Fluid Dr 6th Sem

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Fluid Dr 6th Sem

  1. 2. FLUID D/R NUDRAT JAWED BSMT 3 rd YEAR 5 th SEM LNH
  2. 3. CONTENTS <ul><li>Introduction </li></ul><ul><li>Types of fluids </li></ul><ul><li>Collection & transport of fluid </li></ul><ul><li>Analysis of fluid </li></ul><ul><ul><li>Physical Appearance </li></ul></ul><ul><ul><li>Specific Gravity </li></ul></ul><ul><ul><li>Protein </li></ul></ul><ul><ul><li>Glucose </li></ul></ul><ul><ul><li>Cell Count (RBCs, WBCs, Mono & poly’s %. </li></ul></ul>
  3. 4. INTRODUCTION <ul><li>Fluids are tested instead of blood because they can give more direct answers to what may be going on in a particular part of the body or in diagnosis of many pathological conditions. These fluids are; </li></ul><ul><ul><li>CSF </li></ul></ul><ul><ul><li>Pleural fluid </li></ul></ul><ul><ul><li>Pericardial fluid </li></ul></ul><ul><ul><li>Peritoneal fluid </li></ul></ul><ul><ul><li>Synovial fluid </li></ul></ul>
  4. 5. CEREBROSPINAL FLUID (CSF) <ul><li>CSF is produced by the choroid plexus, present within the brain & around the brain & the surface of the spinal chord. </li></ul><ul><li>It protects & provide cushion to the brain. </li></ul><ul><li>It is clear & colorless. </li></ul><ul><li>Its level in adults is about 150 ml & in neonates is about 60 ml. </li></ul><ul><li>It is collected by lumber puncture . </li></ul>
  5. 6. PURPOSE <ul><li>The purpose of a CSF analysis is to diagnose medical disorders that affect the central nervous system. Some of these conditions are as follows: </li></ul><ul><li>Meningitis & encephalitis </li></ul><ul><li>Metastatic tumors (e.g., leukemia) </li></ul><ul><li>Syphilis </li></ul><ul><li>Guillain-Barré syndrome </li></ul><ul><li>Multiple sclerosis </li></ul>
  6. 7. LUMBER PUNCTURE
  7. 8. PLEURAL FLUID <ul><li>The pleura is thin double layered lining which separates the lung from the chest wall. There is space in between two layers which is called pleura space & it contains pleural fluid. </li></ul><ul><li>It is straw yellow & clear. </li></ul><ul><li>Normally < 20 ml is present in the body. </li></ul><ul><li>It is collected by the process called thoracentesis. </li></ul>
  8. 9. THORACENTESIS
  9. 10. PERICARDIAL FLUID <ul><li>Surrounding the heart is a sac known as the pericardium. It is the serous visceral pericardium that secretes the pericardial fluid into the pericardial cavity, (the space between the two pericardial layers). </li></ul><ul><li>It reduces the friction by lubricating the pericardium. </li></ul><ul><li>It is clear & straw colored. </li></ul><ul><li>Normally 15-50 ml fluid is present. </li></ul><ul><li>It is collected by pericardiocentesis . </li></ul>
  10. 11. MRI OF PERICARDIAL EFFUSION
  11. 12. PERICARDIOCENTESIS
  12. 13. PERITONEAL FLUID <ul><li>A liquid that is made in the abdominal cavity to lubricate the surface of the tissue that lines the abdominal wall and pelvic cavity and covers most of the organs in the abdomen. </li></ul><ul><li>Also called ascitic fluid. </li></ul><ul><li>It is clear & pale yellow. </li></ul><ul><li>It is about 10 ml present in the peritoneal cavity. </li></ul><ul><li>It is collected by the process called paracentesis . </li></ul>
  13. 14. PARACENTESIS
  14. 15. PURPOSE <ul><li>Serous effusions are of two types; </li></ul><ul><li>TRANSUDATES </li></ul><ul><ul><li>End stage of liver diseases, nephrotic syndrome, protein losing enteropathy, hypoproteinemia of any cause & glomerulonephritis, etc. </li></ul></ul><ul><li>EXUDATES </li></ul><ul><ul><li>Pneumonia, malignancy, pancreatitis, pulmonary tuberculosis, ovarian neoplasm, etc. </li></ul></ul>
