Reading Notes-Body Fluids    

StudyBlue printing of Reading Notes-Body Fluids     html, body, div, span, applet, object, iframe, h1, h2, h3, h4, h5, h6, p, blockquote, pre, a, abbr, acronym, address, big, cite, code, del, dfn, em, font, img, ins, kbd, q, s, samp, small, strike, strong, sub, sup, tt, var, b, u, i, center, fieldset, form, label, legend, table, caption, tbody, tfoot, thead, tr, th, td { margin: 0; padding: 0; border: 0; outline: 0; font-size: 100%; background: transparent; } body { line-height: 1; } blockquote, q { quotes: none; } blockquote:before, blockquote:after, q:before, q:after { content: ''; content: none; } /* remember to define focus styles! */ :focus { outline: 0; } /* remember to highlight inserts somehow! */ ins { text-decoration: none; } del { text-decoration: line-through; } /* tables still need 'cellspacing="0"' in the markup */ table { border-collapse: collapse; border-spacing: 0; } /* end RESET */ .header { min-width:800px; } .logo { padding:6px 20px 2px 20px; margin:0; font-size:25px; font-weight:bold; color:#808285; position:relative; border-bottom: 1px solid #c5c5c5; } .logo-blue { color:#70adc4; } .logo-desc { font-weight:normal; font-size:19px; color:#cccccc; margin-top:50px; position:absolute; display: none; } .back-button { position:absolute; top:20px; right:20px; font-size:13px; line-height:25px; color:rgb(0,175,225); font-weight:normal; } .back-button a { color:rgb(0,175,225); } .instructions { padding:0; margin:0; width:100%; position:relative; color:rgb(100,100,100); } .step-holder { border-left:1px solid #ededed; margin-left:20px; } .steps { padding:15px 0; float:left; width:24%; border-right:1px solid #ededed; text-align:center; } .steps-01 { } .steps-02 { } .steps-03 { } .steps-04 { } .label { padding:5px 10px; } .print-button { } .print-button a { background-color:rgb(0,175,225); color:white; line-height: 19px; padding:9px 8px 5px 30px; font-size:14px; text-decoration:none; background-image: url(images/printer.png); background-repeat: no-repeat; background-position: 7px 50%; -moz-border-radius: 5px; -webkit-border-radius: 5px; } .print-button a:hover { background-color:black; } .theNote .content { width: 8.0in !important; margin: 5px auto; padding:20px; background-color:white; } .theNote .header { border-bottom: 1px dashed #C8C8C8; font-size: 17px; padding: 0 0 10px; line-height: 19px; color: #00ADE1; min-width:500px; } .theNote .body { font-size: 14px; line-height: 19px; padding: 10px 0; } .theNote{ padding:6px 0; clear:both; background-color: rgb(200,200,200); } .theNote h3{ color: rgb(100,100,100); } .theNote h1, .theNote h3{ background-color:white; padding:2px 20px; width:8.0in !important; margin: 0 auto; font-size: 15px; } .theNote h1{ padding-top: 10px; font-size: 15px; } .theNote h1:first-child{ font-size: 20px; } .theNote h3 { font-size: 14px; font-weight: normal; } #options { border: 3px double #ccc; padding: 5px 12px; margin: 10px 50px 10px 20px; float: left; } #info { border-top: 1px solid #ccc; padding-top: 5px; font-style: italic; } li { margin: 5px 10px 5px 25px; } ul li { list-style: disc; } ol li { list-style: decimal; } img { border: 0; } table { clear: both; width: 100%; border: 1px solid #c5c5c5; border-width: 1px 0; margin: 0; page-break-after: always; } table#page { page-break-after: auto; } td { text-align: center; font-size: 12px; border-bottom: 1px dashed #c5c5c5; height: 1.75in; width: 50%; padding-left: 15px; } .leftside { border-right: 1px solid #cccccc; padding: 0 15px 0 0; } .bottom td { border-bottom: none; } .clearfix { clear:both; line-height:1px; height:1px; } img { max-width:80%; max-height:150px; margin:20px; } @media print {.header { display: none; } .content .header{ display:inherit; } table { border: 1px dashed #bbb; border-width: 1px 0; } .theNote{ background-color:white; } } Body Fluids Lecture ANATOMY : 3 membranes w/i the