synovial fluid and fecal analysis .group 5
DESCRIPTION
SYNOVIAL FLUID AND FECAL ANALYSIS INTRODUCTIONTRANSCRIPT
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SYNOVIAL FLUIDAND
FECAL ANALYSIS
ABARCA KRIZZA KAY LYKAPUEBLO, JOHN ALFREY D.
PINTON, BETHSONGCUYA, ANN MARI
GROUP5
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PHYSIOLOGY
Joint Fluid
UABF By;Strasinger et.,al.
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UABF By;Strasinger et.,al.
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Ultrafiltrate of plasma Similar concentration of
plasma Nutrition for vascular –
deficient cartilage Hyaluronic acid
SYNOVIAL FLUID
UABF By;Strasinger et.,al.
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Damage of the articular membrane
UABF By;Strasinger et.,al.
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UABF By;Strasinger et.,al.
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UABF By;Strasinger et.,al.
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LABORATORY TEST
UABF By;Strasinger et.,al.
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UABF By;Strasinger et.,al.
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SPECIMEN COLLECTION
AND HANDLING
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NORMAL SYNOVIAL FLUIDS
VOLUME Less than 3.5 mL
Color Colorless to pale yellow
Clarity Clear
Viscosity Able to form a string 4-6 cm long
Leukocyte count 200 cells/uL
Neutrophils Less than 25% of the differential
Crystals None present
Glucose:plasma difference
Less than 10 mg/dL lower than the blood glucose
Total protein Less than3 g/dLUABF By;Strasinger et.,al.
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COLORLESS TO PALE YELLOW
UABF By;Strasinger et.,al.
COLOR AND CLARITY
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MUCIN CLOT TEST
2% - 5% ACETIC ACID
REPORTING VISCOSITYGood SOLID CLOTFair Soft clotLow Friable clotPoor No clot
UABF By;Strasinger et.,al.
VISCOSITY
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Neutrophils-20% of SF
50%-urate gout, pseudogout and RA
75%-acute bacterial rthritis
Lupus erythematosus (LE) cells- present in patient with lupus arthritis
Henry’s 22nd ed.
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Lymphocytes-15% of SF cell
Prominent in early RA
Chronic infection
Monocyte and Macrophage- 65% of all cell count
Most common
Eosinophilia-2% RA, RF, parasitic
and infection.
Henry’s 22nd ed.
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Synovial Cells-no pathologic significance
Lipid bodies- trauma,and RA
Henry’s 22nd ed.
CELLS AND INCLUSIONS SEEN IN SF
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CRYSTAL IDENTIFICATION
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Crystal identification
To evaluate arthritis, microscopic examination of synovial
fluid for the presence of crystals is an important diagnostic test.
Crystal formation is caused by metabolic disorders and
decreased renal excretion that produce elevated blood levels of
crystallizing chemicals, degeneration of cartilage and bone, and
injection of medications, such as corticosteroids into a joint.
Sources: Henry’s 22nd edition,
Analysis of urine and other body fluids by: Susan Stratsinger
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Monosodium urates
- needle-shaped rods 5–20 μm long, 1–2 μm in L
- appear as rounded spherolites
- characteristic of acute urate gout
-occasionally observed as a result of inflammation in septic arthritis
Types of Crystals
Sources: Henry’s 22nd edition
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Cholesterol
-appear as irregular birefringent
plates, with notched corners
-needle or rhomboid-shaped crystals
may be present similar to MSU or CPPD in
chronic effusions
- ethanol and ether soluble
Sources: Henry’s 22nd edition
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Calcium pyrophosphate dihydrate
-these crystals appear as rhomboids, rods, or rectangles 1–20 μm in length
-weakly birefringent with positive elongation
-too small to polarize the light, making them difficult to detect without phase-contrast microscopy
Sources: Henry’s 22nd edition
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Calcium oxalate
-5- to 30-μm bipyramidal octahedral“envelopes” with variable birefringence and positive elongation
-seen in arthropathy associated with chronic renal dialysis andprimary oxalosis, a rare inborn error of metabolism
- monohydrate form is birefringent but nondescript in shape
Sources: Henry’s 22nd edition
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Other crystals:
Lipid crystals
1- to 20-μm spheres with a Maltese cross appearance and positive birefringence; implicated as a cause of acute arthritis
Crystalline corticosteroids
blunt, jagged edges without clear crystal structure
Calcium hydroxyapatite
small and nonbirefringent (isotropic) ,they are clumped into 1- to 50-μm spherical microaggregates
Sources: Henry’s 22nd edition
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Slide Preparation
Fluid is examined as an unstained wet preparation, slide and
coverslip must be cleaned and carefully dried ,the coverslip edges are sealed
with nail polish, and crystals may be observed in Wright stained smears.
