: >3 g/dL
• Albumin level: Higher than transudates
• LD fluid/serum ratio: >0.6
• Glucose: >60 mg/dL
 • Cell count: increased
• Specific gravity: >1.015

TEST PERFORMED

• Ascitic fluid physical examination - provides clues which may an indication of certain conditions or diseases

- Turbid = Microbial infection

- Green = Bile, gallbladder, pancreatic disorders

- Blood-streaked = Trauma, infection, or malignancy

- Milky = Lymphatic trauma and blockage

• Ascitic fluid biochemistry - provides useful insights that could aid in differential diagnosis relating to ascitic fluid.

- Protein

• >4 g/dL = Bacterial peritonitis / Tuberculosis

- Glucose

• decreased in Tubercular peritonitis, Malignancy

- Amylase

• Increased in Pancreatitis, Gastrointestinal perforation

- Alkaline phosphatase

• Increased in Gastrointestinal perforation

- Blood urea nitrogen / creatinine

• Ruptured or punctured bladder

• Ascitic fluid microscopy - provides significant clinical information regarding to the number and type of RBC and
WBC present in the fluid

- RBC count

• >100 g/dL = Malignancy / TB

• >100,000 g/dL = Hemorrhage / Trauma

- WBC count

• >250 cells/uL mostly with neutrophil = Bacterial peritonitis

• >250 cells/uL mostly with lymphocytes = tuberculosis

• Serum ascitic albumin gradient - used to indirectly measures the portal pressure and utilized to
identify if ascites were caused by portal hypertension
- High SAAG (>1.1 g/d) is suggestive of ascitic transudates
• Cirrhosis
• Hepatic failure
• Venous occlusion (e.g. Budd Chiari syndrome)
• Fulminant hepatic failure
• Alcoholic hepatitis
• Kwashiorkor malnutrition
- Low SAAG (<1.1 g/d) is suggestive of ascitic exudates
• Malignancy
• Infection
• Pancreatitis
• Nephrotic syndrome

• Ascitic fluid serological test - used to identify the primary source of tumors producing ascitic exudates, mainly
tumor markers CEA and CA 125
- CA 125 antigen with negative CEA is suggestive that the source of tumor is from ovaries, fallopian tubes, or
endometrium
- Carcinoembryonic antigen is suggestive of Malignancy of gastrointestinal origin

• Ascitic fluid microbiological test - helpful in determining possible infections caused by microbes
- Gram stain and culture = Bacterial peritonitis
- Acid-fast stain = Tubular peritonitis
Adenosine deaminase = Tubular peritonitis

SYNOVIAL FLUID
Description:

Synovial fluid/ AKA: synovia,

 It is a viscous, non-Newtonian fluid found in the cavities of synovial joints.

 It has an egg white–like consistency
 The principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during
movement.

Significance:

 It helps diagnose the cause of joint inflammation.

 Each of the joints in the human body contains synovial fluid.
 This fluid is a thick liquid that lubricates the joint and allows for ease of movement.
 In joint diseases like arthritis, the synovium of the joint is the main place where inflammation occurs.

Macroscopic:

Fluid volume - may be greater than normal. Joints and bursae normally contain very small amounts of synovial
fluid—sometimes less than 1 mL,1 depending on the size of the joint. An inflamed joint or bursa may contain several
times the normal amount of fluid.

Viscosity - may be decreased. Normal synovial fluid is viscous and often compared to egg whites. Inflammation
may cause synovial fluid to be less viscous.

Color and clarity - may vary. Normal synovial fluid is clear and colorless or straw-colored. Abnormal fluid may
look cloudy, opaque, and/or differently colored. For example, cloudy fluid may indicate an infection, and pink or reddish
fluid may indicate the presence of blood.

Test done:

white blood cell count - higher than normal may indicate infectious arthritis, gout, or rheumatoid arthritis. For
example, results that show more than 50,000 WBC µL (white blood cells per cubic millimeter) may indicate a bacterial
infection.

Red blood cell counts - may be high after a traumatic injury and slightly elevated in patients with osteoarthritis.
They may also be present if the patient has a bleeding disorder, such as hemophilia.
 Chemical test/analysis:

Uric acid content - may be higher than normal for people with gout

Lactate dehydrogenase (LDH) - an enzyme normally found in synovial fluid, might be at elevated levels in people
who have rheumatoid arthritis, infectious arthritis, or gout.

Protein - levels that are higher than normal may indicate an infection.

Glucose levels - lower than normal may indicate infection. Slightly low glucose levels are also sometimes seen in
rheumatoid arthritis.

Maglinao, Shanne O.
Manalo, Alyssa Angelica B.

Pleural fluid
Description
 It is a liquid obtained from the pleural cavity
 It is located between the parietal pleural membrane lining the chest wall and visceral pleural
membrane covering the lungs
 It functions by lubricating the space between the pleura, allowing it to glide smoothly during
inhalation and exhalation
 It keeps pleura moist and reduces friction between membranes when we breathe
 It cushions delicate lung tissues against friction from ribs and chest wall

Significance
  It is used to help diagnose the cause of fluid buildup in the chest cavity (pleural effusion)
 It is used to diagnose pneumothorax (collection of air within the pleural cavity)
 It is used to diagnose pleural tumors (abnormal growths on the pleura)
 Bloody pleural fluid is the result of hemothorax and malignancy
 Transudative pleural effusions are associated with diseases such as heart failure, pulmonary
embolism, cirrhosis and post open heart surgery
 Exudative pleural effusions are associated with diseases such as pneumonia, cancer,
pulmonary embolism, kidney disease and inflammation
 Lymphocytosis in pleural fluid indicates tuberculosis
 Granulocytosis in pleural fluid indicates bacterial infection
 High level of amylase in pleural fluid is associated with pancreatitis

Macroscopic appearance
 Normal pleural fluids are clear and pale yellow.
 Pleural fluids associated with microbial infection are turbid and white.
 Pleural fluids associated with hemothorax, hemorrhagic effusion, pulmonary embolus,
tuberculosis, and malignancy are bloody.
 Pleural fluids associated with chylous material from thoracic duct leakage and psudochylous
material from chronic inflammation are milky.
 Pleural fluids associated with amoebic liver abscess rupture are brown.
 Pleural fluids associated with aspergillus are black.
 Pleural fluids associated with malignant mesothelioma are viscous.
Tests performed
 Differential cell count is the most diagnostically significant test in hematology used to
determine the presence of macrophages, lymphocytes, and neutrophils.
 Chemical Tests are used to determine the levels of glucose, lactate, triglyceride, pH,
Adenosine Deaminase, and amylase.
 Gram stains, cultures, acid fast stains and mycobacteria cultures are performed on
pleural fluid when clinically indicated.
 Test for antinuclear antibody (ANA) and rheumatoid factor are used to differentiate
effusions of immunologic origin from non-inflammatory processes.
 Carcinoembryonic antigen (CEA) detection provides valuable diagnostic information in
effusions of malignant origin.
 CA 125 is used to detect metastatic uterine cancer.
 CA 15.3 is used to detect breast cancer.
 CYFRA 21-1 is used to detect lung cancer.