SYNOVIAL FLUIDAND

FECAL ANALYSIS

ABARCA KRIZZA KAY LYKAPUEBLO, JOHN ALFREY D.

PINTON, BETHSONGCUYA, ANN MARI

GROUP5

PHYSIOLOGY

Joint Fluid

UABF By;Strasinger et.,al.

UABF By;Strasinger et.,al.

Ultrafiltrate of plasma Similar concentration of

plasma Nutrition for vascular –

deficient cartilage Hyaluronic acid

SYNOVIAL FLUID

UABF By;Strasinger et.,al.

Damage of the articular membrane

UABF By;Strasinger et.,al.

UABF By;Strasinger et.,al.

UABF By;Strasinger et.,al.

LABORATORY TEST

UABF By;Strasinger et.,al.

UABF By;Strasinger et.,al.

SPECIMEN COLLECTION

AND HANDLING

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.

COLORLESS TO PALE YELLOW

UABF By;Strasinger et.,al.

COLOR AND CLARITY

MUCIN CLOT TEST

2% - 5% ACETIC ACID

REPORTING VISCOSITYGood SOLID CLOTFair Soft clotLow Friable clotPoor No clot

UABF By;Strasinger et.,al.

VISCOSITY

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.

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.

Synovial Cells-no pathologic significance

Lipid bodies- trauma,and RA

Henry’s 22nd ed.

CELLS AND INCLUSIONS SEEN IN SF

CRYSTAL IDENTIFICATION

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

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

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

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

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

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

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

Chemistry Test/ Chemical Analysis

Glucose

Protein

Lactate dehydrogenase

Uric acid

Sources: Henry’s 22nd edition

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

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.

FECAL ANALYSIS

PHYSIOLOGY

DIARRHEA

Secretory diarrhea

Osmotic diarrhea

Altered motility

Steatorrhea

COMMON FECAL TEST FOR DIARRHEA

SPECIMEN COLLECTIONMacroscopic Screening

Color

Appearance

Microscopic Examination of Feces

Leukocytes associated with microbial diarrhea

Muscle fiber Fats associated with

steatorrhea

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

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

Neutral Fat Stain Procedure

Split Fat Stain Procedure

Acid Steatocrit Procedure

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

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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