体液常规 检查 英文PPT课件.ppt

What sthebodyfluids Bodilyfluidsarefluids whicharegenerallyexcretedorsecretedfromthehumanbody Theserespectivefluidswouldinclude 羊水 Amnioticfluid surroundingafetuswhichisreleasedtotheoutsideworldinchildbirth 血液BloodandbloodplasmaCowper sfluidorpre ejaculatoryfluidFemaleejaculateInterstitialfluidLymph What sthebodyfluids 月经Menses乳汁MilkMucus includingsnotandphlegm 脓液Pus唾液Saliva皮脂Sebum skinoil 精液Semen眼泪Tears汗液Sweat尿液Urine阴道分泌物Vaginallubrication呕吐物Vomit What sthebodyfluids Feces whilenotgenerallyclassedasabodyfluid areoftentreatedsimilarlytobodyfluids andaresometimesfluidorsemi fluidinnature Internalbodyfluids whicharenotusuallyleakedorexcretedtotheoutsideworld include cerebrospinalfluidsurroundingthebrainandthespinalcordsynovialfluidsurroundingbonejointsintracellularfluidisthefluidinsidecells 脑脊液CSF Cerebrospinalfluid CSFinshort istheclearfluidthatoccupiesthesubarachnoidspace蛛网膜下腔 thespacebetweentheskullandcortexofthebrain Itactsasa cushion orbufferforthecortex Also CSFoccupiestheventricularsytem脑室ofthebrainandthespinalcord CSFismainlyproducedbythechoroidplexus脉络丛 butalsobytheependymalliningofthebrain sventricles Ithasbeencalculatedthat430to450mlofCSFareproducedeveryday PurposeofCerebrospinalfluidanalysis ThepurposeofaCSFanalysisistodiagnosemedicaldisordersthataffectthecentralnervoussystem Someoftheseconditionsinclude 病毒 细菌感染Viralandbacterialinfections suchasmeningitisandencephalitis 神经系统肿瘤Tumorsorcancersofthenervoussystem 梅毒Syphilis asexuallytransmitteddisease PurposeofCerebrospinalfluidanalysis 出血Bleeding hemorrhaging aroundthebrainandspinalcord 多发性硬化症Multiplesclerosis adiseasethataffectsthemyelincoating髓鞘ofthenervefibersofthebrainandspinalcord Guillain Barrsyndrome aninflammationofthenerves Samplecollection culture Biochemistryimmunology cytology 脑脊液检查项目ContentsofCSFanalysis 颜色Color 细胞计数CellCounts 氯离子CL糖Glucose 蛋白质Protein 颜色Color TheCSFisawatery clearandcolorlessfluid Everychangefromthiswaterlikeappearanceisabnormal TheCSFiscloudywhenahighamountofcellsarepresent 500 l Ahighproteincontentcanenhancethisturbidityandproducesamoreviscousfluid粘性液体 颜色与疾病CerebrospinalFluidSupernatantColorsandAssociatedConditionsorCauses ColorofCSFsupernatantConditionsorcauses Yellow BloodbreakdownproductsHyperbilirubinemia CSFprotein 150mg dL 1 5g L 100 000redbloodcells ul Orange Bloodbreakdownproducts Highcarotenoidingestion Pink Bloodbreakdownproducts Green Hyperbilirubinemia PurulentCSF Brown Meningealmelanomatosis 细胞计数cells TheexaminationofCSFcellsisespeciallyusefulincasesinwhichanongoinginflammatoryreactionissuspected inflammatory infectiousdiseasesoftheCNS tumors IntheCSFofnormal0 3cells larecounted mostlymononuclearcells lymphocytesandmonocytes Incaseofapleocytosis anincreasedcellcount whichisgradedasmild 5 50cells moderate 50 200cells ormarked 200cells 氯离子Chloride Normal higherthanserum 119 129mmol L Tubercular decreasedsignificant 葡萄糖Glucose TheCSFglucoseisdependentuponbloodglucoselevelandtherateofmetabolismintheCNS CSFlevelsareusually60 80 ofbloodlevels lowCSFglucoselevelsintheabsenceofhypoglycemiaindicatethepresenceofadiffusemeningealdisorder associatedwithbacterialandfungalmeningitis tumor 蛋白质Protein MostproteinsnormallypresentintheCSFarederivedfromblood child lumbarcentesis 0 20 0 40g Ladult lumbarcentesis 0 20 0 45g LAlbumin100 300mg L IgG Index TypicalCerebrospinalFluidFindingsinVariousTypesofMeningitis Analysisof Serousmembrane Fluids 浆膜腔积液 Anyofvariousthinmembranes astheperitoneum