Pleural fluid

It is fluid which is present in the pleural cavity of
lungs b/w parietal pleura n visceral pleura.
The pleural cavity is a potential space lined by
mesothelium of the visceral n parietal pleura.

1. PLEURAL FLUID EXAMINATION Ms Ankita R Bhatiya Assistant Professor Shree P.M.Patel COLLEGE OF PARAMEDICAL SCIENCE N TECHNOLOGY

2. PLEURAL FLUID EXAMINATION It include: 1.What is Pleural fluid? 2.Function of Pleural fluid. 3.Collection of Pleural fluid. 4. Examination of Pleural fluid.

3. PLEURAL FLUID Introduction: It is fluid which is present in the pleural cavity of lungs b/w parietal pleura n visceral pleura. The pleural cavity is a potential space lined by mesothelium of the visceral n parietal pleura. Pleural fluid Formation: Pleural fluid is a selective ultrafiltrate of plasma. Small amount of the Pleural fluid is also formed from the cells lining the pleura and other by capillaries. There is about 60-70 ml of pleural fluid at any one time and about 125 ml is generated every day.

4. PLEURAL FLUID Composition of Pleural fluid: Volume: 60-70 ml Cell/mm 3 : 1000-3000 Mesothelial cell :60% Monocyte:30 % Lymphocyte: 5% Neutrophil : 5% Protein: up to 3 gm/dl Glucose: Same as plasma LDH:70-140 U/L

5. PLEURAL FLUID Function of Pleural fluid: Protection: It helps to protect the lungs from the sudden injury n damaged. Also acts as a medium for the transfer of substances from the lung tissue to blood . Nutrition : Removal of waste : Lubrication :

6. PLEURAL FLUID Collection of Pleural fluid: Throracentesis is a process by which pleural fluid is collected. A needle is placed through the skin and muscles of the chest wall into the pleural space.

7. PLEURAL FLUID Indication of Pleural fluid : 1.Infections: Tuberculosis, Pneumonia ( Bacterial,viral,fungal ) 2. Neoplasm: Bronchogenic carcinoma, Metastatic carcinoma, Lymphoma, Mesothelioma 3. Pulmonary infract 4.Non infections non inflammatory disease: Rheumatoid disease Systemic lupus erythreomatous 5. Extra pleural sources: Pancreatitis Ruptured esophagus Urinithrorax

8. PLEURAL FLUID Procedure: 1.Take consent of a patient. 2.Position of patient: The patient is sitting in an upright position with arms & head extended to over bed table. 3.Proper aseptic precautions are taken with the help of spirit –iodine-spirit. 4.Before puncture give injection of atrophin intramuscularly to prevent vasovagal shock. 5.Give xylocane injection as local anesthesia before puncture.

9. PLEURAL FLUID 6.Then insert the needle b/w intercostal space & allow the fluid to flow in container. 7. Pleural fluid is collected in 3 tubes: 1. EDTA Bulb: Cell count n differential count. 2. Flouride Bulb: For glucose examination. 3. Plain Bulb: Chemical n immunology study

10. PLEURAL FLUID Examination of Pleural fluid: Physical examination: Chemical examination: Microscopic examination:

11. PLEURAL FLUID Physical examination of Pleural fluid: 1.Volume: Normally: 60 to 70 ml Transudates – 100 to 150 ml Condition: Increase hydrostatic pressure Decrease plasma oncotic pressure Congestive heart failure Hepatic cirrhosis Hypoproteinemia Exudates– More than 150 ml Condition: Pneumonia( Bacterial, Viral,Fungal ) Tuberculosis Bronchogenic carcinoma, Metastatic carcinoma, Lymphoma, Mesothelioma Pulmonary infract Rheumatoid disease Systemic lupus erythreomatous Pancreatitis, Ruptured esophagus,Urinithrorax

12. PLEURAL FLUID 2. color : Normally: colorless Transudates : Pale yellow or straw clr Exudates: Reddish: Presence of blood (Bacterial pneumonia, Cancer, Pancreatitis.) Green; Pseudochlyous effusion.