  15. 16. SYNOVIAL FLUID <ul><li>The joints are lined by synovial membrane & synovial cells. The cavity in between the membrane is called synovial cavity which contains synovial fluid. </li></ul><ul><li>It lubricates the joints space & provide nutrient to the articular cartilage. </li></ul><ul><li>It is straw colored, clear & viscous. </li></ul><ul><li>Normally it is about 0.15-3.5 ml present. </li></ul><ul><li>Method of collection is called arthocentesis . </li></ul>
  16. 17. PURPOSE <ul><li>Synovial fluid is collected for the diagnosis of; </li></ul><ul><li>Arthritis </li></ul><ul><li>SLE </li></ul><ul><li>Gout </li></ul><ul><li>Inflammation of synovial linings </li></ul>
  17. 18. ARTHOCENTESIS
  18. 19. COLLECTION & TRANSPORT OF FLUID <ul><li>CSF = not < 1.5 ml </li></ul><ul><li>SEROUS FLUID = not < 2 ml </li></ul><ul><li>SYNOVIAL FLUID = not <1 ml </li></ul><ul><li>TRANSPORT : </li></ul><ul><li>Usually fluid is received in syringes or without anticoagulant tubes. </li></ul><ul><li>If received in anticoagulant , it should be in sodium heparin or liquid EDTA. </li></ul>
  19. 20. ANALYSIS OF FLUIDS
  20. 21. PHYSICAL APPEARENCE <ul><li>VOLUME </li></ul><ul><ul><li>If sample in syringe, read the marking </li></ul></ul><ul><ul><li>If in tube, make an estimation </li></ul></ul><ul><ul><li>Report in ml </li></ul></ul><ul><li>COLOR </li></ul><ul><ul><li>May be light yellowish, yellowish, brownish, reddish or colorless . </li></ul></ul><ul><li>TURBIDITY </li></ul><ul><ul><li>May be slightly turbid, turbid or clear . </li></ul></ul>
  21. 22. SPECIFIC GRAVITY <ul><li>Specific gravity denotes the dissolved substances in fluid. Refractometer is used for measuring specific gravity. </li></ul><ul><ul><li>Pour 50 μl sample on the screen of refractometer & close the roof. </li></ul></ul><ul><ul><li>Read the value of scale which is marked on eye piece. </li></ul></ul>
  22. 24. PROTEIN & GLUCOSE <ul><li>Concentration of protein & glucose in fluids are analyzed by means of analyzer in biochemistry department. </li></ul>
  23. 25. CELL COUNT (RBCs & WBCs) <ul><li>EQUIPMENT & REAGENTS </li></ul><ul><ul><li>Capillary tube </li></ul></ul><ul><ul><li>Neubauer chamber & cover glass </li></ul></ul><ul><ul><li>Microscope </li></ul></ul><ul><ul><li>For RBC dilution = Formal citrate </li></ul></ul><ul><ul><li>For WBC dilution = Turk’s solution </li></ul></ul>
  24. 26. HOW TO DECIDE FOR DILUTION <ul><li>To decide for dilution, always charge the neubauer chamber with undiluted sample. </li></ul><ul><li>Focus the one large square (1 WBC) area under microscope. </li></ul><ul><li>See whether cells are overlapping or not I.e.dilution required or not. </li></ul><ul><li>Never make an idea for dilution by physical appearance of fluid. </li></ul>
  25. 27. DILUTION FOR RBC FORMULA = no. of counted RBCs x multiplying factor 400 0.05 FLUID + 1.95 FORMAL CITRATE 1:40 200 0.05 FLUID + 0.95 FORMAL CITRATE 1:20 100 0.1 FLUID + 0.9 FORMAL CITRATE 1:10 20 0.1 FLUID + 0.1 FORMAL CITRATE 1:2 M.FACTOR QUANTITY OF REAGENTS RATIO
  26. 28. DILUTION FOR WBCs FORMULA = no. of counted WBCs ( L1 + L2 + L3 + L4) x multiplying factor 100 0.1 FLUID + 3.9 TURK’S SOLUTION 1:40 50 0.01 FLUID + 1.9 TURK’S SOLUTION 1:20 25 0.1 FLUID + 0.9 TURK’S SOLUTION 1:10 05 0.1 FLUID + 0.1 TURK’S SOLUTION 1:2 M.FACTOR QUANTITY OF REAGENTS RATIO
  27. 29. HOW TO USE NEUBAUER CHAMBER <ul><li>WBCs are counted in 4 corner squares. </li></ul><ul><li>RBCs are counted in middle area which has 25 small squares. </li></ul>
  28. 30. SLIDE PREPARATION <ul><li>Make a smear of fluid on slide </li></ul><ul><li>After the smear dried, fix it in 70 % ethanol. </li></ul><ul><li>Stained with H&E. </li></ul><ul><li>Examine the slide under microscope (mono’s & Poly's % ). </li></ul>

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