It is about interpretation of results of pleural fluid tests including physical characteristics, biochemical analysis, cell counts, culture and cytology.
It is about interpretation of information delivered as results of pleural fluid exams, including physical characteristics, differentiation between transudates and exudates, cell counts, culture and cytology.
Apparently a lengthy presentation actually very good for junior physicians as it covers all aspects of assessment, diagnosis and treatment of pleural effusion
This document provides an overview of pleural effusion, including:
- Pleural effusion is abnormal fluid accumulation in the pleural space between the lungs and chest wall. Fluid builds up due to changes in pressure or permeability.
- Effusions are classified as transudative or exudative based on their mechanism and composition. Causes include infections, cancers, heart failure, and other conditions.
- Symptoms depend on the underlying cause but may include chest pain, difficulty breathing, and cough. Diagnosis involves physical exam, imaging like x-rays, and analyzing pleural fluid obtained via thoracentesis.
- Management consists of treating the underlying condition medically or surgically with drainage
This document discusses pleural effusions, including their mechanism, normal composition, differentiation between transudative and exudative effusions, and causes. It provides details on parapneumonic effusions and empyema, including classification and treatment approaches. Specific conditions discussed in detail include tuberculous pleural effusions, effusions in HIV patients, chylothorax, pseudochylothorax, and malignant pleural effusions. Useful pleural fluid tests are also summarized.
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
This document discusses pre-transfusion testing procedures, including patient identification, blood sample collection and handling, compatibility testing, and crossmatching. The key steps are:
1) Performing ABO and Rh typing on the recipient's sample to determine blood type.
2) Screening for unexpected antibodies and identifying any present to guide compatible blood unit selection.
3) Crossmatching a recipient's plasma with donor red blood cells to confirm compatibility and detect antibodies.
4) Labeling and releasing crossmatched blood units for transfusion only after resolving any discrepancies.
This document discusses sustained low-efficiency daily dialysis (SLEDD) for treating acute kidney injury (AKI) in critically ill patients. SLEDD is a hybrid therapy that combines aspects of continuous renal replacement therapy and intermittent hemodialysis. It allows for a reduced ultrafiltration rate and prolonged treatment duration to maximize dialysis dose while maintaining hemodynamic stability. The document outlines the indications for SLEDD, including patients at risk of disequilibrium or with borderline cardiovascular stability. Preliminary studies suggest SLEDD is a safe and effective option for AKI patients otherwise unsuitable for standard therapies.
The Light criteria from 1972 remains a useful tool for differentiating transudative and exudative pleural effusions. While it accurately classifies most exudates, it falsely classifies around 25% of transudates as exudates, likely due to more powerful diuretic use now. If the Light criteria suggest an exudate but transudate is suspected, measuring the serum-pleural fluid protein gradient, NT-proBNP levels, or albumin gradient can help identify misclassified transudates. The Light criteria provide a good starting point but may require supplementation for accurate classification in some cases.
It is about interpretation of information delivered as results of pleural fluid exams, including physical characteristics, differentiation between transudates and exudates, cell counts, culture and cytology.
Apparently a lengthy presentation actually very good for junior physicians as it covers all aspects of assessment, diagnosis and treatment of pleural effusion
This document provides an overview of pleural effusion, including:
- Pleural effusion is abnormal fluid accumulation in the pleural space between the lungs and chest wall. Fluid builds up due to changes in pressure or permeability.
- Effusions are classified as transudative or exudative based on their mechanism and composition. Causes include infections, cancers, heart failure, and other conditions.
- Symptoms depend on the underlying cause but may include chest pain, difficulty breathing, and cough. Diagnosis involves physical exam, imaging like x-rays, and analyzing pleural fluid obtained via thoracentesis.
- Management consists of treating the underlying condition medically or surgically with drainage
This document discusses pleural effusions, including their mechanism, normal composition, differentiation between transudative and exudative effusions, and causes. It provides details on parapneumonic effusions and empyema, including classification and treatment approaches. Specific conditions discussed in detail include tuberculous pleural effusions, effusions in HIV patients, chylothorax, pseudochylothorax, and malignant pleural effusions. Useful pleural fluid tests are also summarized.
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
This document discusses pre-transfusion testing procedures, including patient identification, blood sample collection and handling, compatibility testing, and crossmatching. The key steps are:
1) Performing ABO and Rh typing on the recipient's sample to determine blood type.
2) Screening for unexpected antibodies and identifying any present to guide compatible blood unit selection.
3) Crossmatching a recipient's plasma with donor red blood cells to confirm compatibility and detect antibodies.
4) Labeling and releasing crossmatched blood units for transfusion only after resolving any discrepancies.
This document discusses sustained low-efficiency daily dialysis (SLEDD) for treating acute kidney injury (AKI) in critically ill patients. SLEDD is a hybrid therapy that combines aspects of continuous renal replacement therapy and intermittent hemodialysis. It allows for a reduced ultrafiltration rate and prolonged treatment duration to maximize dialysis dose while maintaining hemodynamic stability. The document outlines the indications for SLEDD, including patients at risk of disequilibrium or with borderline cardiovascular stability. Preliminary studies suggest SLEDD is a safe and effective option for AKI patients otherwise unsuitable for standard therapies.
