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