Examination of transudates and exudates. Physical and chemical properties of abdominal fluids Transudate causes

The study of fluids obtained by means of a test puncture of the chest and abdominal cavities, joints, abscesses and cysts aims to study the properties of the extracted punctate. The data of this kind of research are of great diagnostic value, in many cases decisive in determining the nature of the disease process that caused the accumulation of fluid. The amount of extracted punctate is not significant in this case. It is important only in a prognostic sense. While in some cases it is barely possible to collect only a few cubic centimeters of effusion, in others it can be removed by liters. The question of the origin of the punctate and the nature of the disease in each individual case is essentially decided on the basis of the data from the study of the fluid.

By means of a test puncture of the chest and abdominal cavities, various kinds of exudates, transudates, blood, contents of the stomach or intestines, urine, contents of various kinds of cysts and blisters of echinococcus can be obtained.

The study of punctates sets the task of determining the physical properties of the liquid, its chemical composition, the study of uniform elements that are mixed with the effusion, and, finally, bacteriological examination.

When determining physical properties, attention is paid to the color of the effusion, its transparency, consistency, specific gravity and reaction.

In appearance, effusions are distinguished: a) completely colorless, b) painted in one or another color, c) transparent, d) opalescent, e) cloudy and f) milky white.

Completely colorless and transparent, pure as water, is the contents of echinococcus blisters and saccular tumors - cysts; transparent, in addition, include transudates and serous exudates, as well as urine that accumulates in the abdominal cavity when the bladder ruptures. The color of the effusion and the intensity of its color may be different.

Serous exudates and transudates are almost completely transparent, only slightly opalescent liquids, of a beautiful lemon-yellow color. The admixture of a small amount of the coloring matter of the blood gives them a reddish tint; with a sharper extravasation, the liquid becomes red and even cherry red, not significantly differing in color from blood.

Turbid liquids include sero-fibrinous, purulent and ichorous exudates, hemorrhagic exudates that accumulate in tuberculous lesions of the serous membranes, as well as in malignant neoplasms of the chest and abdominal organs, the contents of the stomach and intestines, and finally, hemorrhagic transudates that accumulate in the abdominal cavity during thromboembolic colic and some forms of ileus.

Milky white exudates are chylous, chyle-like and pseudo-chylous.

The milky-white color of the chylous exudate, which accumulates in the abdominal cavity when the lymphatic vessels of the cavity are ruptured, is due to the admixture of a large amount of fat, which accumulates in the form of a thick creamy mass on its surface when settling. After adding a few cubic centimeters of ether, alkalized with a drop of caustic potash, the liquid, due to the complete dissolution of fat, becomes completely transparent. In 111 Sudan-treated preparations, microscopic examination shows a mass of intensely red colored fat granules. In chronic inflammation of the serous membranes, for example, tuberculosis, chyle-like exudates accumulate in the cavities, the characteristic color of which depends on the accumulation of a large number of decomposed fatty degenerate cells. This kind of exudates contain much less fat; after the addition of ether, the liquid, only slightly clarified, remains cloudy due to the admixture of a large number of endothelial cells and leukocytes suspended in it.

Pseudo-chylous exudates, which resemble diluted milk in color, contain only a very small amount of fat. They do not clear after the addition of ether and do not form a creamy layer when settling. Some explain their characteristic color by the presence of lecithin-containing globulins, others - by nucleides and mucoids.

By their consistency, the effusions obtained by puncture are most often completely liquid; this includes exudates, transudates, fluid from the echinococcal bladder, urine, etc.; only the contents of the uterine cysts have a clear mucous consistency. Due to the admixture of a large amount of pseudomucin, punctates of ovarian cysts show a clearly mucous consistency and can stretch into long thin threads. The contents of the uterus, which enters the abdominal cavity when it breaks, is a thick, viscous mass that also stretches into long threads. Microscopic examination of the sediment reveals many leukocytes and epithelial cells.

When determining Specific Gravity Punctate is commonly enjoyed Breakdown Detre, Which is just a modification of the Hammershlyag test. Determination with a hydrometer is not always possible due to the rapid coagulation of the liquid; in addition, it requires a large amount (up to 25 cubic cm) of punctate. To delay clotting, it is recommended to collect punctate in a vessel immersed in water heated to 38 °. The study should be carried out with hydrometers set for a temperature of 36 °.

The Detre method is based on the difference in the specific gravity of the stock solution and the test liquid. If a drop of exudate is lowered into a liquid of lighter specific gravity, it quickly sinks to the bottom; in a heavier solution, the drop floats on the surface. With the same specific gravity, it is suspended in a solution, floats in it, neither rising nor falling.

As the main ones, 4 solutions of table salt with a specific gravity of 1.010 (1.380%), 1.020 (2.76%), 1.030 (4.14%) and 1.040 (5.52%) are used. Basic solutions are prepared in distilled water, adding the indicated amounts of table salt. The specific gravity of the reagent must be exactly adjusted to the hydrometer. First, the concentration of boundary solutions is determined. For this purpose, one drop of the test liquid is dipped with a pipette into the stock solutions poured into test tubes. If in a solution with a specific gravity of 1.020 a drop falls to the bottom, and with a specific gravity of 1.030 it floats on the surface, the specific gravity of the liquid under study lies somewhere in the range of 1.020-1.030. Having then prepared intermediate concentrations by appropriately diluting a solution with a specific gravity of 1.030 with distilled water (9+.1.8 + 2.7 + 3, etc.), a final determination is made.

The specific gravity of the transudate ranges from 1.005 to 1.018. The highest specific gravity is found in lunates with pneumothorax, when the properties of the fluid are between transudates and exudates.

Exudates are more dense. Their specific gravity is usually higher than 1.018. However, differences in this respect between exudates and transudates are far from always constant. In many cases, the specific gravity of the exudate is below the limit, on the other hand, there are often transudates with a very high specific gravity.

The reaction of punctate is of great importance in the study of the contents of the stomach and bladder. Effusions with dropsy and inflammation of the serous membranes are usually alkaline. The fluctuations in the concentration of hydrogen ions observed in this case are very unstable and are not significant in the differentiation of transudates from exudates. The contents of the stomach are sharply acidic with a sour smell and often contain blood; urine during rupture of the bladder in carnivores is most often neutral, sometimes acidic, less often markedly alkaline.

Determination of the amount of protein is the main point of the study of effusion, since quite significant differences have been established in this regard, helping to differentiate exudates from transudates. The most accurate results are obtained by weighing the dry protein sediment. For precipitation, a 1% solution of sodium chloride acidified with a drop of acetic acid is used. To 100 cu. cm hot NaCl solution add 10 cu. cm of the investigated liquid and filter after thorough shaking; the precipitate is washed with water, acidified with acetic acid, alcohol, ether, dried in a desiccator and weighed. Subtracting the weight of the filter from the total weight and multiplying the resulting difference by 10 gives the percentage of protein in the liquid.

Of the simpler methods, the Roberts-Stolnikov method gives fairly accurate results (see the definition of protein in urine). Since the specific gravity of punctate depends mainly on the amount of protein dissolved in it, its content in the liquid can be approximately calculated from the specific gravity using the formula: x \u003d AD (UD - weight - 1.000) - 2.88 for exudates Px \u003d r1(UD - weight - 1,000) -2.72 for transudates.