The Light criteria from 1972 remains a useful tool for differentiating transudative and exudative pleural effusions. While it accurately classifies most exudates, it falsely classifies around 25% of transudates as exudates, likely due to more powerful diuretic use now. If the Light criteria suggest an exudate but transudate is suspected, measuring the serum-pleural fluid protein gradient, NT-proBNP levels, or albumin gradient can help identify misclassified transudates. The Light criteria provide a good starting point but may require supplementation for accurate classification in some cases.
The document discusses various functions and properties of blood, including transport, regulation, and protection. It then summarizes different blood products like packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitated antihemophilic factor. It discusses their indications, storage requirements, and risks of transfusion such as allergic reactions, hemolytic reactions, febrile reactions, bacterial contamination, transfusion-related acute lung injury, and disease transmission.
Presentation of laboratory diagnosis of tb final researchAyman Hameed
laboratory daignosis of pulmonary tuberculosis and what happens in the lab and how to deal with the specimens and how to know the positive frome negative results
Dialysis without anticoagulation (Heparin Free Dialysis)Mahmoud Eid
This document discusses techniques for performing dialysis without anticoagulation. It describes indications for heparin-free dialysis such as recent surgery or bleeding risks. Techniques mentioned include regional citrate anticoagulation, saline flushes, heparin-coated membranes, and citrasate dialysate. Signs of clotting and scoring systems are provided. Tips for priming, high blood flows, and alternatives to heparin locking are also outlined. The key recommendations are to prime properly, have no rushing, follow a written protocol, and focus on patient safety above all else.
This document discusses non-infectious complications that can occur from blood transfusions. It describes various types of complications including acute hemolytic transfusion reactions caused by immune or non-immune mechanisms. Other complications discussed include febrile non-hemolytic transfusion reactions, transfusion-related acute lung injury, circulatory overload, and delayed hemolytic transfusion reactions. The mechanisms, signs and symptoms, diagnoses, and risk factors for each complication are explained in detail.
Pleural effusion is an accumulation of excess fluid in the pleural space between the lungs and chest wall. It is usually secondary to other conditions that interfere with fluid drainage or secretion in the pleural space. Common causes include infections like pneumonia, congestive heart failure, cancers, and autoimmune diseases. Diagnosis involves chest x-ray, ultrasound, and thoracentesis to analyze pleural fluid characteristics. Management focuses on treating the underlying cause, relieving symptoms by removing fluid via thoracentesis or chest tube, and preventing further fluid buildup. Surgery may be needed for cases that do not improve with drainage or medication.
Pre-transfusion tests are performed to ensure blood compatibility and safety. These include determining the recipient's blood group and Rh type, screening the recipient's serum for antibodies, and performing a cross-match test between the recipient's serum and donor red blood cells to detect any agglutination. Additional safety tests are done on donor blood to identify infections like HIV, hepatitis B and C, and syphilis. Together these tests help select immunologically compatible blood to minimize adverse transfusion reactions in recipients.
This document discusses plasmapheresis, which is a therapeutic apheresis procedure that removes plasma from the blood. There are two main techniques used: membrane apheresis, which is fast but limited in substance removal, and centrifugal devices, which are more expensive but efficient. Complications can include hypotension, bleeding, and allergic reactions. Plasmapheresis is used to treat autoimmune disorders by removing autoantibodies, and other conditions involving abnormal circulating factors. Care must be taken with anticoagulation and replacement fluids during the procedure.
This document discusses various techniques used in blood banking and transfusion medicine, including:
1. Pretransfusion testing involves ABO/Rh typing, antibody screening, and crossmatching to select compatible blood and prevent hemolytic transfusion reactions.
2. Antibody identification uses a panel of red blood cells to identify the specific antibody in a patient's serum through various testing phases including immediate spin, LISS incubation, and antiglobulin.
3. Special techniques like elution, hemagglutination inhibition, and titration are used to further characterize antibodies or quantify their concentration.
This document discusses various aspects of renal replacement therapy for acute kidney injury. It begins by outlining the stage-based management of AKI, with increasing intervention and monitoring recommended as the stage progresses from risk to injury to failure. The document then addresses indications for starting renal replacement therapy, appropriate modalities including intermittent hemodialysis, slow continuous ultrafiltration, and continuous renal replacement therapy. Key factors like vascular access, solutions, membranes, anticoagulation, and dose are discussed. The overall conclusions are that while data from high-quality randomized controlled trials are still lacking, earlier initiation of renal replacement therapy may aid recovery, and continuous modalities are generally preferred over intermittent hemodialysis for unstable patients. Individualization of
Platelets are blood cells that help control bleeding by collecting at sites of damaged blood vessels and initiating the clotting process. Platelet transfusions can be used prophylactically to prevent bleeding in thrombocytopenic patients with platelet counts below 5x109/L or therapeutically to treat active bleeding. One unit of platelets increases the platelet count by approximately 5x109/L but efficacy can be reduced by non-immune or immune causes. Potential risks of platelet transfusions include allergic reactions, febrile reactions, and transfusion-related acute lung injury.
