Topic: Examination of body fluids, Synovial fluid, Gastric analysis, Sputum examination Faculty: Pathology Course: MLT 1st year, ATOT, RDT

1. Examination of Body Fluids
Dr. Salman Ansari(MBBS)
Tutor, Dept. of Pathology
Kanachur Institute of Medical Sciences

2. Examination of body fluids
● Body fluids - Definition, specimen collection, different types of
examination
● Synovial fluid
● Gastric analysis
● Sputum examination

3. Body fluids - definition
Definition: “Lubricating fluids present within the body
cavities”
They include:
● Pleural - lungs
● Peritoneal - abdomen
● Pericardial - heart
● Synovial - joints
Increase in the volume of fluids in these cavities - called “effusion”

5. How to collect the specimen of body fluid?
Clean dry container, under aseptic conditions and atraumatically
to avoid mixing with blood
Test tubes used:
- For chemical examination: fluoride tube
- Microscopic examination: EDTA tube
- Bacteriological examination: plain tube(no anticoagulant)

7. Examination of body fluids
Physical examination
Chemical examination
Microbiological examination
Microscopic examination

8. 1. Physical examination
● Volume
● Colour: usually clear or straw-yellow
- Blood-stained: malignancy
- Turbid/cloudy: due to high cell count or high
protein content
- Chylous: milky appearance - due to high lipid
content due to lymphatic obstruction

9. ● Whether the fluid is transudate or exudate
Transudate: non-inflammatory, seen in heart
failure, nephrotic syndrome
Exudate: inflammatory - in
infection/malignancy

10. 2. Chemical examination
● Protein estimation
Helps to differentiate transudate(low protein) from
exudate(high protein)
● Glucose estimation
Low glucose suggests bacterial infection,
malignancy
● Amylase levels in ascitic fluid
Useful in patients with pancreatic lesions

11. 3. Microscopic examination
● Differential count:
using Neubauer’s chamber and staining
with Leishman’s stain or Gram’s stain
● Cytological examination
Smear examination

12. 4. Microbiological examination
Culture to identify the organism in case of effusion due to
infections

13. Synovial fluid examination

15. Uses
To diagnose joint disorders, like:
● Infective arthritis(septic arthritis, rheumatic)
● Gouty arthritis
● Rheumatoid arthritis
● Degenerative arthritis

16. Sample collection
By needle aspiration from the joint - called arthrocentesis

17. Examination of synovial fluid
Physical examination
Chemical examination
Microbiological examination
Microscopic examination

18. 1. Physical examination
Appearance Condition
Normal Clear, straw coloured,
viscous, does not clot
Turbid Infection, inflammation,
crystals
Purulent Septic arthritis
Red/brown Hemarthrosis, “traumatic
tap”

20. (...cont.)Physical examination
Viscosity test:
● “String test”
● Viscosity is due to hyaluronic acid
● Decreases in inflammatory joint disorders

22. (...cont.)Physical examination
Mucin clot test:
● If normal synovial fluid is mixed with 20 ml of 5% acetic
acid, it forms a firm clot
● But when hyaluronic acid concentration is low, it fails to
form a good clot
● Poorly formed clot is seen in inflammatory disorders of
joint(like tuberculous arthritis)

24. 2. Chemical examination
● Glucose estimation:
- Usually 0-10% lower than serum glucose levels
- Reduced in inflammatory conditions
● Protein estimation:
- Usually lower than plasma concentration
- Increased in: rheumatoid arthritis, septic arthritis

25. 3. Microscopic examination
● DLC:
Neutrophils more than 70% → bacterial infection
More lymphocytes and macrophages → osteoarthritis
● Wet smear examination:
Smear is prepared and examined with reduced light under
low power objective and then high power objective
- Urate crystals - seen in gouty arthritis
- Rhomboid calcium pyrophosphate crystals
- Cholesterol crystals in rheumatoid arthritis

27. Cholesterol crystals

28. 4. Microbiological examination
Synovial fluid culture - in suspected cases of
pyogenic/tubercular arthritis

29. Gastric analysis

30. Gastric analysis
- Lab tests to measure gastric secretions and serum
gastrin

31. When to do gastric analysis?
Indications:
- To investigate recurrent peptic ulcer disease
- To detect Zollinger-Ellison syndrome
- To find out the cause of raised fasting serum
gastrin levels
- To differentiate between benign and malignant
ulcer

32. Zollinger-Ellison syndrome or Gastrinoma

33. When to NOT do gastric analysis?
Contraindications:
- Esophageal stricture/varices
- Recent history of severe gastric bleed
- Hypertension
- malignancy