The simplest and most convenient method that allows you to determine not only the total amount of protein, but also to establish the relationship between protein fractions, is the refractometric method.

The protein content in transudates, compared with exudates, is not particularly high and is usually below 2.5%. Only in rare cases, such as, for example, with ascites, dropsy, due to pneumothorax, its amount in transudates reaches 3 or even 4%. The protein content in exudates is much higher than 2.5% and often reaches 4 and even 5%. Such ratios help to easily differentiate inflammatory effusions from mechanical ones. However, there are often cases when the protein content in the exudate is slightly below the specified limit. Significant services in assessing this kind of effusion in such cases is provided by the reaction of Rivalt (Rivalt), as well as Moritz (Moritz).

The Rivalta reaction is based on the precipitation of a special protein precipitated by diluted acetic acid. This kind of protein substances can only be established in inflammatory effusions. Transudates do not contain it at all. Weak solutions of acetic acid are used as a reagent (2 drops per 100 cc of distilled water). The technique is extremely simple. In a narrow cylinder with a capacity of 25 cu. cm pour 20 cubic meters. see reagent. Then, using a pipette, one drop of the test liquid is applied to its surface. In the presence of protein, a drop, slowly falling, leaves a cloud of turbidity, and a small cloudy precipitate is obtained at the bottom. Transudates quickly dissolve in the reagent, without giving turbidity.

Moritz reaction. To 2-3 cube. cm punctate add a few drops of 5% acetic acid. Exudate gives turbidity and sediment, transudate - slight turbidity.

Based on the results of these tests, in cases where there is no sharp difference in specific gravity and protein content, it is possible to accurately differentiate exudate from transudate.

Definition of pseudomucin. The content of ovarian cysts, which is a yellowish or dirty brown viscous liquid with a specific gravity of 1.005 to 1.050, is distinguished by the presence of a kind of protein bodies a-pseudomucine. Pseudomucine is not precipitated by either acetic or nitric acid, but is precipitated by the action of alcohol. However, this difference is not conclusive, since serum proteins, a constant constituent of effusions, are also precipitated by alcohol.

To determine pseudomucin to 25 cu. cm punctate, add a few drops of an alcoholic solution of rosolic acid, heat to a boil and then add drops of n / 10 sulfuric acid solution until slightly acidic. Slightly yellowed after this treatment, the liquid is again brought to a boil and then filtered. Complete transparency of the filtrate indicates the absence of pseudomucin.

Particularly important in determining the nature of the effusion and its origin is microscopic examination of the sediment - cytoscopies. The study of the morphological elements of the effusion not only makes it possible to distinguish exudates from transudates, but at the same time sometimes makes it possible to draw conclusions regarding the etiology of the disease, accompanied by the accumulation of effusion in body cavities.

For microscopic examination, the sediment obtained by centrifugation is used. To remove fibrin clots, which greatly complicate the study, it is better to defibrinate the fluid. For this purpose, the effusion is placed in a thick-walled bottle with glass beads and shaken for 30-60 minutes. The liquid defibrinated in this way is poured into conical tubes and centrifuged until the test drop taken from the surface no longer contains formed elements. After draining the clear liquid, the precipitate is gently stirred with a glass rod. The resulting emulsion is used for the preparation of smears and fresh preparations.

Staining of fresh preparations is most often done with a 1% aqueous solution of methylene blue, one drop of which is mixed with a drop of the emulsion taken. After carefully stirring the mixture with a glass rod, cover it with a coverslip, remove the excess liquid that has protruded beyond the edge of the glass with filter paper, and immediately examine it. Under the microscope, it is easy to distinguish between large, loose endothelial cells, compact, with a characteristic nucleus, white blood cells, non-nuclear erythrocytes, cells of various neoplasms and a diverse microbial flora.

Fresh preparations are prepared only for research ex tempore; they quickly deteriorate, it is possible to preserve them only with the help of a special kind of preservative compositions.

Much more convenient in this regard are dry preparations, which are prepared by smearing a drop of emulsion on the surface of a glass slide.

After drying, the smear is fixed with methyl alcohol and stained according to Giemsa.

When evaluating the results obtained, it should be remembered that the reaction of the serous membranes to mechanical irritations (transudates) is expressed by abundant desquamation of the endothelium; serous membranes respond to pyogenic infections with neutrophilia, tuberculosis is characterized by lymphocytosis.

In effusions from heart and kidney diseases, therefore, a huge number of large endothelial cells are found, grouped into heaps of 5-10 cells. These clusters are sometimes so abundant that they completely cover the entire field of view. They are easily distinguished from leukocytes by their large, highly vacuolated, purple-colored nucleus, and the delicate pink protoplasm surrounding the nucleus in a thick layer. In addition to endothelial cells, a large number of erythrocytes, lymphocytes and individual neutrophils are found in transudates.

With serous pleurisy and peritonitis, caused by the action of pyogenic microbes, in the exudates there is an accumulation of a large number of segmented and stab neutrophils, as well as erythrocytes. Endothelial cells and lymphocytes are poorly represented.

With tuberculous pleurisy, the field of view is covered with a mass of small lymphocytes, among them there are individual cells of medium and large size. Red blood cells are sometimes mixed with them in large quantities. Neutrophils and eosinophils are poorly represented. According to Vidal, their number should not be more than 10% of the total mass of leukocytes.

In malignant neoplasms, cells of enormous size are found with highly vacuolated, often degenerated protoplasm and a large reniform or oval nucleus, in which several (2-3) nucleoli can be seen. This kind of cells are considered specific for malignant neoplasms.

Pleural effusion is an accumulation of pathological fluid in the pleural cavity during inflammatory processes in the adjacent organs or pleura, or when the ratio between the colloid osmotic pressure of the blood plasma and the hydrostatic pressure in the capillaries is disturbed.

Pleural fluid of inflammatory origin is an exudate. The fluid accumulated as a result of a violation of the ratio between the colloid osmotic pressure of the blood plasma and the hydrostatic pressure in the capillaries is a transudate.

After receiving the pleural fluid, it is necessary, depending on the color, transparency, relative density, biochemical and cytological composition, to determine whether the effusion is an exudate or a transudate.

Differential diagnostic differences between pleural exudate and transudate

Notes:

* biochemical inflammation syndrome - an increase in the content of seromucoid, fibrin, haptoglobin, sialic acids in the blood - non-specific indicators of the inflammatory process;

** Rivalta test - a test for determining the presence of protein in the pleural fluid: water in a glass cylinder is acidified with 2-3 drops of 80% acetic acid, then the studied pleural fluid is dripped into the resulting solution. If it is an exudate, then after each drop in the water a cloud stretches in the form of cigarette smoke, with transudate there is no trace.

After clarifying the nature of the effusion (exudate or transudate), it is advisable to take into account the most common causes of exudate and transudate, which to a certain extent facilitates the further differentiation of pleural effusions.

