Cairan tubuh dan

kelainannya

Cairan pleura
• Diperoleh dari ruang pleura (antara
membran parietal dan viseral yang
melapisi paru-paru)
• Dapat transudat atau eksudat
• Eksudat:
– Kolesterol cairan pleura > 60 mg/dL
– Rasio kolesterol cairan : serum > 0,3
– Rasio bilirubin total cairan : serum > 0,6

Strasinger SK, Di Lorenzo MS. Urinalysis and body fluids. 5 th eds. F.A. Davis Company,
Philadelphia. 2008

Cairan Pleura
Pengambilan spesimen
cairan pleura:

Volume: 50 ml
Masukkan ke dalam tube 50
ml yang sudah diberi EDTA
Segera kirim ke lab
Sentrifugasi
Sedimen dipergunakan
untuk pemeriksaan
mikroskopik dan biakan

Philadelphia. Makroskopik Hemotoraks  hematokrit cairan > 50% hematokrit darah Efusi hemoragik  hematokrit caitan < hematokrit darah Strasinger SK. Urinalysis and body fluids. F. 2008 . Di Lorenzo MS.A. Davis Company. 5 th eds.

5 th eds.A. F. Philadelphia.Strasinger SK. Davis Company. Urinalysis and body fluids. 2008 . Di Lorenzo MS.

Transudat vs eksudat .

: tidak ada 100 ml kekeruhan akuabidest Strasinger SK. Di Lorenzo MS.A. presipitasi) 1 tetes . Cairan pleura Tes Rivalta 1 tetes + : ada kekeruhan Asam asetat (kabut halus. Philadelphia. F. 5 th eds. 2008 . Urinalysis and body fluids. kabut glasial tebal. Davis Company.

5 th eds. Davis Company. F. Urinalysis and body fluids. dihitung manual – Sel terlalu banyak  diencerkan dgn NaCl 0. Mikroskopik • Pemeriksaan jumlah sel – Menggunakan cell counter XT/XE – Bila ada bekuan.9% Strasinger SK. Di Lorenzo MS.A. 2008 . Philadelphia.

eritrosit < 5.000 dilakukan pengenceran (leukosit <500 dan eritrosit < 5. Philadelphia. eritrosit > 5. 5 th eds. 2008 . Davis Company. Urinalysis and body fluids.A.000) • Reagen : – Zat warna Wright – Metanol untuk fiksasi – Buffer pH 7.2 Strasinger SK. Mikroskopik • Tujuan : membedakan PMN dan MN • Alat :  Cytocentrifuge  Objectglass/Cytoslide • Bahan : Cairan pleura  Leukosit < 500. Di Lorenzo MS.000  tidak perlu diencerkan  Leukosit > 500. F.

Cara kerja • Masukkan 50 µL serum kedalam chamber cytocentrifuge • Tambahkan 200 µL cairan pleura • Cairan disitosentrifus dengan kecepatan 1000 rpm selama 10 menit • Hasil sitosentrifus diwarnai dengan Wright. Urinalysis and body fluids.A. 2008 . Philadelphia. F. Davis Company. 5 th eds. • Dilakukan hitung jenis sel MN dan PMN dengan pembesaran 40x Strasinger SK. Di Lorenzo MS.

Strasinger SK. Davis Company. 5 th eds. F. Philadelphia. Di Lorenzo MS. 2008 . Urinalysis and body fluids.A.

A. Philadelphia. 5 th eds. Urinalysis and body fluids.Strasinger SK. Davis Company. 2008 . F. Di Lorenzo MS.

keganasan Strasinger SK.0  ruptur esofagus • Amilase –Meningkat pertama kali pada cairan pleura –Meningkat  pankreatittis. Philadelphia.A. Davis Company. 2008 . ruptur esofagus. Urinalysis and body fluids. Di Lorenzo MS. F. 5 th eds. infeksi purulen • pH –< 7. Pemeriksaan kimia • LDH cairan dan serum –LDH cairan meningkat pada infeksi bakteri • Protein cairan dan serum • Glukosa –Glukosa cairan menurun  < 60 mg/dL –Menurun  tuberkulosis. rheumatoid inflamation.0  chest tube drainage –< 6.

Enterobacteriaceae. Urinalysis and body fluids. pewarnaan tahan asam  tergantung klinis • Pemeriksaan serologi  membedakan efusi akibat imunologi atau proses noninflamasi – ANA dan RF – CEA. Philadelphia. CYFRA 21-1 (kanker paru) Strasinger SK. 5 th eds. Davis Company.A. kultur. 2008 . Pemeriksaan mikrobiologi • Mikroorganisme  Staphylococcus aureus. dan Mycobacterium tuberculosis • Pewarnaan Gram. CA 15. CA 549 (kanker payudara). Di Lorenzo MS. anaerobes. F.3. CA 125 (metastasis kanker uterus).

F. Davis Company. Urinalysis and body fluids. Philadelphia. 5th eds. 2008 .A. Di Lorenzo MS. Cairan perikardium • Normal  10–50 mL • Perubahan permeabilitas membran – Perikarditis – Keganasan – Eksudat yang dihasilkan karena trauma Strasinger SK.

pewarnaan Gram  Haemophilus. dan Coxsackievirus –pewarnaan tahan asam . Staphylococcus. Adenovirus. Streptococcus. Pemeriksaan laboratorium • Menentukan transudat atau eksudat –Rasio protein cairan dan serum –Rasio laktat dehidrogenase cairan dan serum • Leukosit 1000 sel/L dengan persentase terbesar neutrofil  endokarditis bakterialis • Pemeriksaan sitologi  keganasan • Pemeriksaan mikrobiologi –kultur bakteri.

Cairan PERITONEUM  Tuberculous Peritonitis  Bacterial Peritonitis  Fungal Peritonitis  HIV associated peritonitis .

keganasan atau trauma TOTAL PROTEINS <2.1g/dL peritoneal TB (Accuracy >97%) PH: <7 Infeksi bakterial Glukosa << TB Amylase>> pankreatitis 19 .5g/dL transudat >2.1g/dL portal hypertension: cirrhosis ASCITIC ALBUMIN GRADIENT) < 1. Pemeriksaan Lab cairan peritoneum: Parameter Lab Nilai Keterangan Hitung sel WBCS <500/uL normal & netrofil <250/uL netrofil >250/uL SBP (spontaneous bacterial peritonitis) Limfosit >> Abdominal TB/keganasan RBC >50.5g/dL eksudat SAAG(SERUM >1.000/uL suspek TB.

Limfosit  dominan pada tuberkulosis Strasinger SK. Philadelphia. Davis Company.A. Di Lorenzo MS. F. 2008 . Urinalysis and body fluids. 5 th eds.

Approach to the patient with ascites and its complication. 2008. 442-66 . Ascites Ascites is the accumulation of fluid in the peritoneal cavity • In the western world cirrhosis is the main cause of ascites ( >75%) • Peritoneal malignancy (12%) • Heart failure (5%) • Peritoneal tuberculosis ( < 2%) Guadalupe Garcia Tao. In Yamada : Priciples of clinical gastroenterology 1st ed.

MASSIVE ASCITES .

Picture tekan from : http://www.netterimages.com/images/vpv .

ASCITES Picture taken from : http://medipulse.blogspot.com/2010/08/ascites.html .

Gines P et al. SAAG ASCITES PROTEIN Main etiological factors of ascites Cirrhosis Or Alcoholic High Low Hepatitis Congestive heart failure High High Peritoneal malignancy Low High Peritoneal tuberculosis Low High Moore KP. Hepatology 2003 (38): 258–66 Guadalupe Garcia Tsao. Wong F. "The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club". In Yamada : Priciples of clinical Gastroenterology 1st ed. 2008. Approach to the patient with ascites and its complication. 442-66 .

000/ mm3 –Bloody if RBC > 20.000/ mm3 Guadalupe Garcia Tao. In Yamada : Priciples of clinical gastroenterology 1st ed. 442-66 . 2008.000/ mm3 –Milky if Triglyceride > 200 mg /dL –Pinky if RBC > 10. straw colored to slightly yellow • Complicated cirrhosis : –Cloudy if leucocyte > 5000 / mm3 –Purulent if leucocyte > 50. Appearance of the ascitic fluid • Uncomplicated ascites : –transparent. Approach to the patient with ascites and its complication.

1 : peritoneal process or malignancy Guadalupe Garcia Tao. 2008. 442-66 . Serum ascites albumin gradient and ascites total protein • SAAG is obtained by subtracting the concentration of ascites albumin from that of serum albumin • SAAG = Serum albumin – serum ascites – ( ideally determined from specimen obtained in same time or same day) • SAAG > 1.1 : sinusoidal hypertension • SAAG < 1. Approach to the patient with ascites and its complication. In Yamada : Priciples of clinical gastroenterology 1st ed.

2008. Total and differential count • The predominance of neutrophils or PMN in the ascitic fluid  acute intraabdominal inflammatroy process • SBP : PMN of ascitic fluid PMN > 250/ mm3 • In patient with bloody ascites or RBC > 10. 442-66 .000/mm3 the ratio : 1 PMN per 250 RBC Guadalupe Garcia Tao. Approach to the patient with ascites and its complication. In Yamada : Priciples of clinical gastroenterology 1st ed.

In Yamada : Priciples of clinical gastroenterology 1st ed.27: 2145 . G. Sifuentes J. Garcia Tsao. Approach to the patient with ascites and its complication. Improved method for bacteriologic diagnosis of spontaneous bacterial peritonitis. J Clin Microbiol 1989. Smears and cultures • Ascitic fluid 10 ml for aerobic and anaerobic culture • Although ascites culture is negative in 40% of patients with SBP and increased PMN in the ascitic fluid  important to identify microorganism • Gram stain is found in less than 1/3 cases of SBP Guadalupe Garcia Tao. 442-66 Bobadila M. 2008.

Ascitic fluid analysis in malignancy related ascites. Hepatology 1988. high protein and cytology positive : sensitivity is high ± 97%. Hoefs JC. but could be low as only 42% Runyon BA. 8: 1104 . Ascites fluid test for cancer • Cytology examination of ascites should be performed in all patients with suspected malignancy. low SAAG and high ascites protein • In peritoneal carcinomatosis : low SAAG. Morgan TR.

Ascitic fluid for tuberculosis • AFB stain and culture is the gold standard • < 40% of peritonitis Tb has positive culture • AFB staining is positive in only 3% of peritonitis TB • PCR TB can yield the result of diagnosis but their diagnostic value requires further analysis • Laparoscopic is the test for peritoneal Tb Senai PM. diagnostic strategies and treatment. Bzeiki KI. 22: 685 . Aliment Pharmacol Ther 2005. Syetematic review tuberculous peritonitis presenting features.

HSV. Untuk deteksi: • H. HAV. Saliva Cairan tubuh yang dapat digunakan sebagai alternatif dari serum untuk alat diagnostik Mudah dan tidak invasif. pylori • Shigella • Infeksi virus: IgA> IgG dan IgM: HbsAg. Dengue .

Saliva collecting device .