Crystal Polarization
Polarization of crystals is used to differentiate the linear structures
of their molecules, and to identify them through the color they produced.
Sources: Henry’s 22nd edition,
Analysis of urine and other body fluids by: Susan Stratsinger
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Chemistry Test/ Chemical Analysis
Glucose
Protein
Lactate dehydrogenase
Uric acid
Sources: Henry’s 22nd edition
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Reference Intervals for Synovial Fluid Constituents
Constituent Synovial fluid PlasmaTotal protein 1–3 g/dL 6–8 g/dLAlbumin 55%–70% 50%–65%α1-Globulin 6%–8% 3%–5%α2-Globulin 5%–7% 7%–13%β-Globulin 8%–10% 8%–14%γ-Globulin 10%–14% 12%–22%Hyaluronic acid 0.3–0.4 g/dLGlucose 70–110 mg/dL 70–110 mg/dLUric acid 2–8 mg/dL 2–8 mg/dLLactate 9–29 mg/dL 9–29 mg/dL
Sources: Henry’s 22nd edition
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Microbiologic Tests
An infection may occur as a secondary complication of
inflammation caused by trauma or through dissemination of a
systemic infection.
Gram stains and cultures are two of the most important
tests performed on synovial fluid.
Sources: Henry’s 22nd edition
Serologic Tests
Through measurement of the concentration of acute
phase reactants such as fibrinogen and C- reactive protein the
extent of inflammation can be determined.
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FECAL ANALYSIS
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PHYSIOLOGY
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DIARRHEA
Secretory diarrhea
Osmotic diarrhea
Altered motility
Steatorrhea
COMMON FECAL TEST FOR DIARRHEA
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SPECIMEN COLLECTIONMacroscopic Screening
Color
Appearance
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Microscopic Examination of Feces
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Leukocytes associated with microbial diarrhea
Muscle fiber Fats associated with
steatorrhea
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Fecal Leukocytes
Neutophils ( conditions that affects intestinal mucosa)
-ulcerative - colitis- bacterial desyntery Specimen can be examined:
Wet preparation-methylene blue
Dried smears- Wright's or gram
stain
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Muscle Fibers Procedure:1. Emulsifying a small amount of stool in two drops of eosin in alcohol.2. Coverslip and let it stand for 3 minutes3. Examine under the high power for 5 minutes4. Count the number of undigested fibers
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Neutral Fat Stain Procedure
Split Fat Stain Procedure
Acid Steatocrit Procedure
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Test, Materials, and Instrumentation for fecal fat
fecal analysisPROCEDURE
Sudan III Steatocrit and acid
steatocrit Fecal elastase-I
MATERIALS, INSTRUMENTATION
Sudan stain, microscopy
Hematocrit centrifuge, gravimetric assay
Immunoassay ELISA technique
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Near-infrared reflectance spectroscopy (NIRA)
Van de Kamer
NIRA spectrophotometer.
wavelengths range 1400-2600 nM. computer software for processing spectra Fecal fat extraction
and titration of long chain fatty acid by sodium hydroxide.
ATP Test (fetal hemoglobin)procedure
SUMMARY OF FECAL SCREENING TEST
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