The nature of the exudate is determined not only by a variety of reasons, but also by the ratio of accumulation and resorption of the effusion, the duration of its existence:

• moderate effusion and its good resorption - fibrinous pleurisy;
• exudation exceeds the absorption of exudate - serous or serous-fibrinous pleurisy;
• infection of the exudate with pyogenic microflora - purulent pleurisy (pleural empyema);
• the rate of resorption exceeds the rate of exudation - the formation of adhesions during resorption;
• carcinomatosis, pleural mesothelioma, pulmonary infarction and trauma, pancreatitis, hemorrhagic diathesis, overdose of anticoagulants - hemorrhagic effusion;
• the predominance of allergic processes - eosinophilic exudate;
• traumatization of the thoracic duct with a tumor or tuberculous lesion - chylous exudate;
• chronic long-term course of exudative pleurisy, in particular, with tuberculosis - cholesterol effusion.

Causes of pleural effusion (S. L. Malanichev, G. M. Shilkin, 1998, as amended)

Notes:

* Syndrome of "yellow nails" - congenital hypoplasia of the lymphatic system: thickened and curved nails of yellow color, primary lymphatic edema, less often exudative pleurisy, bronchiectasis are characteristic.

** Meigs syndrome - pleurisy and ascites in ovarian carcinoma.

Tuberculous pleurisy

Tuberculosis is a common cause of exudative pleurisy. More often, tuberculous pleurisy develops against the background of any clinical form of pulmonary tuberculosis (disseminated, focal, infiltrative), bronchoadenitis or primary tuberculous complex. In rare cases, tuberculous exudative pleurisy may be the only and primary form of pulmonary tuberculosis. According to A. G. Khomenko (1996), there are three main variants of tuberculous pleurisy: allergic, perifocal and pleural tuberculosis.

allergic pleurisy

Is hyperergic. It is characterized by the following clinical features:

• acute onset with pain in the chest, high body temperature, rapid accumulation of exudate, severe shortness of breath;
• fast positive dynamics (exudate resolves within a month, rarely longer);
• hypersensitivity to tuberculin, which leads to a positive tuberculin test;
• eosinophilia in peripheral blood and a significant increase in ESR;
• the exudate is predominantly serous (in the early stages it can be serous-hemorrhagic), contains a large number of lymphocytes, sometimes eosinophils;
• a frequent combination with other manifestations caused by hyperergic reactivity - polyarthritis, erythema nodosum;
• absence of Mycobacterium tuberculosis in the pleural effusion.

Perifocal pleurisy

Inflammatory process in the pleural sheets in the presence of pulmonary tuberculosis - focal, infiltrative, cavernous. Perifocal pleurisy is especially easy to occur with a subpleural location of the pulmonary tuberculosis focus. Features of perifocal pleurisy are:

• long, often recurrent course of exudative pleurisy;
• the formation of a large number of pleural commissures (adhesions) in the resorption phase;
• serous nature of the exudate with a large number of lymphocytes and a high content of lysozyme;
• absence of mycobacteria in the exudate;
• the presence of one of the forms of tuberculosis of the lungs (focal, infiltrative, cavernous), which is diagnosed using an x-ray method of examination after a preliminary pleural puncture and evacuation of exudate;
• strongly positive tuberculin tests.

Tuberculosis of the pleura

Direct damage to the pleura by a tuberculous process may be the only manifestation of tuberculosis or be combined with other forms of pulmonary tuberculosis. Tuberculosis of the pleura is characterized by the appearance of multiple small foci on the pleural sheets, but there may be large foci with caseous necrosis. In addition, an exudative inflammatory reaction of the pleura develops with the accumulation of effusion in the pleural cavity.

Clinical features of pleural tuberculosis:

• prolonged course of the disease with persistent accumulation of effusion;
• exudate can be serous with a large number of lymphocytes and lysozyme (with the development of pleurisy due to seeding of the pleura and the formation of multiple foci) or neutrophils (with caseous necrosis of individual large foci). With a widespread caseous lesion of the pleura, the exudate becomes serous-purulent or purulent (with a very extensive lesion) with a large number of neutrophils;
• Mycobacterium tuberculosis is detected in the pleural effusion, both by microscopy and by culture of the exudate.

With widespread caseous necrosis of the pleura, the collapse of large tuberculous foci on the pleura and the blockade of the mechanisms of exudate resorption, purulent tuberculous pleurisy (tuberculous empyema) can develop. At the same time, a very pronounced intoxication syndrome dominates in the clinical picture: body temperature rises to 39 C and above; pronounced sweating appears (during night sweats are especially characteristic); patients lose weight. Characterized by shortness of breath, significant weakness, pain in the side, severe leukocytosis in the peripheral blood, increased ESR, often lymphopenia. Pleural puncture reveals purulent exudate.

Tuberculous empyema of the pleura may be complicated by the formation of a bronchopleural or thoracic fistula.

When making a diagnosis of tuberculous pleurisy, anamnesis data (presence of pulmonary tuberculosis or other localization in a patient or close relatives), detection of Mycobacterium tuberculosis in exudate, identification of extrapleural forms of tuberculosis, specific results of a pleural biopsy and thoracoscopy data are of great importance. Characteristic signs of tuberculosis of the pleura during thoracoscopy are millet tubercles on the parietal pleura, extensive areas of caseosis, a pronounced tendency to form pleural adhesions.

Parapneumonic exudative pleurisy

Bacterial pneumonia is complicated by exudative pleurisy in 40% of patients, viral and mycoplasmal - in 20% of cases. Streptococcal and staphylococcal pneumonias are especially often complicated by the development of exudative pleurisy.

The main characteristic features of parapneumonic exudative pleurisy are:

• acute onset with severe pain in the chest (before the appearance of effusion), high body temperature;
• the predominance of right-sided effusions;
• a significantly higher frequency of bilateral effusions compared with tuberculous exudative pleurisy;
• development of exudative pleurisy against the background of diagnosed pneumonia and radiographically determined pneumonic focus in the lung parenchyma;
• high frequency of purulent exudates with a large number of neutrophils, however, with early and adequate antibiotic therapy, the exudate may be predominantly lymphocytic. A number of patients may have hemorrhagic exudate, in isolated cases - eosinophilic or cholesterol effusion;
• significant leukocytosis in the peripheral blood and an increase in ESR more than 50 mm h (more often than with other etiologies of pleurisy);
• rapid onset of a positive effect under the influence of adequate antibiotic therapy;
• detection of the pathogen in the effusion (by sowing exudate on certain nutrient media), the mycoplasmal nature of exudative pleurisy is confirmed by an increase in blood titers of antibodies to mycoplasmal antigens.

Exudative pleurisy of fungal etiology

Pleural effusions of fungal etiology account for about 1% of all effusions. Fungal exudative pleurisy develops predominantly in individuals with a significant impairment of the immune system, as well as those receiving treatment with immunosuppressants, glucocorticoid drugs, and in patients with diabetes mellitus.

Exudative pleurisy is caused by the following types of fungi: aspergillus, blastomycetes, coccidoids, cryptococci, histoplasmas, actinomycetes.

Fungal exudative pleurisy along the course is similar to tuberculous. Usually, pleural effusion is combined with a fungal infection of the lung parenchyma in the form of focal pneumonia, infiltrative changes; abscesses and even decay cavities.

