1 Chapter 16 Serous Fluid Professor A. S. Alhomida Disclaimer The texts, tables and images contained in this course presentation (BCH 376) are not my own,

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Chapter 16 Serous Fluid

Professor A. S. Alhomida

Chapter 16 Serous Fluid

Professor A. S. Alhomida

DisclaimerDisclaimer

• The texts, tables and images contained in this course presentation (BCH 376) are not my own, they can be found on: • References supplied• Atlases or• The web

King Saud University

College of Science

Department of Biochemistry

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Closed CavitiesClosed Cavities of the of the BodyBody

1. Pleural Cavity

2. Pericardial Cavity

3. Peritoneal Cavity

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1. They are lined by two membranes referred to as the serous membranes. One membrane lines the cavity wall (parietal membrane, and the other covers the organs within the cavity (visceral membrane)

2. Fluid between the membranes is called serous fluid

Closed Cavities of the Closed Cavities of the Body, Cont’dBody, Cont’d

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Function of Serous FluidFunction of Serous Fluid

1. Provide lubrication as the surfaces move against each other

2. Normally, only small amount of serous fluid is present, because production and reabsorption take place at a constant rate

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Formation of Serous FluidFormation of Serous Fluid

• It is formed as ultrafiltrates of plasma, with no additional material contributed by the membrane cells depends on two different pressures:

1. Hydrostatic pressure

2. Colloid pressure

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Formation of Pleural FluidFormation of Pleural Fluid

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Formation of Pleural FluidFormation of Pleural Fluid

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Pleural CavityPleural Cavity

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Effusion of Serous FluidEffusion of Serous Fluid

• It is the disruption of the mechanism of serous fluid formation and reabsroption causes an increase in fluid between the membranes

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Effusion of Serous Fluid, Effusion of Serous Fluid, Cont’dCont’d

• Causes:1. Increased Hydrostatic Pressure

• Congestive heart failure pressure

2. Decreased Colloid Pressure• Hypoproteinemia• Increased capillary permeability (inflammation and

infection)• Lymphatic obstruction (tumors)

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• Fluid is collected by needle aspiration (100 mL) from the respective cavities1. Thoracentesis for pleural cavity

2. Pericardiocentesis for pericardial cavity

3. Paracentesis for peritoneal cavity

Collection of Serous FluidCollection of Serous Fluid

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ThoracentesisThoracentesis

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PericardiocentesisPericardiocentesis

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ParacentesisParacentesis

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Classification of EffusionClassification of Effusion

1. Transudates

• Causes

• They produced because of a systemic disorder that disrupts the balance in the regulation of fluid filtration and reabsorption as the change in hydrostatic pressure created by congestive heart failure or the hypoproteinemia associated with the nephrotic syndrome

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Classification of Classification of Effusion, Cont’dEffusion, Cont’d

2. Exudates• Causes

• They are produced by conditions that directly involve the membranes of the particular cavity, including infections and malignancies

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Transudated and Transudated and ExudatesExudates

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Transudated and ExudatesTransudated and Exudates

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Pleural FluidPleural Fluid

1. It is obtained from the pleural cavity, located between the parietal pleural membrane lining the chest wall and visceral pleural membrane covering the lungs

2. Pleural effusions can be transudative or exudative origin

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Pleural Fluid, Cont’dPleural Fluid, Cont’d

3. Procedures are helpful when analyzing pleural fluid• For Exudates, if

• Pleural Fluid Cholesterol > 60 mg/dL or• Pleural Fluid/Serum Cholesterol Ratio > 0.3• Pleural Fluid/Serum Total Bilirunbin Ratio > 0.6

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Light's CriteriaLight's Criteria

• If at least one of the following three criteria is present, the fluid is virtually always an exudate

• If none is present, the fluid is virtually always a transudate• Pleural fluid protein/serum protein ratio greater than

0.5. • Pleural fluid LDH/serum LDH ratio greater than 0.6. • Pleural fluid LDH greater than two thirds the upper

limits of normal of the serum LDH

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Physical Properties of Physical Properties of Pleural Fluid Pleural Fluid

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Types of Pleural EffusionsTypes of Pleural Effusions

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Evaluation of Pleural FluidEvaluation of Pleural Fluid

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Pleural Fluid CellsPleural Fluid Cells

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Pleural Fluid Cells, Pleural Fluid Cells, Cont’dCont’d

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Pleural Fluid Cells, Pleural Fluid Cells, Cont’dCont’d

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Pleural Cells, Cont’dPleural Cells, Cont’d

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Pleural Cells, Cont’dPleural Cells, Cont’d

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Pleural Cells, Cont’dPleural Cells, Cont’d

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Pleural Cells, Cont’dPleural Cells, Cont’d

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Pleural Cells, Cont’dPleural Cells, Cont’d

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Biochemical Testing of Biochemical Testing of Pleural FluidPleural Fluid

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Pericardial FluidPericardial Fluid

1. Normally, only a small amount (10-50 mL) of fluid is found between the pericardial serous membranes

2. Pericardial effusions are result primarily of changes in the permeability of the membranes due to infection (pericarditis), malignancy, trauma, or metabolic disorders as uremia

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Pericardial Fluid, Cont’dPericardial Fluid, Cont’d

3. Presence of pericardial effusion is expected when cardiac compression is noted during the physician’s examination

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Pericardial CavityPericardial Cavity

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Physical Properties of Physical Properties of Pericardial Fluid Pericardial Fluid

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Pericardial Fluid CellsPericardial Fluid Cells

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Peritoneal CavityPeritoneal Cavity

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Peritoneal DialysisPeritoneal Dialysis

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Peritoneal FluidPeritoneal Fluid

1. Accumulations of fluid in the peritoneal fluid cavity is called ascites, and the fluid is commonly referred to as ascitic fluid rather than peritoneal fluid

2. Hepatic disorder, such as cirrhosis, are frequent causes ascitic transudative fluids

3. Bacterial infections (peritonitis) are most frequent causes of ascitic exudative fluids

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Ascitic Transudates vs Ascitic Transudates vs ExudatesExudates 1. Differentiation between ascitic fluid transudates

and exudates is more difficult that for pleural and pericardial effusions

2. Serum/ascites albumin gradient is recommended over the fluid/serum total protein and LDH ratios for detection for the transudates of hepatic origin

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Ascitic Transudates vs Ascitic Transudates vs Exudates, Cont’dExudates, Cont’d

3. A difference (gradient) of 1.1 or greater suggests a transudates effusion of hepatic origin, and lower gradients are associated with exudative effusions

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Ascitic Transudates vs Ascitic Transudates vs Exudates, Cont’dExudates, Cont’d

4. Example:

Serum albumin = 3.8 mg/dL

Fluid albumin = 1.2 mg/dL

Gradient 3.8 – 1.2 = 2.6 then indicating hepatic effusion

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Physical Properties of Ascitic Physical Properties of Ascitic FluidFluid

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Peritoneal Fluid CellsPeritoneal Fluid Cells

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Peritoneal Fluid CellsPeritoneal Fluid Cells

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Peritoneal Fluid Cells Peritoneal Fluid Cells

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THE ENDTHE END

Any questions?