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งานนำเสนอกำลังจะดาวน์โหลด โปรดรอ

Biological fluids Ramida Amornsitthiwat, M.D. 1. Biological fluids Cerebrospinal fluid Amniotic fluid Seminal fluid Saliva Human milk 2.

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งานนำเสนอเรื่อง: "Biological fluids Ramida Amornsitthiwat, M.D. 1. Biological fluids Cerebrospinal fluid Amniotic fluid Seminal fluid Saliva Human milk 2."— ใบสำเนางานนำเสนอ:

1 Biological fluids Ramida Amornsitthiwat, M.D. 1

2 Biological fluids Cerebrospinal fluid Amniotic fluid Seminal fluid Saliva Human milk 2

3 brain and spinal cord total volume : mL daily production : mL (20 mL/hr) synthesis : 70% choroid plexus (active transport & ultrafiltration) : 30% ependymal cells subarachnoid space, ventricular system (space between arachnoid & pia mater) Cerebrospinal fluid (CSF) 3

4 lateral ventricles (choroid plexus) foramen of Monro third ventricle cerebral aqueduct fourth ventricle foramen of Luschka & Magendi basal cisterns & subarachnoid space reabsorption at venous sinus via arachnoid granulations CSF circulation 4

5 physical support of brain protection of brain chemical stability removes waste products of cerebral metabolism CSF functions 5

6 physiologic barrier (circulating blood & CSF) - endothelial cell of brain capillaries (tight junction, no intercellular pores) - end-feet of astrocytes (astroglia) Infiltration - fat-soluble drugs (e.g. anesthetic & alcohol) - glucose, urea & creatinine - penicillin & streptomycin - proteins Blood brain barrier (BBB) 6

7 Examination of CSF Lumbar puncture (LP) 7

8 Indications 1.diagnostic- CNS infection eg. meningitis, encephalitis - hemorrhage - malignancy - demyelinating disease 2.treatment- spinal anesthesia - antibiotics - chemotherapy 3.follow up 8 Examination of CSF Lumbar puncture (LP)

9 Contraindications 1.local infection at lumbar puncture site 2.intracranial mass lesion (brain herniation) -large brain abscess -brain tumor -subdural hematoma -intracranial hemorrhage 3.thrombocytopenia 9 Examination of CSF Lumbar puncture (LP)

10 Complications 1.headache : CSF leakage 2. cerebellar or tentorial herniation :increase intracranial pressure 3. paralysis 4. meningitis 5. accidental puncture of the spinal cord 10 Examination of CSF Lumbar puncture (LP)

11 CSF analysis pressure gross appearance microscopic examination chemical analysis 11

12 1.Pressure: 70 – 180 mmH 2 O Increase intracranial pressure 1. brain edema e.g.cerebral ischemia, meningitis, encephalitis 2. increase CSF volume e.g. hydrocephalus 3. bleeding e.g. intracerebral hemorrhage or subarachnoid hemorrhage 4. mass lesion e.g. brain tumor, brain abscess CSF analysis 12

13 normal hydrocephalus 13 Increased CSF volume 1.increased CSF production 2. obstruction of CSF circulation 3. decreased CSF reabsorption

14 2. Gross appearance: clear / colourless Abnormal findings cloudy, turbidmeningitis WBC > /mm 3 bloodytraumatic tap subarachnoid hemorrhage intracranial hemorrhage xanthochromiasubarachnoid hemorrhage (SAH) CSF analysis 14

15 SAHtraumatic tap Supernatant (หลังปั่น) xanthochromia (≥2 hr) ใส WBC< 1:1000~ 1:1000 (peripheral blood) three-tube testสีแดงคงเดิมสีจางลง ตามลำดับ Bloody CSF 15 red cells lysis oxyhemoglobin (pink) bilirubin (yellow) onset : 2-4 hrs หลังจากเกิด SAH

16 สาเหตุอื่นๆ 1. jaundice - free and conjugated bilirubin in CSF -total plasma bilirubin > 4-6 mg/dL 2. dietary hypercarotenemia 3. CSF protein > 150 mg/dL 4. drug e.g. rifampicin Xanthochromia 16

17 3. microscopic examination WBC 0-5 cells/mm 3 Abnormal findings - leukocytes - neutrophils in bacterial meningitis - lymphocytes in viral meningitis - tumor cells - bacteria, fungi, yeast CSF analysis 17

18 Protein mg/dL - high protein ( > 65 mg/dL) - permeability of BBB eg. meningitis - traumatic tap, SAH - obstruction of CSF - CNS IgG synthesis - low protein : no significance Chemical analysis of CSF 18