Pleural effusion with fungal exudative pleurisy is usually serous (serous-fibrinous) with a pronounced predominance of Lymphocytes and eosinophils. When a subcapsular abscess breaks into the pleural cavity, the effusion becomes purulent.

The diagnosis of fungal exudative pleurisy is verified by repeated detection of fungal micelles in the pleural fluid, in sputum, also by repeated isolation of the culture of fungi when sowing exudate, biopsy of the pleura, sputum, pus from fistulas. According to K. S. Tyukhtin, S. D. Poletaev from exudate culture of fungi with blastomycosis is isolated in 100% of patients, cryptococcosis - in 40-50%, coccidioidomycosis - in 20% of patients, and when sowing biopsy specimens of the pleura - in almost all cases.

In addition, serological methods for examining blood serum and exudate are of great importance in the diagnosis of fungal exudative pleurisy - high antibody titers in the complement fixation reaction, agglutination-precipitation with antigens of certain fungi. Antibodies can also be detected using immunofluorescence and radioimmunoassay methods. Positive skin tests with the introduction of allergens of the corresponding fungus may have a certain diagnostic value.

Aspergillus pleurisy

Aspergillus exudative pleurisy most often develops in patients with therapeutic artificial pneumothorax (especially in the case of bronchopleural fistula formation) and in patients who have undergone lung resection. The pleural fluid may contain brown lumps in which aspergillus is found. The presence of calcium oxalate crystals in the effusion is also characteristic.

The diagnosis is confirmed by the detection of aspergillus in a culture of pleural causticity when seeded on special media, the detection of antiaspergillus in the pleural effusion using a radioimmunoassay method.

Blastomycotic pleurisy

Blastomycotic exudative pleurisy in the clinical picture resembles tuberculous pleurisy. In the lung parenchyma, infiltrative changes are often observed. The exudate is dominated by lymphocytes. With the help of microscopic analysis, typical yeast fungi Blastomyces dermatitidis can be detected, culture of pleural fluid for blastomycosis is always positive. Biopsy specimens of the pleura revealed non-curdled granulomas.

coccidioid pleurisy

Exudative pleurisy in coccidioidosis in 50% of cases is accompanied by infiltrative changes in the lungs, erythema nodosum or multiforme, eosinophilia in the peripheral blood. The pleural effusion is an exudate, it contains many small lymphocytes and a high level of glucose is determined, effusion eosinophilia is not characteristic.

Pleural biopsy reveals caseous and non-caseating granulomas. Culture of pleural biopsy specimens for coccidiosis gives a positive result in 100% of cases, and culture of effusion in only 20% of cases. All patients tested positive for Coccidioides immitis. After 6 weeks from the onset of the disease, antibodies are detected in a titer of 1:32 using the complement fixation test.

Cryptococcosis pleurisy

Cryptococcus neotormans is ubiquitous and lives in the soil, especially if it is contaminated with pig excrement. Exudative pleurisy of cryptococcal genesis often develops in patients suffering from hemoblastoses, and it is usually unilateral. In most patients, along with pleural effusion, a lesion of the lung parenchyma is found in the form of interstitial infiltration or nodular formation. The pleural effusion is exudate and contains many small lymphocytes. In the pleural fluid and in the blood serum, high levels of cryptococcal antigens are found. Cryptococcosis genesis of pleurisy is confirmed by a positive culture of the pleural fluid and a biopsy of the pleura or lungs for cryptococci.

Histoplasmic pleurisy

Hystoplasma capsulatum is ubiquitous in the soil, rarely causing pleural effusion. Usually, exudative pleurisy caused by histoplasma has a subacute course, while changes in the lungs are detected in the form of infiltrates or subpleural nodes.

The pleural effusion is exudate and contains many lymphocytes. A biopsy of the pleura reveals a noncaseating granuloma. The diagnosis is verified by obtaining a histoplasma culture by sowing pleural fluid, sputum, pleural biopsy, as well as by bacterioscopy of biopsy material. There may be high titers of antibodies to histoplasmas in the blood of patients, which is determined by immunoelectrophoresis.

Actinomycotic pleurisy

Actinomycetes are anaerobic or microaerophilic gram-positive bacteria that normally live in the oral cavity. Infection with actinomycetes usually occurs from infected gums, carious teeth, tonsils of the patient himself. Actinomycosis is characterized by the formation of abscesses, the transition of the inflammatory process to the chest wall with the formation of pleurothoracic fistulas. Perhaps the formation of peripheral skin, subcutaneous and muscle abscesses.

A characteristic feature of the pleural exudate in actinomycosis is the presence of sulfur granules with a diameter of 1-2 mm - these are lumps of thin filaments of bacteria. The diagnosis of actinomycotic exudative pleurisy is established by identifying Actinomyces Israeli when sowing the pleural fluid on special media. It is also possible to stain smears of exudate by Gram and detect thin Gram-positive filaments with long branches, which is characteristic of actinomycosis.

Most often, exudative pleurisy is observed with amoebiasis, echinococcosis, paragonimiasis.

amoebic pleurisy

Amoebiasis is caused by Entamoeba histolytica. Amoebic exudative pleurisy occurs, as a rule, with a breakthrough into the pleural cavity through the diaphragm of an amoebic liver abscess. At the same time, there is a sharp pain in the right hypochondrium and the right half of the chest, shortness of breath, the body temperature rises significantly, which is accompanied by chills. The patient develops purulent pleurisy. The pleural effusion is exudate, has a characteristic "chocolate syrup" or "herring butter" appearance, and contains large numbers of neutrophilic leukocytes, hepatocytes, and small, hard, insoluble pieces of hepatic parenchyma. Amoebas are found in exudate in 10% of patients. With the help of immunoradiological methods, high titers of antibodies to amoeba can be detected. Ultrasound and computed tomography of the liver can diagnose a liver abscess.

Echinococcal pleurisy

Echinococcal exudative pleurisy develops when an echinococcal cyst of the liver, lung or spleen breaks into the pleural cavity. Very rarely, cysts develop primarily in the pleural cavity itself. At the time of the breakthrough, a very sharp pain appears in the corresponding half of the chest, severe shortness of breath, anaphylactic shock may develop in response to the intake of echinococcal antigens. When a festering echinococcal cyst breaks into the pleural cavity, a pleural empyema is formed.

Skin test with echinococcal antigen (Katsoni test) is positive in 75% of cases. Antibodies to echinococcal antigen in the blood are also detected using the complement fixation reaction (Weinberg test).

Paragonimous pleurisy

The development of exudative pleurisy is extremely characteristic of paragonimiasis. At the same time, focal and infiltrative changes in the lungs are detected in many patients. The characteristic features of paragonimous exudative pleurisy are:

• long course with the formation of pronounced pleural adhesions;
• low levels of glucose in the pleural exudate and a high level of lactate dehydrogenase and IgE, and the content of IgE is even higher than in the blood;
• severe eosinophilia of the pleural fluid;
• detection in the pleural fluid, in sputum, feces of eggs of the lung fluke, covered with a shell;
• positive skin test with lung fluke antigen;
• high titers of antibodies in the blood.

Endemic foci of infection are located in the Far East.