This document provides information about hepatopulmonary syndrome (HPS). It defines HPS as the presence of liver disease, impaired oxygenation, and intrapulmonary vascular abnormalities. The pathophysiology involves widespread pulmonary vasodilatation leading to ventilation-perfusion mismatching and right-to-left shunting, causing hypoxemia. Clinical features include signs of liver disease in most patients and dyspnea in some. Diagnosis requires confirming the three criteria through tests like contrast echocardiography to detect intrapulmonary shunting.
Approach oriented presentation for some of the emergencies of clinical gastroenterology, including upper GI bleeding, hepatic encephalopathy, acute severe attack of IBD and acute pancreatitis.
Hepatorenal syndrome is a type of kidney failure seen in patients with liver disease, usually cirrhosis. It is characterized by severe vasodilation in the systemic circulation and constriction of the renal arteries. This leads to decreased renal blood flow and kidney dysfunction. There are two main types - type 1 is a rapidly progressive form with high mortality, while type 2 progresses more slowly over weeks to months. Treatment involves use of vasoconstrictors like terlipressin with albumin to increase renal blood flow. Liver transplantation offers the best chance of cure but is limited by availability and risk of complications in patients with hepatorenal syndrome.
This document discusses the preparation of blood components from whole blood donations. Whole blood is collected and then separated via centrifugation into red blood cells, plasma, platelets, and white blood cells. These components are then processed and stored under specific conditions to maximize their viability and function. Red blood cells are stored in additive solutions, platelets must be processed within 8 hours, and plasma can be frozen into fresh frozen plasma or plasma frozen within 24 hours. The document outlines the preparation methods and storage requirements for various blood components including red blood cells, platelets, plasma, cryoprecipitate, and plasma derivatives.
Fetal hemoglobin and rh incompatibilityrohini sane
A comprehensive presentation on fetal hemoglobin & Rh incompatibility for undergraduate medical, dental, biotechnology & pharmacology students for self-learning .Presentation has physical & chemical properties of fetal hemoglobin along with its function. Binding affinity for O₂ of HbF and oxygen dissociation curve for HbF elucidated with suitable diagrams. Molecular constitution of Embryonic Hb ( Grover I &Grover II )with electrophoretic patterns are presented here . Importance of Kleihauer staining for detection of fetal cells is described briefly.
Diagrammatic representation of Rh- incompatibility is done for complete understanding of the concept. Signs & symptoms Kernicterus are presented diagrammatically.
Direct and indirect Coomb’s Test for Rh- incompatibility for diagnosis of Erythroblastosis Fetalis is illustrated. Biochemical aspects of Hemolytic Disease of Newborn (HDN) and Physiological /Neonatal Jaundice are presented. Comparison of Causes & biochemical findings for Hemolytic Jaundice along hepatic and obstructive jaundice is done in this presentation.
Molecular mechanism involved in biosynthesis of Hb Bart and Hb H along with their electrophoretic patterns for their detection are illustrated.
Hereditary persistent fetal Hb( HPFH ) & Point mutations causing HPFH are described in lucid manner. Google images are used for intense impact of the subject.
This document outlines the plasmapheresis protocol at the New Mansoura General Hospital Nephrology Department in Egypt. It defines plasmapheresis as removing, treating, and returning blood plasma from circulation. Examples of diseases treated with plasmapheresis include idiopathic pulmonary fibrosis, Guillain-Barre syndrome, and thrombotic thrombocytopenic purpura. The procedure, complications, replacement solutions, and post-procedure care are described.
Pleural fluid is the fluid found between the membranes lining the thoracic cavity. An excess amount is called a pleural effusion, which can be caused by conditions like heart failure, pneumonia, or rheumatoid arthritis. A sample of pleural fluid is removed through thoracentesis and analyzed to determine if it is a transudate or exudate and diagnose the cause. A transudate is caused by pressure imbalances while an exudate results from inflammation or injury, requiring additional testing to identify conditions like infection, bleeding disorders, or cancer. Test results provide information on the fluid's characteristics, protein levels, and microscopic examination of cells to diagnose the pleural effusion's underlying cause.
Autologous Blood Transfusion (ABT) means reinfusion of blood or blood products taken from the same patient
ABT is not a new concept, fear of transfusion- transmitted diseases stimulated the growth of autologous programme
This document discusses transfusion-transmitted infections (TTIs) and methods for screening donated blood. It notes that TTIs include viruses like HIV, HBV, HCV that can remain undetected in the blood donor but be transmissible. Screening methods include serological tests like ELISA, CLIA, rapid tests, as well as nucleic acid amplification tests (NAATs) that can detect infections earlier. Implementing individual donor NAT in addition to serological screening provides an additional safety layer and reduces the risk window period for TTIs in blood donations.
Pleural effusions can be transudative or exudative based on the ratio of fluid to serum proteins and lactate dehydrogenase levels. Common causes include congestive heart failure, cirrhosis, pneumonia, and malignancy. Diagnosis involves physical exam, imaging like chest x-ray, and thoracentesis to analyze fluid characteristics. Treatment depends on the underlying cause but may include drainage, antibiotics for infection, or pleurodesis for recurrent malignant effusions.