19 Glucose - plasma glucose  CSF (active transport & diffusion) - high glucose : hyperglycemia - low glucose (<40 mg/dL or 40% serum glucose) * meningitis – bacterial, TB, fungal * hypoglycemia, SAH, neurosyphilis * CNS leukemia & lymphoma causes 1. abnormal transportation of glucose 2. increased glycolytic activity 3. glucose comsumption of leukocytes and microorganisms Chemical analysis of CSF mg/dL (60-70% or 2/3 of serum glucose)

20 Chemical analysis of CSF Lactate - anaerobic metabolism mg/dL CNS hypoxia CSF lactate - meningitis - cerebral infarction - hypotension - brain injury bacterial meningitis > viral meningitis 20

21 LDH (lactate dehydrogenase) - meningitis, leukemia, cerebral ischemia ammonia & glutamine - hepatic encephalopathy - ammonia : toxic to CNS - ammonia + glutamate glutamine IgG - multiple sclerosis, neurosyphylis Tumour markers 1. carcinoembryonic antigen (CEA) 2.  -fetoprotein (AFP) 3. human chorionic gonadotropin (hCG) Chemical analysis of CSF 21

22 Meningitis causes - bacteria -virus -tuberculous -parasite -fungal e.g.Cryptococcus 22 Brudzinski’s sign Kernig’s sign

23 tuberculous Meningitis tuberculous (L)50-400clear viral bacterial Cryptococcal (E>10%)N /- turbideosinophilic cells glucose (mg/dL) protein (mg/dL) macroscopymeningitis (L>P) clear 23

24 Amniotic fluid 24 : cushioning the fetus : fetal movement : promoting muscular/skeletal development : controlling temperature : diagnostic tool for health & maturity of fetus

25 Amniotic fluid early pregnancy- amniotic membrane late pregnancy- fetal urine (16+ wk.) - fetal respiratory tract - desquamated fetal cell Absorbed via fetal swallowing and amniotic membrane maximal volume 1000 mL at gestational age weeks (term pregnancy = weeks) 25

26 1. volume 1.1 oligohydramnios - < 400 mL - renal agenesis, abnormality of urinary tract 1.2 polyhydramnios - > 2000 ml - acute : fetal heart failure, hydrops fetalis - chronic : anencephaly, esophageal atresia 2. color blood, meconium, dark red-brown Abnormalities of amniotic fluid 26

27 colorcondition เหลืองใส (หรือขุ่นเล็กน้อย)normal เหลืองมากHDN* เขียว : meconium stain (ขี้เทา)fetal hypoxia แดงคล้ำfetal death *HDN : hemolytic disease of the newborn (erythroblastosis fetalis) Gross examination of amniotic fluid 27

28 (prenatal diagnosis) Amniocentesis 1. Transabdominal 2. Transcervical 3. Cul de sac Trauma3. infection 2. Hemorrhage4. amniotic fluid leakage  abortion 0.5-1%  preterm labour Complication of amniocentesis

29 cytologic & DNA studies - chromosomal disorders - sex biochemical analysis - alpha 1-fetoprotein (AFP) - phospholipids - bilirubin Amniotic fluid analysis 29

30 30 Amniotic fluid analysis

31 Indications for chromosome study 1.มารดาอายุ > 35 ปี เมื่อถึงวันครบกำหนดคลอด 2. มารดาและ/หรือบิดามีภาวะโครโมโซมผิดปกติ 3. มีบุตรที่มีภาวะโครโมโซมผิดปกติในครรภ์ก่อน 4. มีบุตรพิการแต่กำเนิดโดยไม่ทราบสาเหตุ 5. มีบุตรเสียชีวิตในครรภ์โดยไม่ทราบสาเหตุ 6. บิดามารดาเป็นพาหะของโรคถ่ายทอดทางกรรมพันธุ์แบบลักษณะด้อย 31

32 α 1- fetoprotein (AFP) yolk sac and fetal liver - high level : neural tube defects - low level : Down syndrome - can be detected in maternal serum Amniotic fluid analysis 32

33 - amphipathic molecule - form micelle & lipid bilayer - lecithin (dipalmitoylphosphatidylcholine - DPPC) - phosphatidylglycerol (PG), sphingomyelin (S) Phospholipids Amniotic fluid analysis lung surfactant