Pleurisy of tumor etiology

Among all pleural effusions, tumor effusions account for 15-20%. According to Light (1983), 75% of malignant pleural effusions are due to lung cancer, breast cancer, and lymphoma. In the first place among all tumors that cause the appearance of pleural effusion, is lung cancer. According to N. S. Tyukhtin and S. D. Poletaev (1989), lung cancer (usually central) is diagnosed in 72% of patients with tumor pleurisy.

The second most common cause of malignant exudative pleurisy is metastatic breast cancer, the third is malignant lymphoma, lymphogranulomatosis. In other cases, we are talking about pleural mesothelioma, ovarian and uterine cancer, cancer of various parts of the gastrointestinal tract and tumors of other localizations.

The main mechanisms for the formation of pleural effusion in malignant tumors are (Light, 1983):

• tumor metastases in the pleura and a significant increase in the permeability of its vessels;
• obstruction by metastases of the lymphatic vessels and a sharp decrease in the resorption of fluid from the pleural cavity;
• damage to the lymph nodes of the mediastinum and a decrease in the outflow of lymph from the pleura;
• obstruction of the thoracic lymphatic duct (development of chylothorax);
• the development of hypoproteinemia due to cancer intoxication and violations of the protein-forming function of the liver.

Pleural effusion of a tumor nature has quite characteristic features:

• gradual development of effusion and other clinical symptoms (weakness, anorexia, weight loss, shortness of breath, cough with sputum, often mixed with blood);
• detection of a sufficiently large amount of fluid in the pleural cavity and its rapid accumulation after the thoracentesis;
• detection using computed tomography or radiography (after preliminary removal of exudate from the pleural cavity) signs of bronchogenic cancer, enlarged mediastinal lymph nodes, metastatic lung disease;
• hemorrhagic nature of the effusion; with malignant lymphoma - chylothorax is often observed;
• compliance of the pleural effusion with all the criteria for exudate and very often low glucose (the lower the glucose level in the exudate, the worse the prognosis for the patient);
• detection of malignant cells in the pleural effusion; it is advisable to analyze several samples of pleural fluid to obtain more reliable results;
• detection of cancer-embryonic antigen in the pleural fluid.

In the absence of malignant cells in the pleural exudate and suspicion of a tumor process, thoracoscopy with pleural biopsy and subsequent histological examination should be performed.

Pleurisy in malignant mesothelioma

Malignant mesothelioma is formed from mesothelial cells lining the pleural cavity. Persons who work with asbestos for a long time are especially susceptible to the development of this tumor. The period between the development of a tumor and the time of the onset of contact with asbestos is from 20 to 40 years.

The age of patients varies from 40 to 70 years. The main clinical symptoms of malignant mesothelioma are:

• gradually increasing pain of a constant nature in the chest without a clear connection with respiratory movements;
• paroxysmal dry cough, constantly increasing shortness of breath, weight loss;
• pleural effusion is the most common and early onset sign of malignant mesothelioma;
• syndrome of compression of the superior vena cava by a growing tumor (swelling of the neck and face, dilation of veins in the neck and upper chest, shortness of breath); germination of the tumor in the pericardium and the walls of the cavities of the heart leads to the development of exudative pericarditis, heart failure, cardiac arrhythmias;
• characteristic data on computed tomography of the lungs - thickening of the pleura with an uneven knotted inner border, especially at the base of the lung, in some cases, tumor nodes in the lungs are determined;
• features of the pleural fluid: yellowish or serous-bloody color; has all the signs of exudate; decrease in glucose content and pH value; a high content of hyaluronic acid and the associated high viscosity of the liquid; a large number of lymphocytes and mesothelial cells in the exudate sediment; detection of malignant cells in multiple studies of exudate in 20-30% of patients.

For the final verification of the diagnosis, multiple biopsy of the parietal pleura, thoracoscopy with biopsy, and even diagnostic thoracotomy should be performed.

Pleurisy in Meigs' syndrome

Meigs syndrome is ascites and pleural effusion in malignant tumors of the pelvic organs (cancer of the ovary, uterus). With tumors of this localization, significant ascites develops due to peritoneal carcinomatosis and ascitic fluid seeps through the diaphragm into the pleural cavity. Most often, pleural effusion is observed on the right, but bilateral localization is also possible. Pleural effusion may also be due to tumor metastases in the pleura.

The pleural effusion in Meigs syndrome is an exudate, malignant cells can be found in it.

Pleurisy in systemic connective tissue diseases

Most often, exudative pleurisy develops with systemic lupus erythematosus. The defeat of the pleura in this disease is observed in 40-50% of patients. Exudative pleurisy is usually bilateral, serous exudate, contains a large number of lymphocytes, it contains lupus cells, antinuclear antibodies. A characteristic feature of exudative pleurisy in systemic lupus erythematosus is the high efficiency of glucocorticoid therapy. Pleural biopsy reveals chronic inflammation and fibrosis.

With rheumatism, exudative pleurisy is observed in 2-3% of patients, the effusion is a serous exudate, contains many lymphocytes. Usually, pleurisy develops against the background of other clinical manifestations of rheumatism, primarily rheumatic heart disease, and responds well to treatment with non-steroidal anti-inflammatory drugs. Puncture biopsy reveals a picture of chronic inflammation of the pleura and its fibrosis.

Exudative pleurisy in rheumatoid arthritis is characterized by a chronic relapsing course, serous lymphocytic exudate, contains rheumatoid factor in high titers (

Exudative pleurisy can also develop with other systemic connective tissue diseases - scleroderma, dermatomyositis. To make an etiological diagnosis of exudative pleurisy, diagnostic criteria for these diseases are used and other causes of pleural effusion are excluded.

Pleurisy in acute pancreatitis

Pleural effusion in acute pancreatitis or severe exacerbation of chronic pancreatitis is observed in 20-30% of cases. The pathogenesis of this effusion is the penetration of pancreatic enzymes into the pleural cavity through the lymphatic vessels through the diaphragm.

Pleural effusion corresponds to the signs of exudate, serous or serous-hemorrhagic, rich in neutrophils and contains a large amount of amylase (more than in blood serum). Pancreatogenic effusion is more often localized on the left and tends to be chronic.

Pleurisy with uremia

Exudative uremic pleurisy, as a rule, is combined with fibrinous or exudative pericarditis. The exudate is serous-fibrinous, sometimes hemorrhagic, contains few cells, usually monocytes. The level of creatinine in the pleural fluid is increased, but it is lower than in the blood.

medicinal pleurisy

Pleural effusion may occur during treatment with hydralazine, procainamide, isoniazid, chlorpromazine, phenytoin, and sometimes with bromocriptine. Long-term treatment with these drugs leads to the appearance of effusion. There is also usually drug-induced lung injury.

