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Tim Pengampu
Kuliah Patologi Klinik
Chyle (/kaɪl/; from the Greek word χυλός chylos, "juice") is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids (FFAs).
Thoracocentesis is used to remove air or
fluid from the pleural space
Rivalta’s test is a very simple, inexpensive method that does not require special laboratory equipment and can be easily performed in private practice.
This test was originally developed by the Italian researcher Rivalta around 1900 and was used to differentiate transudates and exudates in human patients.
This test is very useful in cats to differentiate between effusions due to FIP and effusions caused by other diseases [Hartmann et al., 2003]. Not only the high protein content, but high concentrations of fibrinogen and inflammatory mediators lead to a positive reaction.
To perform this test, a transparent reagent tube (volume 10 ml) is filled with approximately 7-8 ml distilled water, to which 1 drop of acetic acid (98%) is added and mixed thoroughly. On the surface of this solution, 1 drop of the effusion fluid is carefully layered.
If the drop disappears and the solution remains clear, the Rivalta’s test is defined as negative.
If the drop retains its shape, stays attached to the surface or slowly floats down to the bottom of the tube (drop- or jelly-fish-like), the Rivalta’s test is defined as positive
The Rivalta’s test had a high positive predictive value (86%) and a very high negative predictive value for FIP (96%) in a study in which cats that presented with effusion were investigated (prevalence of FIP 51%) [Hartmann et al., 2003].
Positive Rivalta’s test results can occur in cats with bacterial peritonitis or lymphoma.
Ascites is the accumulation of unwanted fluid in the abdominal cavity,
either from normal functions (physiologic) or resulting from disease
(pathologic). Fluid accumulates between the body wall and the
internal organs.
INDICATIONS
1. The examination of cerebrospinal fluid is indicated for the diagnosis of diseases of central nervous system.
2. In the evaluation of clinical signs associated with central nervous system, the cerebrospinal fluid is examined.
3. For the evaluation of prognosis and effect of therapy, the examination of cerebrospinal fluid is advised.
4. Cerebrospinal fluid is used for radiographic procedures employed to demonstrate the shape of cerebrospinal fluid containing system and to reveal the changes due to disease
Spinal needles for use in small animals
are available in 20 to 22 gauge and 1- 1/2
to 3- 1/2 inches in length. All spinal
needles have a stylet.
COLLECTION OF CEREBROSPINAL FLUID
In horses, sheep, goats, pigs and dogs,
the cerebrospinal fluid is collected from
sub-occipital region
while in cattle and buffaloes, the lumbo-
sacral site is preferred.
CEREBROSPINAL FLUID
On midline, halfway between wings
of atlas and occipital protuberanceAnesthetized and head flexed
Needle placed perpendicular Clear fluid allowed to drip out
Collection Procedure
CSF GROSS EXAMINATION
Photos-Davide De Lorenzi
ColorClarity
CSF Chemistry Evaluation
Microprotein Analyzers
Protein estimation
CEREBROSPINAL FLUID
Low Protein Normal
Normal CellCount
Protein-CytologicDissociationHigh Protein
NucleatedCells Neutrophilic
Eosinophilic
Pleocytosis
Mononuclear
Mixed Cells
MICROSCOPIC EVALUATION
Protein-Cytologic Dissociation
Increased protein but normal cell count and lack of
cytologic abnormalities
May be seen in inflammatory, degenerative,
compressive (disc rupture), necrotic, or neoplastic
lesions
CSF Pressure (by manometer)• Tekanan CSF meningkat karena neoplasma,
abses, hemoragi, hydrocephalus. Vena sinus
mengalami tekanan oleh lesi sehingga
penyerapan cairan melalui villi arachnoid
terganggu
• Defisiensi vitamin A, menyebabkan gangguan
penyerapan cairan
• Peningkatan cairan CCF pada edema cerebral
akibat luka di kepala
Tekanan CSF pada beberapa kondisi
penyakit di hewan
No Disease CSF
Pressure
Normal
1 Canine distemper 120 170
2 Canine cryptococcal
meningitis
364 170
3 Canine toxoplasma
encephalitis
256 170
4 Suppurative
meningoencephalitis
pada sapi
168 200
5 Polioencephalitis 220
6 Brain tumors 170-410
7 Polioencephalomalacia
in goats
210
Warna merah karena chronic hemmorhagic; kuning-putih pada infeksisepticemic thromboembolic meningoencephalitis.
Kuning karena adanya bilirubin (xantochormic) pada kondisi perdarahansubarachnoid, hematoma extradural, spinal block, brain tumor, abses, keratonemia dantoxoplasma akut.
kehijauan atau keabuan bisa terjadi karenaadanya sel radang pada peradangan akut.
