體液常規(guī) 檢查 英文

What’sthebodyfluids？Bodilyfluidsarefluids,whicharegenerallyexcreted

orsecreted

fromthehumanbody.Theserespectivefluidswouldinclude:羊水（Amnioticfluid）surroundingafetuswhichisreleasedtotheoutsideworldinchildbirth)血液Blood

andbloodplasmaCowper'sfluidorpre-ejaculatoryfluidFemaleejaculateInterstitialfluid

LymphWhat’sthebodyfluids？月經(jīng)Menses乳汁MilkMucus

(includingsnotandphlegm)膿液Pus唾液Saliva皮脂Sebum

(skinoil)精液Semen眼淚Tears汗液Sweat尿液Urine陰道分泌物Vaginallubrication

嘔吐物VomitWhat’sthebodyfluids？Feces,whilenotgenerallyclassedasabodyfluid,areoftentreatedsimilarlytobodyfluids,andaresometimesfluidorsemi-fluidinnature.Internalbodyfluids,whicharenotusuallyleakedorexcretedtotheoutsideworld,include:cerebrospinalfluid

surroundingthebrainandthespinalcordsynovialfluidsurroundingbonejointsintracellularfluidisthefluidinsidecells腦脊液CSFCerebrospinalfluid,CSFinshort,istheclearfluidthatoccupiesthesubarachnoidspace蛛網(wǎng)膜下腔

(thespacebetweentheskullandcortexofthebrain).Itactsasa“cushion”orbufferforthecortex.Also,CSFoccupiestheventricularsytem腦室

ofthebrainandthespinalcord.CSFismainlyproducedbythechoroidplexus脈絡(luò)叢,butalsobytheependymalliningofthebrain'sventricles.Ithasbeencalculatedthat430to450mlofCSFareproducedeverydayPurposeofCerebrospinalfluidanalysis

ThepurposeofaCSFanalysisistodiagnosemedicaldisordersthataffectthecentralnervoussystem.Someoftheseconditionsinclude:病毒、細(xì)菌感染Viralandbacterialinfections,suchasmeningitisandencephalitis;神經(jīng)系統(tǒng)腫瘤Tumorsorcancersofthenervoussystem;梅毒Syphilis,asexuallytransmitteddisease;PurposeofCerebrospinalfluidanalysis出血Bleeding(hemorrhaging)aroundthebrainandspinalcord;多發(fā)性硬化癥Multiplesclerosis,adiseasethataffectsthemyelincoating髓鞘

ofthenervefibersofthebrainandspinalcord;Guillain-Barrsyndrome,aninflammationofthenerves.SamplecollectioncultureBiochemistryimmunologycytology腦脊液檢查項(xiàng)目

ContentsofCSFanalysis

顏色Color;細(xì)胞計(jì)數(shù)CellCounts;氯離子CL糖Glucose;蛋白質(zhì)Protein;顏色Color

TheCSFisawatery,clearandcolorlessfluid.Everychangefromthiswaterlikeappearanceisabnormal.TheCSFiscloudywhenahighamountofcellsarepresent(>500/μl).Ahighproteincontentcanenhancethisturbidityandproducesamoreviscousfluid粘性液體.顏色與疾病

CerebrospinalFluidSupernatantColorsandAssociatedConditionsorCauses

ColorofCSFsupernatantConditionsorcausesYellow

BloodbreakdownproductsHyperbilirubinemia;CSFprotein>=150mg/dL(1.5g/L);>100,000redbloodcells/ul

Orange

Bloodbreakdownproducts;Highcarotenoidingestion

Pink

BloodbreakdownproductsGreen

Hyperbilirubinemia;PurulentCSF

Brown

Meningealmelanomatosis細(xì)胞計(jì)數(shù)cellsTheexaminationofCSFcellsisespeciallyusefulincasesinwhichanongoinginflammatoryreactionissuspected(inflammatory/infectiousdiseasesoftheCNS,tumors).IntheCSFofnormal0

-

3cells/μlarecounted,mostlymononuclearcells(lymphocytesandmonocytes).

Incaseofapleocytosis,anincreasedcellcount,whichisgradedasmild(5

-

50cells),moderate(50

-

200cells)ormarked(>200cells).氯離子

ChlorideNormal:higherthanserum(119～129mmol/L)Tubercular:decreasedsignificant葡萄糖Glucose

TheCSFglucoseisdependentuponbloodglucoselevelandtherateofmetabolismintheCNS.

CSFlevelsareusually60

-

80%ofbloodlevels.lowCSFglucoselevelsintheabsenceofhypoglycemiaindicatethepresenceofadiffusemeningealdisorder.(associatedwithbacterialandfungalmeningitis,tumor)蛋白質(zhì)Protein

MostproteinsnormallypresentintheCSFarederivedfromblood.

child(lumbarcentesis)0.20—0.40g／Ladult(lumbarcentesis)0.20—0.45g／LAlbumin

100-300mg/LIgG-IndexTypicalCerebrospinalFluidFindingsinVariousTypesofMeningitis

AnalysisofSerousmembraneFluids漿膜腔積液Anyofvariousthinmembranes(astheperitoneum,pericardium,orpleurae)thatconsistofasinglelayerofthinflatmesothelialcellsrestingonaconnective-tissuestroma,secreteaserousfluid,andusuallylinebodilycavitiesorenclosetheorganscontainedinsuchcavities胸腔積液PleuralEffusions

Definition:Lungsarecompletelylinedbyathininnermembranecalledthevisceralpleura.Itiscontinuouswithanotherthinoutermembranecalledtheparietalpleurawhichalsoinveststhelungs,butattachestothechestwall.Normally,thepleuralspace(theareabetweenthetwopleura)containsnoairandonlyathinfilmoflubricatingfluid(＜20ml).