Pleural empyema

Pleural empyema (purulent pleurisy) - accumulation of pus in the pleural cavity. Pleural empyema can complicate the course of pneumonia (especially streptococcal), spontaneous pneumothorax of penetrating chest wounds, pulmonary tuberculosis, and can also develop due to the transition of a purulent process from neighboring organs (in particular, when a lung abscess ruptures)

Pleural empyema is characterized by the following clinical and laboratory features:

• there are intense chest pains and shortness of breath;
• body temperature rises to 39-40 ° C, tremendous chills and profuse sweating appear;
• there is swelling of the tissues of the chest on the side of the lesion;
• there are pronounced symptoms of intoxication, good pain, general weakness, anorexia, myalgia, arthralgia;
• analysis of peripheral blood is characterized by significant leukocytosis, a shift of the leukocyte formula to the left, a sharp increase in ESR, toxic granularity of neutrophils;
], [

Chylothorax

Chylothorax is a chylous pleural effusion, i.e. accumulation of lymph in the pleural cavity. The main causes of chylothorax are damage to the thoracic lymphatic duct (during operations on the esophagus, aorta and injuries), as well as blockade of the lymphatic system and mediastinal veins by a tumor (most often lymphosarcoma). The development of chylothorax is also extremely characteristic of lymphangioleiomyomatosis.

Often the cause of chylothorax cannot be determined. Such chylothorax is called idiopathic. According to Light (1983), idiopathic chylothorax in adults is most often the result of minor trauma to the thoracic lymphatic duct (coughing, hiccups) that occurs after ingestion of fatty foods. In rare cases, chylothorax develops with cirrhosis of the liver, heart failure.

Clinical manifestations of chylothorax fully correspond to the symptoms of pleural effusion: patients complain of progressive shortness of breath and heaviness in the region of the corresponding half of the chest. Characterized by an acute onset of the disease. Unlike pleural effusions of a different nature, chylothorax is usually not accompanied by chest pain and fever, since the lymph does not irritate the pleura.

An objective examination of the patient reveals signs of pleural effusion, which is confirmed by x-ray examination.

The diagnosis of chylothorax is verified by pleural puncture. Chylothorax is characterized by the following properties of the pleural fluid:

• color is milky white, the liquid is not transparent, cloudy, odorless;
• contains a large amount of neutral fat (triglycerides) and fatty acids, as well as chylomicrons. It is generally accepted that chylothorax is characterized by a triglyceride content of more than 10 mg%. If the level of triglycerides is less than 50 mg%, then the patient does not have chylothorax. If the triglyceride content is between 50 and 110 mg%, it is necessary to determine lipoproteins in the pleural fluid by polyacrylamide gel disc electrophoresis. If at the same time chylomicrons are found in the pleural fluid, then this is a chylothorax.

Chylothorax is also characterized by the determination of a large number of drops of neutral fat (triglycerides) during microscopy of smears of chylous fluid after staining with Sudan.

With prolonged existence of chylothorax, especially when a large amount of lymph accumulates in the pleural cavity, it is often necessary to perform pleural punctures due to compression of the lung and mediastinal displacement. This leads to the loss of a large amount of lymph and exhaustion of the patient. This is due to the fact that about 2500-2700 ml of fluid containing a large amount of protein, fats, electrolytes and lymphocytes flows daily through the thoracic lymphatic duct. Naturally, the frequent removal of lymph from the pleural cavity leads to a drop in the patient's body weight and a violation of the immunological status.

As a rule, in patients with pseudochylothorax, there is a thickening and often calcification of the pleura as a result of a long stay in the pleural cavity of the effusion. The lifespan of a pleural effusion can range from 3 to 5 years, sometimes even longer. It is assumed that cholesterol is formed in the pleural fluid as a result of degenerative changes in erythrocytes and leukocytes. Pathological changes in the pleura itself disrupt the transport of cholesterol, which leads to its accumulation in the pleural fluid.

The clinical picture of pseudochylothorax is characterized by the presence of the physical and radiographic symptoms of pleural effusion described above. The final diagnosis is established by pleural puncture and analysis of the resulting pleural fluid. It is necessary to conduct a differential diagnosis between chylous and pseudochylous effusion.

]

Pathological processes occurring in the body can lead to fluid accumulation. Its sampling and examination are of great importance at the stage of diagnosis. The goal here is to determine whether the extracted material is an exudate or a transudate. The results of this analysis allow us to identify the nature of the disease and choose the right treatment tactics.

Exudate- a liquid, the origin of which is associated with ongoing inflammatory processes.

transudate- an effusion formed for reasons unrelated to inflammation.

Comparison

Thus, by determining the type of liquid, important conclusions can be drawn. After all, if the punctate (material extracted from the body) is an exudate, then inflammation occurs. This process is accompanied, for example, by rheumatism or tuberculosis. Transudate also indicates a violation of blood circulation, problems with metabolism and other abnormalities. Inflammation is ruled out here. This fluid collects in cavities and tissues in, say, heart failure and certain liver diseases.

It must be said that the difference between exudate and transudate is not always present in appearance. Both can be transparent and have a yellowish tint. However, the exudate often has a different color, and is also cloudy. There are quite a few variations of this liquid. The serous variety is especially close in its characteristics to the transudate. Other samples are more specific. For example, purulent exudate is viscous and greenish, hemorrhagic - with a red tint due to the large number of red blood cells, chylous - contains fat and, when visually assessed, resembles milk.

When comparing the density of exudate and transudate, its lower parameters are noted in punctate of the second type. The main distinguishing criterion is the content of protein in fluids. As a rule, the exudate is very saturated with it, and the amount of this substance in the transudate is small. The Rivalta test helps to obtain information regarding the protein component. Drops of the test material are added to the container with the acetic composition. If, falling, they turn into a cloudy cloud, then there is an exudate. The biological fluid of the second type does not give such a reaction.

More detailed information on what is the difference between exudate and transudate is reflected in the table:

Prevention

Part X Exudate and transudate examination Exudate

Exudate

Exudate (exsudatum; lat. exsudare - go out, stand out) - a liquid rich in protein and containing blood cells; formed during inflammation. The process of moving exudate into the surrounding tissues and body cavities is called exudation, or sweating. The latter occurs after damage to cells and tissues in response to the release of mediators.

Serous, purulent, hemorrhagic, fibrinous exudate is distinguished depending on the quantitative content of the protein and the type of emigrant cells. There are also mixed forms of exudate: serous-fibrinous, serous-hemorrhagic. Serous exudate consists mainly of plasma and a small number of blood cells. Purulent exudate contains decomposed polymorphonuclear leukocytes, cells of the affected tissue and microorganisms. For hemorrhagic exudate, the presence of a significant admixture of erythrocytes is characteristic, and for fibrinous - a high content of fibrin. The exudate may be resorbed or organized.

transudate

Transudate (lat. trans - through, through + sudare - ooze, seep) - non-inflammatory effusion, edematous fluid that accumulates in body cavities and tissue crevices. The transudate is usually colorless or pale yellow, transparent, rarely cloudy due to the admixture of single cells of the deflated epithelium, lymphocytes, and fat. The content of proteins in the transudate usually does not exceed 3%; they are serum albumins and globulins. Unlike exudate, transudate lacks the enzymes characteristic of plasma. The relative density of the transudate is 1.006–1.012, and that of the exudate is 1.018–1.020.

Differential diagnosis of exudate and transudate

Sometimes the qualitative differences between the transudate and exudate disappear: the transudate becomes cloudy, the amount of protein in it increases to 4-5%). In such cases, the study of the whole complex of clinical, anatomical and bacteriological changes (the presence of pain in the patient, elevated body temperature, inflammatory hyperemia, hemorrhages, detection of microorganisms in the fluid) is important for the differentiation of fluids. To distinguish between transudate and exudate, the Rivalta test is used, based on the different protein content in them.