pericardium orpleurae thatconsistofasinglelayerofthinflatmesothelialcellsrestingonaconnective tissuestroma secreteaserousfluid andusuallylinebodilycavitiesorenclosetheorganscontainedinsuchcavities 胸腔积液PleuralEffusions Definition Lungsarecompletelylinedbyathininnermembranecalledthevisceralpleura Itiscontinuouswithanotherthinoutermembranecalledtheparietalpleurawhichalsoinveststhelungs butattachestothechestwall Normally thepleuralspace theareabetweenthetwopleura containsnoairandonlyathinfilmoflubricatingfluid 20ml Theprimaryfunctionofthepleuraistoallowthechestwallandlungstoactinharmonyduringinspirationandexpiration Apleuraleffusionisanabnormalaccumulationoffluidinthepleuralspace 腹水Ascite Ascitesistheabnormalaccumulationoffluidintheabdominalcavity Thevolumeofthefluidcanbequitesubtle oritmaybesignificant causingdistentionoftheabdomen Ascitesiscausedbytheleakageoffluidintotheabdomenfrombloodvessels lymphatics internalorgansorabdominalmasses 漏出液Transudates Causedbynon infectiousreasons Transudatesarefluidsoflowcellcount under1500cells mcl andlowproteinconcentration under2 5g dl Examplesoftransudatesincludethosecausedby hypoproteinemia liverdisease sometumorsandobstructionoflymphaticdrainage 渗出液Exudates Causedbyinfectiousreasons Exudatesarefluidswiththehighestcellcounts over7 000cells ml andproteinconcentrations usuallyover3 0g dl Examplesinclude bleedingconditions tumors bacterialinfectionscausedbybowelcompromise chyloabdomen lymphfluidintheabdomen urineandbileleakageandpancreatitis Causesoftransudativepleuraleffusion 1 充血性心力衰竭Congestiveheartfailure Thiscausespleuraleffusionsinabout40 ofpatientsandisoftenpresentonbothsidesofthechest Heartfailureisthemostcommoncauseofbilateral two sided effusion Whenonlyonesideisaffecteditusuallyistheright becausepatientsusuallylieontheirrightside 2 心包炎Pericarditis Thisisaninflammationofthepericardium themembranecoveringtheheart Causesoftransudativepleuraleffusion 3 Toomuchfluidinthebodytissues whichspillsoverintothepleuralspace Thisisseeninsomeformsofkidneydisease whenpatientshaveboweldiseaseandabsorbtoolittleofwhattheyeat andwhenanexcessiveamountoffluidisgivenintravenously 4 Liverdisease About5 ofpatientswithachronicscarringdiseaseofthelivercalled肝硬化cirrhosisdeveloppleuraleffusion Causesofexudativepleuraleffusions 1 胸腔肿瘤Pleuraltumorsaccountforupto40 ofone sidedpleuraleffusions Theymayariseinthepleuraitself mesothelioma orfromothersites notablythelung 2 结核Tuberculosisinthelungsmayproducealong lastingexudativepleuraleffusion 3 肺炎Pneumoniaaffectsabout3millionpersonseachyear andfourofeverytenpatientswilldeveloppleuraleffusion Ifeffectivetreatmentisnotprovided anextensiveeffusioncanformthatisverydifficulttotreat Causesofexudativepleuraleffusions 4 Patientswithanyofawiderangeofinfectionsbyavirus fungus orparasitethatinvolvethelungsmayhavepleuraleffusion 5 Uptohalfofallpatientswhodevelopbloodclotsintheirlungs pulmonaryembolism肺栓塞 willhavepleuraleffusion andthissometimesistheonlysignofembolism 6 Connectivetissuediseases includingrheumatoidarthritis lupus andSj gren ssyndromemaybecomplicatedbypleuraleffusion Causesofexudativepleuraleffusions 7 Patientswithdiseaseoftheliverorpancreasmayhaveanexudativeeffusion andthesameistrueforanypatientwhoundergoesextensiveabdominalsurgery About30 ofpatientswhoundergoheartsurgerywilldevelopaneffusion 8 Injurytothechestmayproducepleuraleffusionintheformofeitherhemothoraxorchylothorax PathogenicMechanismsinAscitesFormation A 静水压升高Incresasedhydrostaticpressure1 