The document discusses various functions and properties of blood, including transport, regulation, and protection. It then summarizes different blood products like packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitated antihemophilic factor. It discusses their indications, storage requirements, and risks of transfusion such as allergic reactions, hemolytic reactions, febrile reactions, bacterial contamination, transfusion-related acute lung injury, and disease transmission.
Presentation of laboratory diagnosis of tb final researchAyman Hameed
laboratory daignosis of pulmonary tuberculosis and what happens in the lab and how to deal with the specimens and how to know the positive frome negative results
Dialysis without anticoagulation (Heparin Free Dialysis)Mahmoud Eid
This document discusses techniques for performing dialysis without anticoagulation. It describes indications for heparin-free dialysis such as recent surgery or bleeding risks. Techniques mentioned include regional citrate anticoagulation, saline flushes, heparin-coated membranes, and citrasate dialysate. Signs of clotting and scoring systems are provided. Tips for priming, high blood flows, and alternatives to heparin locking are also outlined. The key recommendations are to prime properly, have no rushing, follow a written protocol, and focus on patient safety above all else.
This document discusses non-infectious complications that can occur from blood transfusions. It describes various types of complications including acute hemolytic transfusion reactions caused by immune or non-immune mechanisms. Other complications discussed include febrile non-hemolytic transfusion reactions, transfusion-related acute lung injury, circulatory overload, and delayed hemolytic transfusion reactions. The mechanisms, signs and symptoms, diagnoses, and risk factors for each complication are explained in detail.
Pleural effusion is an accumulation of excess fluid in the pleural space between the lungs and chest wall. It is usually secondary to other conditions that interfere with fluid drainage or secretion in the pleural space. Common causes include infections like pneumonia, congestive heart failure, cancers, and autoimmune diseases. Diagnosis involves chest x-ray, ultrasound, and thoracentesis to analyze pleural fluid characteristics. Management focuses on treating the underlying cause, relieving symptoms by removing fluid via thoracentesis or chest tube, and preventing further fluid buildup. Surgery may be needed for cases that do not improve with drainage or medication.
Pre-transfusion tests are performed to ensure blood compatibility and safety. These include determining the recipient's blood group and Rh type, screening the recipient's serum for antibodies, and performing a cross-match test between the recipient's serum and donor red blood cells to detect any agglutination. Additional safety tests are done on donor blood to identify infections like HIV, hepatitis B and C, and syphilis. Together these tests help select immunologically compatible blood to minimize adverse transfusion reactions in recipients.
This document discusses plasmapheresis, which is a therapeutic apheresis procedure that removes plasma from the blood. There are two main techniques used: membrane apheresis, which is fast but limited in substance removal, and centrifugal devices, which are more expensive but efficient. Complications can include hypotension, bleeding, and allergic reactions. Plasmapheresis is used to treat autoimmune disorders by removing autoantibodies, and other conditions involving abnormal circulating factors. Care must be taken with anticoagulation and replacement fluids during the procedure.
This document discusses various techniques used in blood banking and transfusion medicine, including:
1. Pretransfusion testing involves ABO/Rh typing, antibody screening, and crossmatching to select compatible blood and prevent hemolytic transfusion reactions.
2. Antibody identification uses a panel of red blood cells to identify the specific antibody in a patient's serum through various testing phases including immediate spin, LISS incubation, and antiglobulin.
3. Special techniques like elution, hemagglutination inhibition, and titration are used to further characterize antibodies or quantify their concentration.
This document discusses various aspects of renal replacement therapy for acute kidney injury. It begins by outlining the stage-based management of AKI, with increasing intervention and monitoring recommended as the stage progresses from risk to injury to failure. The document then addresses indications for starting renal replacement therapy, appropriate modalities including intermittent hemodialysis, slow continuous ultrafiltration, and continuous renal replacement therapy. Key factors like vascular access, solutions, membranes, anticoagulation, and dose are discussed. The overall conclusions are that while data from high-quality randomized controlled trials are still lacking, earlier initiation of renal replacement therapy may aid recovery, and continuous modalities are generally preferred over intermittent hemodialysis for unstable patients. Individualization of
Platelets are blood cells that help control bleeding by collecting at sites of damaged blood vessels and initiating the clotting process. Platelet transfusions can be used prophylactically to prevent bleeding in thrombocytopenic patients with platelet counts below 5x109/L or therapeutically to treat active bleeding. One unit of platelets increases the platelet count by approximately 5x109/L but efficacy can be reduced by non-immune or immune causes. Potential risks of platelet transfusions include allergic reactions, febrile reactions, and transfusion-related acute lung injury.
This document provides information about hepatopulmonary syndrome (HPS). It defines HPS as the presence of liver disease, impaired oxygenation, and intrapulmonary vascular abnormalities. The pathophysiology involves widespread pulmonary vasodilatation leading to ventilation-perfusion mismatching and right-to-left shunting, causing hypoxemia. Clinical features include signs of liver disease in most patients and dyspnea in some. Diagnosis requires confirming the three criteria through tests like contrast echocardiography to detect intrapulmonary shunting.
Approach oriented presentation for some of the emergencies of clinical gastroenterology, including upper GI bleeding, hepatic encephalopathy, acute severe attack of IBD and acute pancreatitis.
Hepatorenal syndrome is a type of kidney failure seen in patients with liver disease, usually cirrhosis. It is characterized by severe vasodilation in the systemic circulation and constriction of the renal arteries. This leads to decreased renal blood flow and kidney dysfunction. There are two main types - type 1 is a rapidly progressive form with high mortality, while type 2 progresses more slowly over weeks to months. Treatment involves use of vasoconstrictors like terlipressin with albumin to increase renal blood flow. Liver transplantation offers the best chance of cure but is limited by availability and risk of complications in patients with hepatorenal syndrome.
This document discusses the preparation of blood components from whole blood donations. Whole blood is collected and then separated via centrifugation into red blood cells, plasma, platelets, and white blood cells. These components are then processed and stored under specific conditions to maximize their viability and function. Red blood cells are stored in additive solutions, platelets must be processed within 8 hours, and plasma can be frozen into fresh frozen plasma or plasma frozen within 24 hours. The document outlines the preparation methods and storage requirements for various blood components including red blood cells, platelets, plasma, cryoprecipitate, and plasma derivatives.
Fetal hemoglobin and rh incompatibilityrohini sane
A comprehensive presentation on fetal hemoglobin & Rh incompatibility for undergraduate medical, dental, biotechnology & pharmacology students for self-learning .Presentation has physical & chemical properties of fetal hemoglobin along with its function. Binding affinity for O₂ of HbF and oxygen dissociation curve for HbF elucidated with suitable diagrams. Molecular constitution of Embryonic Hb ( Grover I &Grover II )with electrophoretic patterns are presented here . Importance of Kleihauer staining for detection of fetal cells is described briefly.
Diagrammatic representation of Rh- incompatibility is done for complete understanding of the concept. Signs & symptoms Kernicterus are presented diagrammatically.
Direct and indirect Coomb’s Test for Rh- incompatibility for diagnosis of Erythroblastosis Fetalis is illustrated. Biochemical aspects of Hemolytic Disease of Newborn (HDN) and Physiological /Neonatal Jaundice are presented. Comparison of Causes & biochemical findings for Hemolytic Jaundice along hepatic and obstructive jaundice is done in this presentation.
Molecular mechanism involved in biosynthesis of Hb Bart and Hb H along with their electrophoretic patterns for their detection are illustrated.
Hereditary persistent fetal Hb( HPFH ) & Point mutations causing HPFH are described in lucid manner. Google images are used for intense impact of the subject.
This document outlines the plasmapheresis protocol at the New Mansoura General Hospital Nephrology Department in Egypt. It defines plasmapheresis as removing, treating, and returning blood plasma from circulation. Examples of diseases treated with plasmapheresis include idiopathic pulmonary fibrosis, Guillain-Barre syndrome, and thrombotic thrombocytopenic purpura. The procedure, complications, replacement solutions, and post-procedure care are described.
Pleural fluid is the fluid found between the membranes lining the thoracic cavity. An excess amount is called a pleural effusion, which can be caused by conditions like heart failure, pneumonia, or rheumatoid arthritis. A sample of pleural fluid is removed through thoracentesis and analyzed to determine if it is a transudate or exudate and diagnose the cause. A transudate is caused by pressure imbalances while an exudate results from inflammation or injury, requiring additional testing to identify conditions like infection, bleeding disorders, or cancer. Test results provide information on the fluid's characteristics, protein levels, and microscopic examination of cells to diagnose the pleural effusion's underlying cause.
Autologous Blood Transfusion (ABT) means reinfusion of blood or blood products taken from the same patient
ABT is not a new concept, fear of transfusion- transmitted diseases stimulated the growth of autologous programme
This document discusses transfusion-transmitted infections (TTIs) and methods for screening donated blood. It notes that TTIs include viruses like HIV, HBV, HCV that can remain undetected in the blood donor but be transmissible. Screening methods include serological tests like ELISA, CLIA, rapid tests, as well as nucleic acid amplification tests (NAATs) that can detect infections earlier. Implementing individual donor NAT in addition to serological screening provides an additional safety layer and reduces the risk window period for TTIs in blood donations.
Pleural effusions can be transudative or exudative based on the ratio of fluid to serum proteins and lactate dehydrogenase levels. Common causes include congestive heart failure, cirrhosis, pneumonia, and malignancy. Diagnosis involves physical exam, imaging like chest x-ray, and thoracentesis to analyze fluid characteristics. Treatment depends on the underlying cause but may include drainage, antibiotics for infection, or pleurodesis for recurrent malignant effusions.
Pleural effusion occurs when excess fluid accumulates in the pleural space between the lungs and chest wall. A pleural effusion is considered an exudate if fluid formation exceeds lymphatic absorption, usually due to local inflammation, infection, or malignancy. Diagnostic evaluation involves determining if the effusion is a transudate or exudate based on pleural fluid analysis and comparing values to serum. Additional tests on exudative fluid including cell count, cultures, pH, and cytology aim to identify the specific cause. Treatment focuses on resolving the underlying condition causing fluid accumulation or drainage in some exudative cases.