The formation of transudate is most often caused by heart failure, portal hypertension, lymph stagnation, vein thrombosis, and renal failure. The mechanism of occurrence of transudate is complex and is determined by a number of factors: increased hydrostatic blood pressure and reduced colloid osmotic pressure of its plasma, increased permeability of the capillary wall, retention of electrolytes in tissues, mainly sodium and water. The accumulation of transudate in the pericardial cavity is called hydropericardium, in the abdominal cavity - ascites, in the pleural cavity - hydrothorax, in the cavity of the testicular membranes - hydrocele, in the subcutaneous tissue - anasarca. Transudate is easily infected, turning into exudate. So, infection of ascites leads to the occurrence of peritonitis (ascites-peritonitis). With prolonged accumulation of edematous fluid in the tissues, dystrophy and atrophy of parenchymal cells, sclerosis develop. With a favorable course of the process, the transudate can resolve.

Ascites

Ascites is the accumulation of fluid in the abdominal cavity. A small amount of it may not give symptoms, but an increase in fluid leads to distension of the abdominal cavity and the appearance of discomfort, anorexia, nausea, heartburn, pain in the side, respiratory disorders.

Valuable information is provided by diagnostic paracentesis (50–100 ml); use a size 22 needle; perform a puncture along the white line 2 cm below the navel or with a displacement of the skin in the left or right lower quadrant of the abdomen. The usual examination includes examination, determination of the content of total protein, albumin, glucose in the fluid, the number of cellular elements, cytological examination, culture; sometimes amylase, LDH, triglycerides are examined, cultures are carried out for Mycobacterium tuberculosis. Rarely, laparoscopy or even exploratory laparotomy is required. Ascites in CHF (constrictive pericarditis) may require diagnostic right heart catheterization.

Table 24

Characteristics of the peritoneal fluid in ascites of various origins

transudate

Transudate (lat. (hapz - through, through + zibage - ooze, seep) - non-inflammatory effusion, edematous fluid that accumulates in body cavities and tissue crevices. Transudate is usually colorless or pale yellow, transparent, less often cloudy due to the admixture of single cells of the deflated epithelium, lymphocytes, fat.The content of proteins in the transudate usually does not exceed 3%; they are serum albumins and globulins.Unlike exudate, there are no enzymes characteristic of plasma in the transudate.

Differences between exudate and transudate

The relative density of the transudate is 1.006-1.012, and that of the exudate is 1.018-1.020. Sometimes the qualitative differences between the transudate and the exudate disappear: the transudate becomes cloudy, the amount of protein in it increases to 4-5%). In such cases, the study of the entire complex of clinical, anatomical and bacteriological changes (the presence of pain in the patient, elevated body temperature, inflammatory hyperemia, hemorrhages, detection of microorganisms in the fluid) is important for the differentiation of fluids. To distinguish between transudate and exudate, the Rivalta test is used, based on the different protein content in them.

The formation of transudate is most often caused by heart failure, portal hypertension, lymph stagnation, vein thrombosis, and renal failure. The mechanism of occurrence of transudate is complex and is determined by a number of factors: increased hydrostatic blood pressure and reduced colloid osmotic pressure of its plasma, increased permeability of the capillary wall, retention of electrolytes in tissues, mainly sodium and water. The accumulation of transudate in the pericardial cavity is called hydropericardium, in the abdominal cavity - ascites, in the pleural cavity - hydrothorax, in the cavity of the testicular membranes - hydrocele, in the subcutaneous tissue - anasarca. Transudate is easily infected, turning into exudate. So, infection of ascites leads to the occurrence of peritonitis (ascites-peritonitis). With prolonged accumulation of edematous fluid in the tissues, dystrophy and atrophy of parenchymal cells, sclerosis develop. With a favorable course of the process, the transudate can resolve.

Part X Exudate and transudate examination Exudate

Exudate ( exsis1a(um; lat exzibag- go outside, stand out) - a liquid rich in protein and containing blood cells; formed during inflammation. The process of moving exudate into the surrounding tissues and body cavities is called exudation, or sweating. The latter occurs after damage to cells and tissues in response to the release of mediators.

Serous, purulent, hemorrhagic, fibrinous exudate is distinguished depending on the quantitative content of the protein and the type of emigrant cells. There are also mixed forms of exudate: serous-fibrinous, serous-hemorrhagic. Serous exudate consists mainly of plasma and a small number of blood cells. Purulent exudate contains decomposed polymorphonuclear leukocytes, cells of the affected tissue and microorganisms. Hemorrhagic exudate is characterized by the presence of

a significant admixture of erythrocytes, and for fibrinous - a high content of fibrin. The exudate may be resorbed or organized.

Part I. Hematology. a common part

Clinical Study Digestive Disorders Let us first study the patient with a digestive disorder. Let's not forget that the main provocative reasons for this are cold and fear. In the digestive patient of the Aconite type we meet again

Clinical study Antimonium krudum in general is equally suitable for people of any age of life - both a child and an adult or an old man.

Ultrasound examination (ultrasound) This simple procedure has great advantages over the previous one, since it does not require the use of isotopes. Ultrasound can be done in young children and pregnant women. With this kind of research, you can

Comparative Research Music is a space of human experience that affects the mind, body and emotions. It can change the behavior of the listener or performer. Music penetrates the subconscious and can bring to life much of what is hidden there. She is

Practical part Chapter 9. Mula bandha as an integral part of yogic practice It is very important that a person practicing yoga perceives mula bandha in combination with other yogic practices. According to tradition, along with the mula bandha, the student masters the following aspects

Part I. Blood test

Part II. Urine Examination Not all waste products are removed from the body by the kidneys, but the kidneys are the organs of the only body system concerned primarily with the removal of waste materials. All other organs that also act as "waste cleaners" are in other

Part III. Examination of the contents of the stomach The gastrointestinal tract (GIT) is one of the body systems that provides mechanical and chemical processing of food. It consists of the proper digestive tube and accessory glands. Stomach, small intestine, part

Part V Examining Feces The colon (also called the large intestine) collects and removes waste that the body cannot digest (process). By the time food debris reaches the colon, the body has absorbed almost all of it.

Part VI. Study of hormonal status Our body has two ways of controlling tissues. The first is with the help of the nervous system, with its endless kilometers of neural pathways. The undoubted advantage of this method of control is the speed of action. This speed can

Part VII Examination of genital secretions Examination of genital secretions is a series of clinical tests that both women visiting a gynecological office and men visiting urologists have to do. These analyzes make it possible to determine

Part VIII. Sputum examination Sputum is secreted from the respiratory tract during coughing. When the patient collects material for analysis, he must remember this and not collect saliva or mucus from the nasopharynx instead of sputum. Composition, quantity, color, smell and consistency of sputum

Part IX. Examination of cerebrospinal fluid Cerebrospinal fluid is a liquid biological medium of the body circulating in the ventricles of the brain, subarachnoid space of the brain and spinal cord. Performs in the central nervous system

Part XI Examination of the bone marrow Red bone marrow in an adult is located in the epiphyses (terminals) of tubular bones and spongy substance of flat bones. Despite the disconnected position, functionally the bone marrow is connected into a single organ due to

There is far from one difference between transudate and exudate, although for an ignorant person both of these terms are incomprehensible. But a professional doctor must be able to distinguish one from the other, because these types of effusion fluid require a different approach. Let's try to talk about transudates and exudates in such a way that it is understandable even to a person without a medical education.