13. PLEURAL FLUID 3.Appreance: Normally: Clear or transparent Transudate : Clear or transparent Exudate : Turbid: Bacterial n viral Pneumonia, Tuberculosis, Pancreatitis Cloudy: Bacterial n fungal pneumonia Purulent: Bacterial Pneumonia Milky : Chylous effusion

14. PLEURAL FLUID 4. Clot: Normally: absent Transudate : absent Exudate : Present Tuberculous Peunomia 5,Specific gravity: Transudate : below 1.010 Exudate : above 1.010 Pneumonia( Bacterial, Viral, Fungal) Cancer Pancreatitis Rheumatoid pleuritis

15. PLEURAL FLUID Chemical examination of Pleural fluid: 1.Glucose: Normal range: same as blood glucose Transudate : same as blood glucose Exudate : slightly reduce Method: 1.Visualised method Benedict test 2.Colorimetric method GOD-POD Condition for decrease glucose: Bacterial pneumonia Viral pneumonia Fungal pneumonia Pancreatitis Tuberculosis Rheumatoid pleuritis Esophagaus rupture Cancer

16. PLEURAL FLUID 2. Protein: Normal range: 6-8gm/dl Transudate : below 3 gm/dl Exudate : Above 3 gm/dl Method: 1.Turbidometric method method SSA Heat n acetic acid 2.Colorimetric method Biuret Condition for Increase protein: Pneumonia(Bacterial, fungal,viral ) Tuberculosis

17. PLEURAL FLUID 3. Lactate: Normal range: 140-280U/L Transudate : NORMAL Exudate : Above 280U/L Method: 1.Colorimetric method 2. U.V.Kinetic method Condition for Increase protein: Pleuritis (Bacterial, fungal,viral ) Tuberculosis Melingancy

18. PLEURAL FLUID 4. Amylase: Normal range: 30-110 U/L Transudate : Normal Exudate : Above 110U/L Method: 1.Colorimetric method 2. U.V.Kinetic method Condition for Increase protein: Pancreatitis Melingancy Esophageal rupture

19. PLEURAL FLUID 5 . Lipid : ( Tg ) Normal range: 50-110 mg/dl Transudate : Normal Exudate : Above 110U/L Method: 1.Colorimetric method Condition for Increase protein: Chylous effusion

20. PLEURAL FLUID 6.Tumor marker: CEA: Carcino embryogenic antigen Transudate : Absent Exudate : Positive Condition for present tumor marker: Lung carcinoma Brest carcinoma

21. PLEURAL FLUID Microscopic examination of pleural fluid: 1.TLC (Total leukocyte count): Normally: 0-50 cell/ cumm Transudate : 0-50 cell/ cumm Exudate : 50-500 cell Method: Same as Blood Condition in increase TLC count: Bacterial Pneumonia Viral Pneumonia Fungal Pneumonia Parasitic Infection Pancreatitis Tuberculosis Malignancy SLE Congestive heart failure Hypersensitivity reaction

22. PLEURAL FLUID 2. DC: Method: Same as Blood Neutrophilia : Bacterial Peumonia Pulmonary infraction Tuberculous Peumonia Pancreatitis Metastatic Tumor Lymphocytosis : Viral Peumonia Tuberculosis Malignancy Rheumatoid pleuritis SLE Leukemia Eosinophilia : Parasitic Infection Air in pleural space Leukemia Hypersensitivity reaction Congestive heart failure

23. PLEURAL FLUID 3.Gram’s Stain: Normally: Bacteria absent Transudate : Bacteria absent Exudates: Bacteria present Clinical Condition: Bacterial Pneumonia,pancreatitis Bacteria: Diplococci Streptococcus Pseudomonas Neisseria Homophiles influenza 4.AFB Stain: Normally: Bacteria absent Transudate : Bacteria present Exudates: Bacteria present Clinical Condition: Tuberculous Peumonia Bacteria: Mycobacterium Tuberculosis