This document discusses pleural effusions, which are collections of fluid in the pleural space between the lungs and chest wall. It covers the etiology, mechanisms, classification as transudates or exudates, clinical presentation, diagnostic evaluation including thoracentesis, and treatment approaches for pleural effusions. Common causes include congestive heart failure, pneumonia, malignancy, and pulmonary embolism. Diagnostic thoracentesis is performed to analyze pleural fluid characteristics and determine the underlying condition. Treatment depends on the cause but may involve drainage procedures, chemotherapy, or sclerosing agents.
Aproach To Diagnosis of Pleural EffusionAmitKalne1
1. Pleural effusion occurs when the rate of fluid formation in the pleural space exceeds the rate of absorption, causing an imbalance.
2. Common tests to classify pleural effusions as transudative or exudative include measuring the pleural fluid to serum protein ratio, LDH ratio, and albumin gradient. Low glucose or high amylase can indicate other conditions.
3. Tuberculosis is diagnosed through pleural fluid tests like ADA, interferon-gamma, PCR, or biopsy showing granulomas. Bacterial cultures should also be performed to identify other infections.
Approach to patients with pleural effusion (1).pptxaashishkoirala6
The document discusses the approach to evaluating and diagnosing patients with pleural effusions. It outlines the leading causes of transudative and exudative pleural effusions and describes how pleural fluid analysis can be used to differentiate between them. Tests like LDH, protein, glucose and cytology are routinely performed on pleural fluid to help determine the etiology. Imaging like chest x-rays, ultrasound and CT scans can provide additional diagnostic information. When the cause remains unclear after initial testing, procedures like thoracoscopy may be needed to establish a diagnosis.
1. Cytology of body fluids involves examining fluids from various body cavities including cerebrospinal fluid, pleural fluid, peritoneal fluid, pericardial fluid, and synovial fluid. Specimen collection and laboratory analysis includes gross examination, cell counts, biochemical analysis, and microscopic examination.
2. Transudates and exudates are distinguished based on characteristics like protein content and cell differentials. Infection, inflammation, and malignancy can be identified by analyzing changes in fluid characteristics.
3. Cytology of body fluids provides diagnostic information for conditions affecting various organ systems. Proper collection and analysis of physical and chemical properties aids in differential diagnosis.
Pleural effusion results from an imbalance between pleural fluid formation and absorption, causing fluid to accumulate in the pleural space. Fluid formation occurs through capillaries in the parietal pleura, and absorption occurs via lymphatic vessels. When the rate of formation exceeds absorption, effusion occurs. Effusions are classified as transudative or exudative based on fluid characteristics. Diagnostic testing of pleural fluid aims to determine the cause of effusion. Radiography and ultrasound are used to identify and characterize pleural fluid.
This document discusses pleural effusions, including their definition, etiology, types, diagnostic approach, and differential diagnoses. Key points include:
- Pleural effusions occur when fluid accumulation in the pleural space exceeds drainage by lymphatics.
- Transudative effusions are caused by systemic factors altering fluid balance, while exudative effusions result from local damage or inflammation.
- Diagnostic testing includes pleural fluid analysis to classify as transudate or exudate using Light's criteria, and further tests based on clinical context to identify specific causes.
- Differential diagnoses include conditions altering hydrostatic pressure or oncotic pressure (transudates), or involving the pleura directly through
This document provides an overview of pleural effusions, including:
1. Definitions of pleural effusion and normal pleural fluid composition.
2. Causes and characteristics of transudative and exudative effusions. Transudative effusions are caused by systemic processes while exudative effusions are caused by local processes like infection or cancer.
3. Diagnostic tools for pleural effusions including thoracentesis, imaging modalities like ultrasound, chest x-ray, and CT scan. Thoracentesis allows examination of pleural fluid.
The document provides information on routine biochemical investigations. It discusses the need for laboratory investigations to supplement clinical findings. Biochemical investigations, also called chemical pathology, deal with investigating metabolic abnormalities through assays of compounds in body fluids. Common tests include complete blood count, liver function tests, kidney function tests, and blood glucose levels. The document describes various hematological parameters, their normal ranges, and clinical significance when abnormal. It also classified investigations as frequently used, occasionally done, and rarely ordered.
Pleural effusion is an abnormal accumulation of fluid in the pleural space between the lungs and chest wall. It can be caused by conditions that alter fluid pressure or permeability of the pleura. A pleural effusion is classified based on its location, mechanism, and fluid characteristics. Evaluation involves physical exam, chest x-ray, ultrasound, and thoracentesis to analyze the fluid. Management depends on treating the underlying cause, with antibiotics for infections, diuretics for heart failure, or drainage procedures for large or infected effusions.
Cerebrospinal fluid (CSF) analysis involves laboratory tests performed on a CSF sample to examine conditions affecting the brain and spine. The analysis includes measuring pressure, proteins, glucose, cells, chemicals, and testing for bacteria, viruses, and other substances. It provides information on CSF composition and any infectious organisms or foreign materials present.