brain from outer-most to inner-most 1. Dura matter 2. Arachnoid matter 3. Pia matter Normal vol. of CSF Adults: 90-150 mL Neonates: 10-60 mL FXNs of CSF -Protection: like a cushion -Lubrication of CNS -Collection of wastes -Circulation of nutrient SPINAL TAP 1. Numb the area: usually drawn between the 3rd and 4th lumbar vertebrae 2. Get the pressure A. Normal pressure: 90-180 mmHg- would be ^ if upright @ this pressure can draw 20 mL B. Abnormal pressure: >200 mmHg- can withdraw 2 mL 3. Record closing pressure Three tubes: First tube: Chemistry/Immunology- store frozen -15 C Second tube: Microbiology- store at RT Third tube: Hematology- store in fridge 4 C WHAT DOES CSF INDICATE? Infections : -meningitis -encephalitis -abscess -syphilis Hemorrhage -subarachnoid -intracerebral CNS malignancy demyelinating disease: MS or gillian deray Intrathecal therapy : need to inject drug into CNS b/c otherwise can't pass bld/brain barrier Contradictions : Do NOT do CSF if there is: A lumbar infection Complications of Spinal tap : -headache -painful paresthesia -bleeding -brain herniation CSF PHYSICAL EXAMINATION Normal: looks like water Cloudy/turbid can be due to: -pleocytosis = cells in CSF A. WBCs >200/microliter B. RBCs > 500/ microliter - microorganisms -Increased total protein A. >150 mg/dL B. Normal: 15-45 mg/dL Oily b/c: radiographic contrast media- myelogram Bloody: smoky, pink, red b/c RBCs Traumatic tap: -higher RBC ct. in first tube--> dilutes as more tubes taken -Supernate clear -Fibrin clots Hemorrhage -subarachnoid, intracerebral -Each tube equally bloody -Supernate A. xanthochromic XANTHOCHROMIA Xanthochromic- pink, orange, or yellow Hemorrhage: pink Previous traumatic tap: pink hyperbilirubinemia: yellow- due to RBC degradation -Hypercarotenemia- orange -Meningeal melanoma: brown/black -Hyperproteinemia A. >150 mg/dL PROTEIN -Normal 15-45 mg/dL -Causes of ^ a. traumatic tap b. ^ bld./brain barrier permeability c. CSF circulation defects d. collagen vascular disease e. neurosyphilis MTHDS: 1. Turbidimetric -TCA/SSA 2. Chemical -Folin/Lowry or Coomassie Blue 3. Electorphoresis -pre-albumin spike too/ oligoclonal banding CHEMICAL EXAM Glucose= 60% of plasma A. 50-80 mg/dL Increase can be due to: hyperglycemia, traumatic tap Decrease=hypoglycorrhacia A. meningitis: bac./fungal, viral is uncommon B. Symptomatic hypoglycemia C. meningeal tumor LD= 10 % of plasma -CNS leukemia, lymphoma, hemorrhage, meningitis Lactate= 10-22 mg/dL -impaired body supply/meningitis- bacterial OTHER BODY FLUIDS Pleural cavity- lungs pericardial- heart peritoneal- abdomen paracentesis: aspiration of body fluid from body cavity thoracentesis: aspiration of pleural fluid pericardiocentesis: aspiration of pericardial fluid peritoneocentesis: aspiration of peritoneal fluid ascites: build up of peritoneal fluid Effusion: accum. of fluid w/i body cavities as result of pathological process transudate: ultrafiltrate of plasma across intact vascular wall-CHF, cirrhosis, hypoproteinemia (N.S.) Exudate: effusion of pleural or peritoneal surfaces assoc. w/ damage to the capillary wall, infections, neoplasma, trauma, pul. infarcts Serous fluid cell counts - WBC <1,000- transudates/microliter >1,000/microliter exduates -RBCs 5,000-10,000/microliter= prod. bld. tinged >100,000 = malignant neoplasm, trauma, pulmonary infarct FLUID COLORS Hemorrhagic (bloody)- traumatic tap, pulmonary infarct, trauma, panreatitis, TB, malignancy Chylous (milky)- lymphatic obstruction: contains fat droplets Pseudochylous (milky or greenish)-TB, RA, Cholesterol crystals. Synovial fluid: fluid in joint spaces FXN: transport nutrients, lubricate Collection: arthrocentesis- can withdraw about 8 mL- might add heparin Physical exam: color, clarity, viscosity, hyaluronic acid Microscopic: cell ct, differential cell ct., crystals Chemical : glucose, TP Microbiological: culture