What are effusion fluids

Exudative fluids form and accumulate in the serous cavities, which include the pleural, abdominal, pericardial, epicardial, and synovial spaces. In these cavities, there is a serous fluid that ensures the normal functioning of the corresponding internal organs (lungs, abdominal organs, heart, joints) and prevents them from rubbing against the membranes.

Normally, these cavities should contain only serous fluid. But with the development of pathologies, effusions can also form. Cytologists and histologists are engaged in their research in detail, because a competent diagnosis of transudates and exudates allows prescribing the correct treatment and preventing complications.

transudate

From Latin trans - through, through; sudor - sweat. Effusion of non-inflammatory origin. It can accumulate due to problems with blood circulation and lymph circulation, water-salt metabolism, and also due to increased permeability of the vascular walls. The transudate contains less than 2% protein. These are albumins and globulins that do not react with colloidal proteins. In terms of characteristics and composition, the transudate is close to plasma. It is transparent or has a pale yellow hue, sometimes with cloudy impurities of epithelial cells and lymphocytes.

The occurrence of transudate is usually due to congestion. It can be thrombosis, renal or heart failure, hypertension. The mechanism of formation of this fluid is associated with an increase in internal blood pressure and a decrease in plasma pressure. If at the same time the permeability of the vascular walls is increased, then the transudate begins to be released into the tissues. Some diseases associated with the accumulation of transudates have special names: hydropericardium, abdominal ascites, ascites-peritonitis, hydrothorax.

By the way! With proper treatment, the transudate can resolve, and the disease will go away. If you start it, the extravasation will increase, and over time, the stagnant fluid can become infected and turn into exudate.

Exudate

From Latin exso - go outside sudor - sweat. Formed in small blood vessels as a result of inflammatory processes. The fluid exits through the vascular pores into the tissues, infecting them and contributing to the further development of inflammation. The exudate contains 3 to 8% protein. Also, it may contain blood cells (leukocytes, erythrocytes).

The formation and release of exudate from the vessels is due to the same factors (an increase in blood pressure, an increase in the permeability of the vascular walls), but inflammation in the tissues is additionally present. Because of this, the effusion fluid has a different composition and inflammatory nature, which is more dangerous for the patient. This is the main difference between transudate and exudate: the latter is more dangerous, so more time is devoted to its research.

Important! They try to get rid of the detected exudate as soon as possible. Otherwise, cancer cells may begin to form in it, causing an oncological disease of the organ in the cavity of which the exudate is located.

Exudate and its types

Different types of exudates differ from each other in their composition, the causes of inflammation and its features. It is possible to determine the type of exudative fluid using a puncture, after which the evacuated (pumped out) contents of a particular cavity are sent for laboratory research. Although the doctor can sometimes draw primary conclusions from the appearance of the liquid.

Serous exudate

In fact, a serous effusion is a transudate that has begun to be modified due to infection. Almost completely transparent; the protein content is moderate (up to 5%), there are few leukocytes, no erythrocytes. The name reflects the fact that such an exudate occurs in the serous membranes. It can form as a result of inflammation caused by allergies, infection, deep wounds or burns.

fibrinous exudate

It contains a large amount of fibrinogen - a colorless protein, the increased content of which indicates the presence of acute inflammatory or infectious diseases: influenza, diphtheria, myocardial infarction, pneumonia, cancer. Fibrinous exudate is found in the bronchi, gastrointestinal tract, and trachea. The danger of fibrinous deposits lies in the risk of their germination in the connective tissue and the formation of adhesions.

Purulent exudate

Or just pus. Contains dead or destroyed cells, enzymes, fibrin threads and other elements. Due to their decomposition, such an exudate has a pronounced bad odor and a pathological color for organic liquids: greenish, brownish, bluish. Purulent exudate is also distinguished by increased viscosity, which is due to the content of nucleic acids in it.

A type of pus is putrefactive exudate. It is formed as a result of inflammation caused by anaerobic (oxygen-free) bacteria. It has a more pronounced disgusting smell.

Hemorrhagic exudate

It has a pinkish hue, which is explained by the increased content of red blood cells in it. Hemorrhagic exudate often forms in the pleural cavity as a result of tuberculosis. Some of the fluid may be coughed up.

Other types of exudates (serous, fibrinous, purulent) can be modified into hemorrhagic with a progressive increase in vascular permeability or with their destruction. Other diseases reported by hemorrhagic exudate: smallpox, anthrax, toxic influenza.

Slimy

It contains a large amount of mucin and lysozyme, which provides it with a mucous structure. More often it is formed in inflammatory diseases of the nasopharynx (tonsillitis, pharyngitis, laryngitis).

Chylous exudate

Contains chyle (lymph), as evidenced by its milky color. If chylous exudate stagnates, a more oily layer with lymphocytes, leukocytes, and a small number of erythrocytes forms on its surface. Most often, such an inflammatory effusion is found in the abdominal cavity; less often - in the pleural.

There is also pseudochylous exudate, which is also formed by lymph, but the amount of fat in it is minimal. Occurs with kidney problems.

Cholesterol

Quite thick, with a beige, pinkish or dark brown (in the presence of a large number of erythrocytes) shade. It contains cholesterol crystals, from which it got its name. Cholesterol exudate may be present in any cavity for a long time and be discovered by chance during surgery.

Rare exudates

In exceptional cases, neutrophilic (consists of neutrophils), lymphocytic (from lymphocytes), mononuclear (from monocytes) and eosinophilic (from eosinophils) exudates are found in the cavities. Outwardly, they almost do not differ from those listed earlier, and their composition can be clarified only with the help of chemical analysis.

Laboratory studies of effusion fluids

The importance of determining the type and composition of effusion fluids is evidenced by the fact that their first laboratory studies began in the 19th century. In 1875, the German surgeon Heinrich Quincke pointed out the presence of tumor cells isolated from the fluids of serous cavities. With the development of chemical analysis and the advent of new research methods (in particular, staining of biological fluids), it has also become possible to determine the characteristics of cancer cells. In the USSR, clinical cytology began to develop actively since 1938.

Modern laboratory analysis is based on a specific algorithm. The nature of the effusion fluid is initially clarified: inflammatory or not. This is determined by the content of several indicators:

• protein (key indicator);
• albumins and globulins;
• cholesterol;
• the number of leukocytes;
• absolute amount of liquid (LDH), its density and pH.

A comprehensive study allows you to accurately distinguish exudate from transudate. If the inflammatory nature is determined, then a series of analyzes follows, allowing to determine the composition of the exudate and its appearance. Information enables the doctor to make a diagnosis and prescribe treatment.

If cytological analysis is not enough, then the exudative fluid is sent for histology. Such a study can reveal the presence of cancer cells in the inflammatory effusion (for example, mesothelioma in the pleura, angiosarcoma in the heart, etc.).