Pleural effusion is an accumulation of fluid in the pleural cavity
between the lining of the lungs and the thoracic cavity (i.e., the visceral
and parietal pleurae
).
This document provides guidelines for evaluating hematuria in children. It begins by defining hematuria and differentiating between gross and microscopic hematuria. Common causes of hematuria are then outlined, separating glomerular from non-glomerular causes. The document recommends confirming hematuria with a urine microscopy and categorizing patients based on history and exam to determine if the cause is glomerular or non-glomerular. It provides guidance on evaluating common glomerular causes like post-infectious glomerulonephritis and non-glomerular causes such as urinary tract infections and nephrolithiasis. Throughout, algorithms and tables aid primary care physicians in systematically managing a child presenting with hematuria.
The document discusses pleural effusion and empyema in children. It covers pleural anatomy and pathophysiology of fluid accumulation. Common causes of pleural effusion in children are bacterial pneumonia. Evaluation involves chest X-ray, ultrasound, and thoracentesis. Pleural fluid is classified as transudate or exudate using Light's criteria. Parapneumonic effusions are further classified into uncomplicated and complicated categories depending on pH, glucose and LDH levels. Treatment involves antibiotics with chest tube drainage for complicated parapneumonic effusions or empyema. Fibrinolytics like streptokinase may be given for loculated collections.
Pleural Effusion in Children-converted.pptxLadderGroup
1. Pleural effusion is fluid that accumulates in the pleural space between the lungs and chest wall. It is usually caused by conditions that increase fluid production or decrease absorption such as bacterial pneumonia.
2. Evaluation of pleural effusion involves chest x-ray, ultrasound, and thoracentesis. Analysis of pleural fluid helps determine if it is a transudate or exudate. Chest tube insertion may be needed for large or loculated effusions.
3. Management of parapneumonic effusion involves antibiotics along with serial thoracentesis or chest tube drainage depending on the size and characteristics of the effusion. Chest tubes are indicated for frank pus, large effusions over half the
Pleural effusions occur when there is an imbalance between fluid formation and absorption in the pleural space, causing fluid accumulation. The four most common causes are pulmonary embolism, cardiac failure, malignant pleural infiltration, and pneumonia. Effusions are classified as transudates or exudates based on fluid characteristics. Imaging like chest x-rays and CT scans are used to detect and characterize effusions. Diagnostic thoracentesis is indicated for clinically significant effusions to analyze fluid appearance, chemistry, cell counts, and microbiology to determine the underlying cause and guide treatment.
- Ascitic fluid appearance can indicate underlying conditions, such as clear fluid indicating uncomplicated cirrhosis, milky fluid indicating malignancy or lymphoma, and bloody fluid indicating trauma or malignancy.
- Diagnosis of ascites involves physical examination and ultrasound, as 1,500mL of fluid is needed for flank dullness. Cell count with differential is most helpful test, with >250 polymorphonuclear cells indicating spontaneous bacterial peritonitis.
- Causes of ascites include portal hypertension from cirrhosis, hypoalbuminemia, peritoneal disease like cancer, and other rare conditions. Serum-ascites albumin gradient helps determine if ascites is caused by portal hypertension.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
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3. Certain types of pleural effusions can be suspected
simply by observing the physical characteristics of
the fluid obtained:
A purulent fluid (pus) indicates an empyema
A bad (putrid) odor suggests an anaerobic empyema
A milky white fluid suggests a chylothorax (an
accumulation of lymphatic fluid in the pleural
space)
4. A bloody fluid suggests either
hemorrhagic effusion (hemothorax) or
traumatic pleural taps.
Differentiation is possible by observing serial samples of
pleural tap which clear up in the case of a traumatic pleural
tap.
Moreover, A hematocrit performed on the pleural fluid can
assist diagnosis.
Bloody pleural fluid with a hematocrit of ≥ 50 % of the
peripheral blood hematocrit is termed a hemothorax.
5. A Black pleural fluid can be seen with some diseases
including:
• Aspergillus niger infection,
• malignant melanoma,
• non-small cell lung cancer,
• ruptured pancreatic pseudocyst,
• charcoal-containing empyema
CONT.
6. Normal pleural fluid is a Clear ultrafiltrate of plasma that
originates from the parietal pleura:
pH of 7.60-7.64
Protein content of less than 2% (1-2 g/dL)
Fewer than 1000 white blood cells (WBCs) per cubic
millimeter
Glucose content similar to that of plasma
Lactate dehydrogenase (LDH) less than 50% of plasma
7. Light’s criteria are the standard way to
differentiate.
Light’s criteria for exudative pleural effusion:
Pleural fluid protein divided by serum protein > 0.5
Pleural fluid LDH divided by serum LDH > 0.6
Pleural fluid LDH more than two-thirds the upper
limit of normal serum LDH
8. The fluid is considered an exudate if any of the three
criteria (Light’s criteria) is found.
The fluid is considered a transudate if all of the three
criteria are absent.
Light’s criteria require simultaneous measurement of
pleural fluid and serum protein and LDH.
Clinical judgment is required when pleural fluid test
results fall near the cutoff points.