Turbiditas, CSF yang keruh menandakan
adanya komponen seluler karena proses
radang
Koagulasi, CSF normal tidak mengalami
koagulasi, koagulasi terjadi karena
peningkatan unsur fibrinogen, pada
kejadian meningitis supurative akut,
CSF–Normal Cell Components
Neutrophil
um
Large mononuclear
Lymphocytes
Meningotheli
CSF–Neural Tissue
Neuropyle
CSF–Neural Tissue
Nissl bodies
Neutrophil and neuron
Tissue Injury–Hemorrhage
Acute hemorrhage
CSF–Tissue Injury
1 - : r . •
t.r 'S _ : . . . . . J : : - . .
·,···.· .....-
...' � -..•
••
May be associated with myelomalacia or degenerative myelopathies
Pleocytosis
steroid-responsive
steroid-responsive
granulomatous meningoencephalitis
Neutrophilic Nonseptic (steroid-responsive, neoplasia) Septic (bacterial, FIP)
Eosinophilic
protozoal, cryptococcosis, parasitic,
Mixed cell
granulomatous meningoencephalitis, fungal,
Lymphocytic
viral, necrotizing encephalitis of small breeds,
NEUTROPHILIC PLEOCYTOSIS
Salm
.,onella cultured, not seen
•••.·
•- 0
Steroid-responsive meningitis
Bacteria seen in this case
EOSINOPHILIC PLEOCYTOSIS
Toxoplasmosis
MONONUCLEAR PLEOCYTOSIS
RabiesCryptococcosis
DOG - GRANULOMATOUS
MENINGOENCEPHALOMYELITIS (GME)
Lymphocytic Pleocytosis
Cytoplasmic vacuolation
Pug Encephalitis
CSF NEOPLASIA
Lymphoma
Arthrocentesis
can generally be
performed with
light sedation of
the animal
A 20 gauge
needle and 3 ml
syringe are used
CARPUS FLUID COLLECTION
STIFLE FLUID COLLECTION
STEPS IN JOINT FLUID EVALUATION
Microbiology
Physical Features
Protein Concentration
Cell Count
Smear Preparation
Flu
id S
am
ple
The inflammatory conditions of joints are
of 3 types (i) non infectious (ii) infectious
and (iii) immune complex mediated.
Earlier the immune complex mediated
arthritis was included in the non-
infectious joint inflammations but in this,
it has been described in a separate class
for a better understanding of immune
mediated arthritis.
The non-infectious arthritis includes
degenerative and traumatic type of joint
inflammations. In this the synovial fluid is
clear with good or fair mucin clot, normal
glucose and protein contents with a
cellular content of 100-1000/mm3.
PHYSICAL FEATURES
String TestEquine synovial fluid
normal yellow color
VISCOSITY
Mucin clot test qualitatively reflects hyaluronic acid composition
DIRECT SMEAR PREPARATION
SYNOVIAL FLUIDLow CellCount
Non-Suppurative
High CellCount
NucleatedCells
Noninfectious
Suppurative
Infectious
MICROSCOPIC EVALUATION
SYNOVIUM LINING CELL
20um
SYNOVIAL HYPERPLASIA
NON-SUPPURATIVE SYNOVIAL FLUID
and Cytology
Degenerative Change
with increased cellularityNormal Cartilage
CHRONIC BICIPITAL TENOSYNOVITIS - SHOULDER
MIXED CELL INFLAMMATION
M I N E R A L D E P O S I T S P O S I T I V E F O R C A L C I U M
737-410 CANINE ELBOW JOINT
737-410 CANINE ELBOW JOINT
Osteoclast
SUPPURATIVE (NEUTROPHILIC) SYNOVIAL FLUID
E. ewingii morula
Windrowing with cells in rows
SepticNon-Septic
IMMUNE-MEDIATED POLYARTHRITIS
Ragocytes represent
nuclear remnants or
phagocytized immune
complexes.
EQUINE SYNOVIAL FLUID
LYME DISEASE - DOG
POLYARTHROPATHY
The infectious arthritis is caused by bacteria,mycoplasma, chlamydia or viral agents either in single or in combination. The synovial fluid is less viscous, coloured, foul smelling, turbid, thick, opaque, often clots on standing with poor mucin test. The glucose content is lowered with increased protein contents.
Microorganisms can be demonstrated or isolated from the synovial fluid.
Normal rectal columnar epithelium
RECTAL
Histoplasmosis
•
•
Weight loss
Chronic
diarrhea
Squamous
cells, neuts,
mac
•
RECTAL
Histoplasmosis
• Macrophagewith yeast
RECTAL
Phycomycosis
•
•
•
Scraping
Weight loss
3 months of
diarrhea
100X objective, GMS stain
RECTAL
100X objective, Wright stain
RECTAL
Normal bacterial flora
100X objective, Wright stain
FECAL
100X objective, Romanowsky stain
FECAL
5 month cat
Serpulina spp.
CYTOLOGY EFFUSI
Sebutkan sel apa yang bisa kalian amati
Pleural Effusion Actinomycosis
Hemorraghic Effusion
Neoplastic, Lymphoma
Hemorraghic Effusion,
Candidiasis
Mixed Cell Pleocytosis
ACUTE HEMORRHAGE WITH MONONUCLEAR
MIXED CELL