Cirrhosis2 Hepaticveinocclusion肝静脉闭锁 Budd Chiarisyndrome 3 Inferiorvenacava 下腔静脉 obstruction4 Constrictivepericarditis5 Congestiveheartfailure PathogenicMechanismsinAscitesFormation B 胶体渗透压减低Decreasedcolloidosmoticpressure1 End stageliverdiseasewithpoorproteinsynthesis2 Nephroticsyndromewithproteinloss3 Malnutrition4 Protein losingenteropathy PathogenicMechanismsinAscitesFormation C 毛细血管通透性增加Increasedpermeabilityofperitonealcapillaries1 Tuberculousperitonitis2 Bacterialperitonitis3 Malignantdiseaseoftheperitoneum PathogenicMechanismsinAscitesFormation D Leakageoffluidintotheperitonealcavity1 Bileascites2 Pancreaticascites secondarytoaleakingpseudocyst 3 Chylousascites4 Urineascites PathogenicMechanismsinAscitesFormation E 其它原因Miscellaneouscauses1 Myxedema粘液性水肿2 Ovariandisease Meigs syndrome 卵巢纤维瘤伴胸腹水 或其它盆腔肿瘤伴胸腹水 3 Chronichemodialysis血液透析 Separatingtransudatesandexudates Anexudatemeetsoneormoreofthefollowingcriteriawhileatransudatemeetsnone Pleuralfluid serumprotein 0 5Pleuralfluid serumLDH 0 6PleuralfluidLDH two thirdsofuppernormallimitforserum Newertestsfordifferentiatingtransudatesandexudates Proposedtestshaveincludedthelevelsofcholesterol bilirubin andcholinesteraseinthepleuralfluidandthedifference gradient betweenthealbumininthepleuralfluidandserumIngeneralLight scriteriaoccasionallymisidentifyatransudativeeffusionasanexudativeeffusionClinicallyifapatientshouldhaveatransudativeeffusion butmeetsLight scriteriaforanexudativeeffusion measureserum pleuralfluidalbumingradientGradientof 1 2g dlindicatestransudate Grossexaminationofpleuralfluid AppearanceChardonnay yellow ifcloudy centrifugatecloudysupernatant chylothoraxorpseudochylothoraxclearsupernatant cellsordebrisresponsibleforcloudinessRose blood tingedCabernetSauvignon obtainHCThemothoraxifHCT 20 OdorPutrid anaerobicempyemaUrine urinothorax Initiallaboratorytestsforanundiagnosedpleuraleffusion ProteinandLDHinpleuralfluidandserumforseparationoftransudatesandexudatesPleuralfluidsmearsandcultureCellcountanddifferentiaPleuralfluidglucose amylase pHPleuralfluidcytologyMarkersforTBpleuritisADA gammainterferonorPCR Differentialcellcount AbsolutecellcountnotveryusefulmanydiseaseshaveWBCabove10 000MosttransudateshaveWBC 1000Differential polys smalllymphocytes othermononuclearcellsandeosinophilspolys acuteprocessmononuclearcells chronicprocesssmalllymphocytes malignant tuberculosisorpostcabgpleuraleffusioneosinophils Pleuralfluideosinophilia 10 UsuallyduetoairorbloodinthepleuralspaceConsiderdrugreactionsDantrolene丹曲林钠 bromocriptine溴隐亭 nitrofurantoin呋喃托因Frequentwithasbestos石棉pleuraleffusionRarelyparagonimiasis肺吸虫orChurg StrausssyndromealsolowglucoseandpHFrequentlynodiagnosisobtained PleuralfluidLDH NotusefulinthedifferentiationofexudatesbecauseallexudatestendtohaveelevatedLDHVeryusefulwhenfollowingapatientwithapleuraleffusionbecausethelevelofpleuralfluidLDHreflectsdegreeofpleuralinflammationIfLDHworsenswithserialthoracenteses processisworseningandoneshouldbemoreagrressiveIfLDHdecreaseswithserialthoracenteses processisimproving Differentialdiagnosis lowglucose 40mg dl ComplicatedparapneumoniceffusionMalignantpleuraleffusionTuberculouspleuraleffusionRheumatoidpleuraleffusionParagonimiasHemothoraxChurg Strausssyndrome Differentialdiagnosisofhighamylasepleuraleffusion AcutepancreaticdiseaseChronicpancreticdiseaseEsophagealruptureMalignantpleuraleffusion Commentsofanalysis 1 Theserum asciticalbumingradient SAAG serumalbumin effusionalbumi