9. Light’s criteria identify nearly all exudates correctly, but they
misclassify approximately 20-25% of transudates as exudates,
usually in patients with HF-associated effusions and those with
liver cirrhosis-associated effusions because of the
concentrating effect of long-term diuretic therapy on protein
and LDH levels within the pleural space).
10. To solve such a problem it is recommended to use one of the following If the
clinical picture is consistent with HF-associated effusion or liver cirrhosis-
associated effusion but the pleural fluid meets Light's exudative criteria:
1. - serum-effusion protein gradient (serum protein minus pleural protein
concentration). If >3.1 g/dL, it indicates transudate effusion.(5)
2. - serum-effusion albumin gradient (serum albumin minus pleural effusion
albumin level). If it is > 1.2 g/dL, it indicates transudate. (this criterion
is preferable If the clinical picture is consistent with HF but the pleural
fluid meets Light's exudative criteria). (5)
3. - effusion-to-serum albumin ratio (pleural fluid albumin divided by serum
albumin). If <0.6, it indicates transudate. this criterion is preferable In
the context of cirrhosis. (5)
11. In a more recent systematic review,
• pleural fluid cholesterol greater than 55 mg/dL and
• pleural fluid LDH greater than 200 U/L
each had better positive and negative likelihood ratio for
distinguishing exudates from transudates than did Light’s
criteria. [4]
12. Pleural fluid LDH
Pleural fluid LDH levels › 1000 IU/L suggest:
empyema, malignant effusion, rheumatoid effusion.
Pleural fluid LDH levels are also increased in effusions from
Pneumocystis jiroveci (formerly, Pneumocystis carinii)
pneumonia.
The diagnosis of Pneumocystis jiroveci pneumonia is suggested
by: - a pleural fluid/serum LDH ratio of › 1, with
- a pleural fluid/serum protein ratio of ‹ 0.5.
13. Pleural fluid glucose
A low pleural glucose concentration (30-50 mg/dL)
suggests malignant effusion, tuberculous pleuritis,
esophageal rupture, or lupus pleuritis.
A very low pleural glucose concentration (ie, < 30
mg/dL) further restricts diagnostic possibilities, to
rheumatoid pleurisy or empyema.
14. Pleural fluid pH
Pleural fluid pH is highly correlated with pleural fluid
glucose levels.
A pleural fluid pH of less than 7.30 with a normal
arterial blood pH level is caused by the same diagnoses
listed for low pleural fluid glucose.
15. Pleural fluid pH
For parapneumonic effusions, a low pleural fluid pH
level is predictive of complicated effusions (that
require drainage) .
In such cases, a pleural fluid pH of less than 7.1-7.2
indicates the need for urgent drainage of the effusion,
while a pleural fluid pH of more than 7.3 suggests that
the effusion may be managed with systemic antibiotics
alone.
16. If an exudate is suspected clinically or is confirmed by
chemistry test results, send the pleural fluid for :
total and differential cell counts,
Gram stain and culture,
cytology.
17. Pleural fluid lymphocytosis, with lymphocyte values greater than
85% of the total nucleated cells, suggests:
TB,
lymphoma,
Chylothorax,
sarcoidosis,
chronic rheumatoid pleurisy,
yellow nail syndrome.
Pleural lymphocyte values of 50-70% of the nucleated cells
suggest malignancy.
18. Cultures of infected pleural fluids yield positive
results in approximately 60% of cases.
This occurs even less often for anaerobic
organisms.
Diagnostic yields, particularly for anaerobic
pathogens, may be increased by directly culturing
pleural fluid into blood culture bottles.
19. Malignancy is suspected in patients with
lymphocytic exudative effusions, especially when
bloody.
Direct tumor involvement of the pleura is diagnosed
most easily by performing pleural fluid cytology.
The reported diagnostic yields in cytology vary
from 60-90%, depending on the extent of pleural
involvement and the type of primary malignancy.
20. Suspect tuberculous pleuritis in patients with
lymphocytic exudative effusions, especially if less
than 5% mesothelial cells are detected on
differential cell counts.
21. Most tuberculous pleural effusions probably result from a
hypersensitivity reaction to the Mycobacterium rather
than from microbial invasion of the pleura. So that,
acid-fast bacillus stains of pleural fluid are rarely
diagnostic (< 10% of cases), and
Pleural fluid cultures grow M tuberculosis in < 65% of
cases.
22. pleural biopsy:
The combination of histology and culture of pleural
tissue obtained by pleural biopsy increases the
diagnostic yield for TB to 90%.
23. Adenosine deaminase (ADA) activity of greater than
50 U/mL in pleural fluid supports the diagnosis of
tuberculous pleuritis.
However, pleural ADA values of less than 50 U/mL
do not exclude the diagnosis of TB pleuritis.
24. Exudate,
lymphocytic predominance,
positive acid-fast bacillus smear or cultures,
ADA > 50 U/L
25. Exudative with PMN predominance/pus,
positive Gram stains or cultures,
LDH > 1000,
glucose < 40 mg%,
pH < 7.2
PMNs = polymorph nuclear leukocytes, which are a
special family of white blood cells that ncludes
neutrophils, eosinophils, and basophils.