34 surfactant decreases surface tension pulmonary compliance alveolar collapse Respiratory distress syndrome (RDS) Roles of Lung surfactant 34 Fetal lung maturity - L/S ratio -phosphatidylglycerol -foam stability or shake test L/S < 1.5 immature L/S intermediate L/S ≥ 2 lung maturity

35 Shake test (foam stability test) Amniotic fluid + 95% ethanol shake 30 sec ดูฟอง ตั้งทิ้งไว้ 15 sec Qualitative test lung surfactant  foam stability 35

36 36

37 ลูกคนแรก Rh +ve เลือดมารดา Rh -ve ลูกคนที่ 2 Rh +ve Ag sensitized : ตรวจพบ Rh Ab ในเลือดมารดา Rh Ab ของแม่ผ่านรกมาทำปฏิกิริยากับ Rh +ve ในเลือดของลูก RBC hemolysis bilirubin (scan spectrophotometer ที่ 450 nm) Isoimmunization : fetal-maternal blood incompatibility (hemolytic disease of the newborn) 37 Amniotic fluid analysis

38 a suspension of spermatozoa in the seminal plasma Semen, Seminal fluid 38

39 Semen testis5%spermatozoa seminal vesicle60%สารน้ำเหนียว, pH กลาง-ด่าง, มี fructose ซึ่งเป็นแหล่งพลังงาน ของ sperm prostate gland20%คล้ายน้ำนม, pH เป็นกรดอ่อน (~6.5) ผลิต acid phosphatase & proteolytic enzyme (coagulation & liquefaction) epididymis, vas deferens, bulbourethral gland 10-15%สร้าง protein ที่จำเป็นสำหรับ การเคลื่อนที่ของ sperm 39

40 - gross examination - microscopic examination Indications 1.ประเมินภาวะมีบุตรยาก (infertility) 2.ประเมินผลของการทำหมันชาย (vasectomy) 3.ประเมินผลประกอบคดีทางนิติเวช (forensic medicine) Semen analysis 40

41 volume : 2-5 mL coagulation process - fibrin-liked precursor (seminal vesicle) - clotting enzyme (prostate) liquefaction process - proteolytic enzyme (prostate) Gross examination of semen 41

42 sperm count normal million/mL oligospermia < 20 million/mL azoospermia : no spermatozoa motility motile spermatozoa % sperm morphology normal morphology % Microscopic examination of semen 42

43 การประเมินผลของการทำหมันชาย - หลังทำหมัน 6 เดือน ไม่ควรตรวจพบ sperm การตรวจอสุจิประกอบคดีทางนิติเวช 1. sperm cytology - 7 วัน หลังร่วมเพศ 2. acid phosphatase activity - prostate gland - 3 วัน หลังร่วมเพศ - high sensitivity Analysis of semen 43

44 44 Saliva Production mL/day -salivary gland parotid : serous sublingual : mucous > serous submandibular : serous > mucous - autonomic nervous system -physiological/pathological condition Composition -inorganic compounds : hypotonic fluid -organic compounds: uric acid -protein compounds: amylase,IgA -hormones: catecholamines

45 Biochemical laboratory analysis of saliva 1.viral and bacterial infections - genome and antibodies detection 2. cancer e.g. c-erb-2 soluble fragment 3. pharmaceutical and drug abuse 4. hormones - cortisol 5. DNA test - biomarker profiling or forensic identification 6. sialochemistry analysis - heavy metal

46 46 Mumps -contagious disease : virus -children age 2-12 years -respiratory secretions, saliva -fever, headache, painful and swollen parotid gland at the face, neck and jaw -complications : orchitis : meningitis : encephalitis

47 47 Human milk Stage of lactation 1. colostrum (first few days) - immunologic compound (secretory immunoglobulin A) 2. transitional milk (5 days-2 weeks) - rumped up milk 3. fully mature milk (4-6 weeks)

48 48 Human milk Composition 1.Nutrition component macronutrient - protein : casien, Haptocorrin (transcobalamin II), α-lactalbumin, whey - fat : palmatic acid and oleic acid - lactose micronutrient - vitamin : low vitamin K

49 49 bioactive factors - bile-salt stimulated lipase - epidermal growth factor - growth factors 2. Bioactive component 3. Immunologic factors anti-infective factors -secretory immunoglobulin A (sIgA) -white blood cells -whey proteins (lysozyme and lactoferrin) -oligosacccharides

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ดาวน์โหลด ppt Biological fluids Ramida Amornsitthiwat, M.D. 1. Biological fluids Cerebrospinal fluid Amniotic fluid Seminal fluid Saliva Human milk 2.

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