Theprimaryfunctionofthepleuraistoallowthechestwallandlungstoactinharmonyduringinspirationandexpiration.Apleuraleffusionisanabnormalaccumulationoffluidinthepleuralspace.腹水AsciteAscitesistheabnormalaccumulationoffluidintheabdominalcavity.Thevolumeofthefluidcanbequitesubtle,oritmaybesignificant,causingdistentionoftheabdomen.Ascitesiscausedbytheleakageoffluidintotheabdomenfrombloodvessels,lymphatics,internalorgansorabdominalmasses.漏出液TransudatesCausedbynon-infectiousreasons.Transudatesarefluidsoflowcellcount(under1500cells/mcl)andlowproteinconcentration(under2.5g/dl).

Examplesoftransudatesincludethosecausedby:hypoproteinemia,liverdisease,sometumorsandobstructionoflymphaticdrainage.滲出液ExudatesCausedbyinfectiousreasons.Exudatesarefluidswiththe

highestcellcounts

(over7,000cells/ml)and

proteinconcentrations

(usuallyover3.0g/dl).

Examplesinclude:bleedingconditions,tumors,bacterialinfectionscausedbybowelcompromise,chyloabdomen(lymphfluidintheabdomen),urineandbileleakageandpancreatitis.Causesoftransudativepleuraleffusion1.充血性心力衰竭Congestiveheartfailure.Thiscausespleuraleffusionsinabout40%ofpatientsandisoftenpresentonbothsidesofthechest.Heartfailureisthemostcommoncauseofbilateral(two-sided)effusion.Whenonlyonesideisaffecteditusuallyistheright(becausepatientsusuallylieontheirrightside).2.心包炎

Pericarditis.Thisisaninflammationofthepericardium,themembranecoveringtheheart.Causesoftransudativepleuraleffusion3.Toomuchfluidinthebodytissues,whichspillsoverintothepleuralspace.Thisisseeninsomeformsofkidneydisease;whenpatientshaveboweldiseaseandabsorbtoolittleofwhattheyeat;andwhenanexcessiveamountoffluidisgivenintravenously.4.Liverdisease.About5%ofpatientswithachronicscarringdiseaseofthelivercalled肝硬化cirrhosisdeveloppleuraleffusion.Causesofexudativepleuraleffusions

1.胸腔腫瘤Pleuraltumorsaccountforupto40%ofone-sidedpleuraleffusions.Theymayariseinthepleuraitself(mesothelioma),orfromothersites,notablythelung.2.結(jié)核Tuberculosisinthelungsmayproducealong-lastingexudativepleuraleffusion.

3.肺炎Pneumoniaaffectsabout3millionpersonseachyear,andfourofeverytenpatientswilldeveloppleuraleffusion.Ifeffectivetreatmentisnotprovided,anextensiveeffusioncanformthatisverydifficulttotreat.Causesofexudativepleuraleffusions4.

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)靜水壓升高Incresasedhydrostaticpressure

1.Cirrhosis

2.Hepaticveinocclusion肝靜脈閉鎖(Budd-Chiarisyndrome)

3.Inferiorvenacava(下腔靜脈）obstruction

4.Constrictivepericarditis

5.Congestiveheartfailure

PathogenicMechanismsinAscitesFormationB)膠體滲透壓減低Decreasedcolloidosmoticpressure

1.End-stageliverdiseasewithpoorproteinsynthesis

2.Nephroticsyndromewithproteinloss

3.Malnutrition

4.Protein-losingenteropathy

PathogenicMechanismsinAscitesFormationC)毛細(xì)血管通透性增加Increasedpermeabilityofperitonealcapillaries

1.Tuberculousperitonitis

2.Bacterialperitonitis

3.Malignantdiseaseoftheperitoneum

PathogenicMechanismsinAscitesFormation

D)Leakageoffluidintotheperitonealcavity

1.Bileascites

2.Pancreaticascites(secondarytoaleakingpseudocyst)

3.Chylousascites

4.Urineascites

PathogenicMechanismsinAscitesFormation

E)其它原因Miscellaneouscauses

1.Myxedema粘液性水腫

2.Ovariandisease(Meigs‘syndrome)卵巢纖維瘤伴胸腹水（或其它盆腔腫瘤伴胸腹水）

3.Chronichemodialysis血液透析SeparatingtransudatesandexudatesAnexudatemeetsoneormoreofthefollowingcriteriawhileatransudatemeetsnone:Pleuralfluid/serumprotein>0.5Pleuralfluid/serumLDH>0.6PleuralfluidLDH>two-thirdsofuppernormallimitforserumNewertestsfordifferentiatingtransudatesandexudatesProposedtestshaveincludedthelevelsofcholesterol,bilirub