34. Collection of sample
- Patient should be fasting overnight - no eating or
drinking after midnight
- Withhold any drugs which affect gastric acid
secretion(such as antacids, H2 blockers)
- Collected using oral or nasogastric tube

35. Gastric analysis
Tests for gastric acid secretions
Test for intrinsic factor
Cytological examination for
malignant cells
Test for gastrin

37. 1. Gastric acid secretion tests
3 things are measured:
BAO(Basal Acid output): amount of HCl
secreted without any stimulation
MAO(Maximum Acid output): amount secreted
after stimulation - patient injected with a drug to
stimulate gastric acid secretion - e.g:
pentagastrin(peptavlon), histalog(betazole)
PAO(Peak Acid Output)

38. For BAO:
- sample collected every 15 minutes for 1 hour - total of 4
samples
For MAO:
- patient given an injection of pentagastrin s.c/i.m and then
sample collected every 15 minutes for 1 hour - total of 4
samples
PAO:
- calculated from 2 consecutive samples showing the highest
acid secretion

40. Interpretation
High values seen in:
● Duodenal ulcer
● Zollinger-Ellison
syndrome(gastrinoma)
● Anastomotic ulcer
Low values(achlorhydria) in:
● Atrophic
gastritis(pernicious
anemia)
● Malignant ulcer of
stomach

41. 2. Test for intrinsic factor
● IF is needed for absorption of Vit. B12 from small intestine
● Schilling test: to detect pernicious anemia

42. 3. Tests for gastrin
Serum gastrin levels: by radioimmunoassay
High levels seen in: atrophic gastritis, ZE
syndrome
Gastrin provocation test
Done for diagnosing gastrinoma

43. 4. Cytological examination for malignant cells
● By brushing, lavage, aspirate or biopsy material through
endoscopy
● Smear is prepared and stained and examined for
malignant cells

44. Sputum examination

45. Sputum examination
Sputum: highly specialised watery, colourless and odorless product of
the respiratory tract
- Saliva + mucus(of airways) = sputum

46. Sample collection
Sputum collection:
- Early morning sputum sample:
best
- First rinse mouth with water for 10-
15 seconds
- Coughing into a wide mouthed,
sterile glass/plastic container with
screw cap
- If unable to get sample by
coughing, nebulisation to promote
sputum production

47. - For TB: 3 samples on 3 consecutive days

48. Sputum examination
Physical examination
Microscopic examination
Microbiological(Culture
study)

49. Physical examination
Quantity
Appearance
Colour

50. 1. Physical examination
Quantity:
● Increased and purulent: in bronchiectasis
● Increased and watery, pinkish colour: in pulmonary oedema
Appearance:
● Normally clear
Odour:
Foul smelling - in bronchiectasis, lung abscess

51. Different colours of sputum and their causes
White, viscid, mucoid Asthma
Serous, pinkish, watery Pulmonary oedema
Clear/ gray, sticky Chronic bronchitis
Yellow(pus) Lower respiratory tract infection
Green Long standing infection(Bronchiectasis, lung
abscess)
Rusty Pneumonia
Bright red Pulmonary TB, lung tumours
Black(coal dust) Coal workers pneumoconiosis, heavy smokers
Anchovy sauce(chocolate brown) Rupture of amoebic liver abscess into lung
Blood tinged sputum Lung tumours, TB

52. 2. Microscopic examination
● “Sputum smear microscopy”
● Procedure: 2-3 smears are prepared on glass slide and stained
with Leishman stain
● Other stains like: - Gram’s stain for microorganisms
- Ziehl-Neelson stain for acid fast tubercle
bacilli
- Special stains for fungi
- Papanicolaou stain for malignant cells

53. Cells:
Normal sputum consists of few neutrophils, lymphocytes, red
cells rarely

54. Cells seen in sputum and their significance
Pus cells(neutrophils) Pyogenic infection of respiratory
tract
Eosinophils Asthma, parasitic infection of lungs
Lymphocytes Early pulmonary tuberculosis
RBCs Hemorrhage into lungs
Heart failure cells(macrophages
containing hemosiderin)
CVC(chronic venous congestion)
lung
Anthracotic pigment-laden cells Coal workers’ pneumoconiosis,
smoky areas

55. 3. Culture study
To identify causative organism

56. For notes,
scan:
References:
● Ramadas Nayak - Textbook of Pathology for
Allied Health Sciences
Questions:
salman.s.ansari92@gmail.com
For PPT, scan: