How to count the analysis of peritoneal fluid. What is peritoneal fluid. Indications for peritoneal dialysis

The Douglas space, or retrouterine space, is an anatomical space located in the back of the woman's small pelvis. It is located between the posterior wall of the uterus, the cervix, the vaginal posterior fornix and the anterior wall of the rectum. In physiological terms, the space of Douglas is said to be free, that is, it does not contain fluid or tissue.

The presence of traces of fluid in the retrouterine space may indicate ovulation, in which case there is no cause for concern. A larger volume of fluid can be visualized during transvaginal ultrasound. It is always necessary to determine the nature of the detected secret - bloody fluid, peritoneal fluid (ascites), pus, etc. For this purpose, a diagnostic puncture of the retrouterine space is often performed to obtain material for research and determine the probable cause of fluid accumulation.

The causes of the presence of fluid in the Douglas space, as a rule, are diseases of the genital organs, but not always. If fluid in the retrouterine space appears on certain days of the menstrual cycle, there is no cause for concern.

Sexually mature women and girls regularly - especially immediately after ovulation (just after half a cycle) - have a small amount of free fluid. However, if the presence of fluid is detected in the first phase of the cycle or at the end of the second, and in large quantities, then pathology of the uterine appendages or abdominal cavity can be suspected.

Fluid in the retrouterine space causes

The most common causes of fluid behind the uterus are diseases:

• rupture of an ovarian cyst;
• dropsy of the ovary;
• endometriosis;
• rupture of an ectopic pregnancy;
• adnexitis;
• ovarian cancer;
• peritonitis;
• enteritis;
• cirrhosis of the liver;
• ovarian hyperstimulation (after hormonal stimulation).

Depending on the nature of the fluid behind the uterus:

The presence of bloody fluid behind the uterus can result from:

• bleeding into the abdominal cavity from the pelvic organs,
• rupture of an ectopic pregnancy,
• ruptured ovarian cysts
• foci of peritoneal endometriosis.

A large amount of ascitic (peritoneal) fluid may be due to:

• female genital cancer (cancer of the ovary, fallopian tube, cervix),
• cirrhosis of the liver,
• circulatory failure.

The presence of purulent fluid may indicate:

• inflammation of the small pelvis (for example, appendages);
• or abdominal cavity (eg, peritonitis, inflammatory bowel disease).

Diseases in which there is free fluid in the space of Douglas

Rupture of an ovarian cyst

An ovarian cyst is an abnormal space inside the ovary surrounded by a wall. There are several types of ovarian cysts: simple, serous fluid-filled, dermoid cysts, and endometrial cysts (chocolate cysts that form during endometriosis). Sometimes a cyst can form at the site of an unruptured follicle around the time of ovulation - this type of cyst tends to spontaneously reabsorb. Unfortunately, it can also happen that a cyst in the ovary indicates the presence of cancer. Cysts may sometimes cause no symptoms and are discovered incidentally during a routine abdominal ultrasound. Sometimes, however, their presence can cause various ailments:

• menstrual irregularities,
• irregular bleeding not related to the menstrual cycle,
• abdominal pain,
• pain in the area of ​​the ovary where the cyst is located.

It happens that the cyst ruptures, then the woman feels severe pain, and during the abdominal ultrasound they find the presence of fluid in the retrouterine space. Treatment of cysts, if they do not give any symptoms, can only consist in their systematic observation. However, if cysts cause problems or enlarge, they need to be removed (either laparoscopically or conventionally, depending on the type of cyst).

Rupture of an ectopic (ectopic) pregnancy

When does an ectopic pregnancy occur? An ectopic pregnancy occurs when fertilized eggs implant in a different location than the body of the uterus. The frequency of ectopic pregnancy is estimated at about 1% of all pregnancies. The most common site of an ectopic pregnancy is the fallopian tube. In fact, the embryo can implant almost anywhere: in the cervix, ovary or abdomen. The most dangerous for the health and life of a woman is an abdominal or cervical pregnancy, but, fortunately, they occur very rarely.

What are the symptoms of an ectopic pregnancy? During an ectopic pregnancy, abnormal discharge and bleeding may occur, in addition, there are abdominal pains, sometimes difficulty with defecation. In a situation where an ectopic pregnancy ruptures, there is sharp pain in the abdomen, while an ultrasound will reveal fluid in the pouch of Douglas. The treatment of an ectopic pregnancy is always surgical.

Inflammation of the appendages

For adnexitis, the so-called ascending path is characteristic - vaginal microbes enter the higher organs of the female reproductive system. Until recently, the most common pathogen causing inflammation of the appendages was gonococcus. Currently, due to a significant decrease in the incidence of gonorrhea, the bacterium is no longer the most common organism. The following pathogens are also included in the etiological factors of adnexitis:

• chlamydia;
• mycoplasma genitalis and other mycoplasmas;
• coli;
• group B streptococci and other streptococci;
• Gardnerella gardnerella vaginalis.

Chlamydia and gonococci have the largest share in the formation of infection leading to inflammation of the appendages.

What are the symptoms of adnexitis? First of all, there may be pain in the lower abdomen, usually the pain is bilateral. In addition, dyspareunia (pain during intercourse) may be present, as well as abnormal discharge from the genital tract associated with inflammation of the cervix or vagina. There is abnormal bleeding - intermenstrual bleeding or very heavy menstrual bleeding and fever above 38 C. Ultrasound examination may reveal the presence of fluid behind the uterus. Treatment of inflammation of the appendages is the use of antibiotics and symptomatic therapy.

ovarian cancer

This cancer does not cause any symptoms for a long time, the presence of symptoms such as pain in the lower abdomen, enlargement of the abdominal cavity or vaginal bleeding, unfortunately, indicates the severity of the cancer.

Peritonitis

The presence of purulent fluid in the retrouterine space may indicate the presence of peritonitis and requires clarification of the diagnosis and examination of the gastrointestinal tract and urinary tract.

Symptoms of Fluid in Douglas Space

Symptoms depend on the cause of fluid accumulation. For example, in the event of a rupture of an ovarian cyst, pain in the abdominal cavity may appear, which periodically become sharp and cutting, nausea and vomiting, diarrhea, and loss of appetite. With the rupture of an ectopic pregnancy - spotting and bleeding from the vagina, pain in the lower abdomen, pain in the ovaries, and sometimes a feeling of incomplete emptying of the intestine.

With inflammation of the appendages, there is a sudden cramping pain on both sides of the abdomen, aggravated during intercourse. Sometimes it radiates to the groin and thighs. Accompanied by weakness, fever or febrile state.

Diagnostic puncture through the posterior fornix of the vagina

Puncture of the retrouterine space is a simple invasive method, especially useful for diagnosing bleeding in the abdominal cavity of the pelvic organs and for detecting a disturbed ectopic pregnancy. The procedure is performed under general anesthesia in a hospital setting. The puncture of the Douglas pocket is performed through the vagina using a 20 ml syringe and a needle with a length of min. 20 cm and 1.5 mm in diameter. After inserting a speculum, the gynecologist inserts a needle through the posterior fornix of the vagina, and then aspirates its contents into a syringe.

Sometimes the puncture is performed under ultrasound guidance to avoid the risk of puncturing large pelvic vessels. After the needle is removed, the contents of the syringe are carefully examined. The obtained material can also be transferred for cytological or bacteriological examination. Detection of fragments of clots or bloody fluid may indicate bleeding into the abdominal cavity due to a disturbed ectopic pregnancy. This condition, with the presence of clinical, laboratory and ultrasound symptoms, is an indication for surgery to remove a disturbed ectopic pregnancy, most often using the laparoscopic method.

The lack of content obtained by puncture of the retrouterine cavity does not exclude bleeding into the peritoneal cavity or the existence of an ectopic pregnancy, especially when symptoms indicate peritoneal irritation. Bleeding may be minimal or there may be post-inflammatory adhesions that prevent collection of material for examination. The presence of bloody fluid can also indicate endometriosis. The bloody contents of the Douglas cavity can become infected (superinfection), worsening the condition of a patient with endometriosis. Treatment includes aspiration of hemolyzed blood from the pouch of Douglas and laparoscopic removal of the endometriosis.

Cytological examination of the fluid

The detection of an increased amount of peritoneal fluid may be sufficient reason for maintaining oncological activity. Ascitic fluid collected at the time of puncture of the retrouterine cavity should be sent for cytological examination to confirm or exclude a tumor. Detection of the presence of cancer cells in the fluid from the abdominal cavity provides valuable information for the doctor, as it may indicate the appearance of a primary malignant neoplasm of the female genital organs.

In women who have previously had cancer and have undergone surgery, this symptom may indicate a recurrence of the cancer. As a rule, the presence of tumor cells in the peritoneal fluid is associated with a high prevalence of female genital cancer, which is an unfavorable prognostic factor in these patients. It should be noted that cytological examination of fluid from the peritoneal cavity is only an auxiliary method in detecting malignant tumors of the ovary, fallopian tube, and cervix.

Cytological examination of the fluid sediment can also reveal an increased number of inflammatory cells that appear with various inflammations of the pelvic organs. Finally, an increased amount of peritoneal fluid is the result of other diseases, such as cirrhosis of the liver or circulatory failure.

When should you see a doctor?

Patients should seek immediate medical attention if, in addition to increased fluid in Douglas's cavity, the following symptoms are present:

• abdominal pain,
• painful intercourse,
• bleeding from the genital tract, not associated with menstruation, contact bleeding,
• nausea, vomiting,
• a rapid increase in the circumference of the abdominal cavity,
• fever, chills,
• weight loss.

Treatment

Treatment depends on the cause of fluid in the retrouterine space. For example, if an ovarian cyst ruptures, surgery is usually needed to remove the cyst. If an ectopic pregnancy ruptures, it must be removed laparoscopically.

UDC 579.842.23+ 616-092.19

T.P. Starovoitova, T.A. Ivanova, G.B. Mukhturgin, S.A. Vityazeva, V.I. Dubrovina,

K.M. Korytov, S.V. Balakhonov

CHANGES IN THE CELLULAR COMPOSITION OF THE PERITONEAL FLUID OF WHITE MICE DURING THE INFECTIOUS PROCESS CAUSED BY YERSINIA PESTIS WITH DIFFERENT PLASMID COMPOSITION

Irkutsk Research Anti-Plague Institute of Siberia and the Far East (Irkutsk)

The article presents data on the effect of the plasmid composition of the plague microbe on the subpopulation composition of mononuclear cells in the peritoneal fluid of white mice in the early stages of the infectious process. It was shown that the change in the cellular composition of the peritoneal fluid of experimental animals depends on the plasmid profile of the plague microbe strains. During the experiment, phases were also revealed in the change in the quantitative composition of mast cells in the peritoneal fluid of white mice infected with Yersinia pestis strains with different plasmid spectrum. Keywords: Yersinia pestis, peritoneal fluid, virulence

CHANGES IN CELLULAR COMPONENTS OF PERITONEAL FLUID OF WHITE MICE WITH INFECTION CAUSED BY YERSINIA PESTIS WITH DIFFERENT PLASMID PROFILE

T.P. Starovoytova, T.A. Ivanova, G.B. Mukhturgin, S.A. Vityazeva, V.I. Dubrovina,

K.M. Korytov, S.V. Balakhonov

Irkutsk Antiplague Research Institute of Siberia and Far East, Irkutsk

The article presents the data on the influence of Yersinia pestis plasmid profile on subpopulation structure of mononuclear cells of peritoneal fluid of mice at the early stages of infectious process. It was shown that change of cellular composition of peritoneal fluid of the experimental animals depended on the plasmid profile of Yersinia pestis strains. The phase character in the changes of quantitative composition of the mast cells of peritoneal fluid of white mice infected with Y. pestis strains with different plasmid spectrum was determined. Key words: Yersinia pestis, peritoneal fluid, virulence

The vast majority of Yersinia pestis virulence factors are associated with plasmid composition. The genome of the plague pathogen of the main subspecies - Yersinia pestis subspecies pestis - has three plasmids - pYY(45MDa), pYP(6MN), and pYT(61MDa), their role in the implementation of the pathogenic properties of Yersinia has been well studied. With the presence of the pYV plasmid, Yersinia strains exhibit many phenotypic features: cell adhesion, auto-agglutination, surface agglutination, as well as the synthesis of outer membrane proteins, including V- and W-antigens and other proteins, the action of which is aimed at suppressing the phagocytic activity of immune cells. systems. Plasmids pYP and pYT are vidospecific. Plasmid pYP determines the synthesis of bacteriocin pesticin 1 and plasminogen activator, and plasmid pYT encodes two of the most well-studied virulence factors - mouse toxin and F1 capsule. A distinguishing feature of the pathogen circulating in the Tuva focus is the presence in its genome of an additional fourth plasmid pTR33 with functions that have not yet been elucidated. This plasmid is believed to be a genetically modified version of the 9.5 kD resident plasmid carrying the pla (plasminogen activator) and pstl (pesticin 1) genes. The loss of plasmid leads to a change in biochemical, cultural properties, as well as to a decrease or complete loss of the virulence of the pathogen.

The leading clinical sign of plague infection and intoxication, which determines the severity of the course

and the outcome of the disease is a violation of the homeostasis of the macroorganism. Primary targets for endotoxin are polymorphonuclear leukocytes, macrophages, monocytes, endothelial cells and other cellular elements. Changes in the cellular composition of the peritoneal fluid can be regarded as a diagnostic criterion for the severity of the disease in many diseases, including plague. In this regard, the assessment of the quantitative and qualitative cellular composition of the peritoneal fluid in white mice with an infectious process caused by Y. pestis with different plasmid composition is of great interest.

Purpose of work: to study the dynamics of changes in the subpopulation composition of mononuclear cells in the peritoneal fluid of white mice in the early stages of experimental plague infection.

MATERIALS AND METHODS

The experimental model in the experiments was 175 outbred, but standard in terms of keeping conditions and weight (18-20 g) white mice of both sexes. Animals were withdrawn from the experiment in accordance with the "Rules of Laboratory Practice in the Russian Federation" approved by the Order of the Ministry of Health of the Russian Federation No. 267 dated June 19, 2003, and the National Standard of the Russian Federation GOST R 53434-2009 "Principles of Good Laboratory Practice".

We used 6 strains of Y. pestis subsp. pestis and Y. pestis subsp. altaica from the collection of the Ir-

Table 1

Characteristics of the tested strains of the plague microbe

Strain Place of isolation Plasmid composition Virulence for white mice (RbO), m.c.

Y. pestis subsp. pestis I-2638 Tuva natural plague focus pYP+pYV+pTP33+pYT+ 10 / highly virulent

Y. pestis subsp. pestis I-3479 Irkutsk Anti-Plague Institute pYP+pYV-pTP33+pYT+ avirulent

Y. pestis subsp. pestis I-3480 Irkutsk Anti-Plague Institute pYP-pYV-pTP33+pYT+ avirulent

Y. pestis subsp. altaica I-2359 Gorno-Altai natural plague focus pYP+pYV+pYT+ 4 x 104/weakly virulent

Y. pestis subsp. altaica I-2948 Gorno-Altai natural plague focus pYP-pYV+pYT+ 3 x 108/residual virulence

Y. pestis subsp. altaica I-2948/3 Irkutsk Anti-Plague Institute pYP-pYV-pYT+ avirulent

Kutsk Research Anti-Plague Institute of Rospotrebnadzor (Table 1).

Intact white mice were divided into 6 experimental and 1 control groups of 25 mice each. Animals of the experimental groups were infected with Y. pestis at a concentration of 1 x 106 mc in a volume of 0.5 ml by the intraperitoneal method. The first experimental group of animals was injected with a two-day culture of Y. pestis subsp. grown at a temperature of 28 °C. pestis I-2638, group II - Y. pestis subsp. pestis I-3479, group III - Y. pestis subsp. pestis I-3480, IV experimental group of animals were infected with the reference Gorno-Altai strain of Y pestis subsp. altaica I-2359, group V - Y. pestis subsp. altaica I-2948, group VI - with a selection strain of Y. pestis subsp. altaica I-2948/3.

Material sampling from experimental animals (peritoneal fluid) was performed after 30, 60, 90, 120 and 180 minutes. The total number of nuclear cells in 1 ml of peritoneal fluid was counted in fixed preparations stained by standard methods. For bacteriological analysis, blood from the heart and peritoneal fluid (0.1 ml each) were inoculated on a solid nutrient medium (Hottinger agar, pH 7.2).

Survey microscopy methods were used in the work. Quantitative assessment of the total number of leukocytes was carried out using a unified method for counting cells in the Goryaev chamber. The percentage of different types of leukocytes was carried out by the method of morphological examination of peritoneal fluid in smears. In the study of drugs using the computer program "MoticImagesPlus" (version 2), a differentiated count of tissue basophils (TC) was carried out, their diameter and area were measured. The degree of MC activation was assessed by the cell degranulation index (IDTC) - the percentage ratio of degranulated mast basophils to their total number.

Automatic image analysis was performed using a Zeiss light microscope (Germany) with a Moticam 2000 video camera, resolution 1392 x 1040 pixels, approx. 10, vol. one hundred.

The significance of the results of the study was obtained by mathematical methods of statistical processing using a comparative analysis according to the Student's t-test and using the computer program Statistica, version 6.0 (StatSoft Inc. 19842001, IPHI 31415926535897) and the software package

Microsoft Office Excel (2003). The results were considered significant in relation to the control at p< 0,05.

RESULTS AND DISCUSSION

The total number of cells in the peritoneal fluid in intact animals is 4.3 ± 0.9 x 103 in 1 cm3, while macrophages are the predominant cell type and account for 60.5 ± 5.6% of the total 17.0±2.8%; 5.5 ± 0.8% are mesothelial cells and other cellular elements.

In infected white mice, phasicity is observed in the change in the total number of nuclear cells. In animals infected with a virulent strain of Y. pestis subsp. pestis I-2638, after 30 min the total number of nuclear cells increases sharply to 1.5 ± 0.4 x 104 in 1 cm3, which is 3.4 times higher than in intact animals. By 60 minutes of the study, the indicators decrease to intact values, continuing to decrease in subsequent periods. The cytological picture of the peritoneal fluid has a clear relationship with the infecting culture. In animals of group I, 30 minutes after infection, an increase in the number of lymphocytes was noted, exceeding the value in intact animals by 4 times due to a sharp decrease in the number of monocytes. These changes were detected in all periods of observation. In the peritoneal fluid of white mice infected with Y. pestis subsp. pestis I-2638, after 120 minutes from the beginning of the experiment, an increase in the number of segmented neutrophils by 2.5 times was registered, compared with the control (p< 0,05), и незначительное увеличение количества палочкоядерных нейтрофилов. На последнем сроке исследования в мазках перитонеальной жидкости выявляется большое количество фибробластов, агрегация лимфоцитов и большое количество делящихся клеток.

White mice infected with Y. pestis subsp. altaica I-2359, Y. pestis subsp. pestis I-3479 and Y. pestis subsp. altaica I-2948/3, 30 min after the start of the experiment, there were no statistically significant changes. By 180 min, the number of nuclear cells in the peritoneal exudate exceeds the control values ​​by 2.8 (p< 0,01), 1,9 (р < 0,05) и 1,5 раза соответственно. При введении животным Y. pestis subsp. pestis И-3480 и Y. pestis subsp. altaica И-2948 через 30 мин отмечается повышение общего числа ядерных клеток с последующим снижением (120 мин) до уровня контроля, и к 180 мин показатель вновь увеличивается.

When viewing smears of peritoneal fluid in animals of all experimental groups, cell proliferation of lymphocytes, histiocytes, an increase in eosinophils, tissue basophils, plasma cells, mesothelial cells and fibroblasts are recorded.

Evaluation of the morphological properties of basophils, their number and functional activity are of interest in the study of the cellular composition of the peritoneal fluid of infected animals.

It has been established that in experimental white mice there is a phase in the change in the quantitative composition of tissue basophils of the peritoneal fluid. An increase in their number in animals infected with Y. pestis subsp. pestis I-2638, is registered 60 minutes after the introduction of the culture, exceeding the values ​​in intact animals by 2.6 times (p< 0,05). Затем данные показатели снижаются (90-120 мин) до значений ин-тактных животных, к 180 мин вновь возрастают, достигая значений 8,5 против 2,5 в контроле (р < 0,05). Часть ТК представлены интестинальными - незрелыми формами (рис. 1), появление которых можно расценивать как процесс компенсации.

Rice. 1. White mouse infected with Y. pestis subsp. pestis I-2638. peritoneal fluid. intestinal mast cells. Coloring according to Romanovsky - Giemsa, SW. x 100.

In the first terms of the study, atypical MCs accounted for 21.0 ± 1.8% of the total number of MCs, by the last terms, these figures increased to 25.2 ± 2.1%. Atypical TCs have minimal functional potential and are much smaller. The cell diameter is 6.8-8.6 μm, which is on average 2.3 times less (p< 0,05), по сравнению с диаметром типичных ТК. Таких клеток значительно меньше в перитонеальной жидкости белых мышей, зараженных Y. pestis subsp. altaica И-2359, и только в период 120-180 мин после заражения отмечаются единичные интестинальные тканевые базофилы. У животных других опытных групп атипичные ТК не выявляются.

In general, the activation of the TC system reflects the general adaptive restructuring of the body in response to the introduction of an antigen. Degranulation of tissue basophils proceeds along the path of whole-granular exocytosis (Fig. 2). The functional activity of tissue basophils in the peritoneal fluid of experimental animals has a phase character. The highest IDTK is noted

in white mice 60 minutes after infection with Y. pestis subsp. pestis I-2638 - 3.9 ± 0.6, which is 18.5 times (p< 0,01) выше значения у интактных животных, затем показатель резко снижается, но к 180 мин исследований он вновь повышается, превышая значение в контрольной группе в 4,4 раза (р < 0,01). У селекционных клонов Y. pestis subsp. pestis И-3479 и И-3480 максимальное значение индекса дегрануляции имеет место через 90 мин от начала опыта и составляет 2,0 ± 0,3 и 1,3 ± 0,4 соответственно, при этом у белых мышей II опытной группы показатели во все сроки исследования были выше, чем у животных III опытной группы.

Rice. 2. White mouse infected with Y. pestis subsp. pestis I-2638. peritoneal fluid. Mast cells. Degranulation. Coloring according to Romanovsky - Giemsa, SW. x 100.

The most pronounced phase character of changes in tissue basophils is observed in white mice of the IV experimental group. The maximum value of IDTC falls on the second and fourth stages of the study, exceeding the values ​​of intact animals by 5.8 and 7.4 times (p< 0,05) соответственно. У особей, зараженных Y. pestis subsp. altaica И-2948/3, только на двух сроках исследования (60-90 мин) регистрируется увеличение дегрануляции тучных клеток в 3,6 и 2,6 раза соответственно (р < 0,05), в другие сроки данные статистически не значимы. У белых мышей V опытной группы максимальное значение ИДТК приходится на второй и последний срок исследования - 0,99 и 0,92 у. е., при в контроле отмечается 0,21 у. е.

CONCLUSION

Thus, the development of the infectious process in the first hours after inoculation of the plague pathogen depends on its plasmid profile, since the most pronounced changes in the quantitative and qualitative cellular composition of the peritoneal fluid were detected in experimental animals when infected with strains containing pYP+pYV+pYT+.

The phase pattern revealed during the experiment in the change in the quantitative composition of mast cells in the peritoneal fluid, especially in individuals infected with the virulent Y. pestis subsp. pestis I-2638 (pYP+pYV+pTP33+pYT+), as well as the presence of immature and atypical forms of MC, indicates the development of compensation processes.

In general, the activation of the mast cell system reflects the general adaptive restructuring of the body in response to the introduction of an antigen.

LITERATURE REFERENCES

1. Anisimov A.N. Ypestis factors that ensure circulation and preservation of the plague pathogen in ecosystems of natural foci. Message 1 // Molecular Genetics, Microbiol. and virusol. - 2002. - No. 3. - S. 3-23.

Anisimov A.N. Factors of Y. pestis providing circulation and preserving of plague infectious agent in the ecosystems of natural foci. Report I // Molekuljarnaja genetika, mikrobiol. i virusol. - 2002. - N 3. - P. 3-23. (in English)

2. Balakhonov S.V. Detection of the nucleotide sequences of the pla, pstl and cafl genes on the 33 kd cryptic plasmid of Yersiniapestis strains from the Tuva plague focus // 8th Int. Symp. on Yersinia. - Turku, Finland, 2002. - No. 10. - S. 352-355.

Balakhonov S.V. Detection of pla, pstl and cafl gene nucleotide sequences in cryptic plasmid 33 kb Yersinia pestis strains from Tuva plague focus // 8th Int. Symp. on Yersinia. - Turku, Finland, 2002. - N 10. - P. 352-355. (in English)

3. Vityazeva S.A., Starovoitova T.P., Bushkova A.V. Tissue basophils as representatives of a large cell population of the APUD system. - Dep. in VINITI No. 376-B2010 06/17/2010. - 18 s.

Vityazeva S.A., Starovoytova T.P., Bushkova A.V. Tissue basophiles as the representatives of numerous cell population of APUD-system. - Dep. in VINITI N 376-B2010 06/17/2010. - 18 p.m. (in English)

4. Krasnozhenov E.P., Fedorov Yu.V. Influence of the infectious process on the morphofunctional characteristics of tissue basophils // Zh. microbiol., epidemiol. and immunol. - 1996. - No. 1. - S. 107-108.

Krasnozhenov E.P., Fedorov Yu.V. Influence of infectious process on morphofunctional characteristics

of tissue basophiles // Zhurn. mikrobiol., jepidemiol. i immunol. - 1996. - N 1. - P. 107-108. (in English)

5. Lebedeva S.A., Trukhachev A.L., Ivanova V.S., Arutyunov Yu.I. et al. Variability of the plague pathogen and problems of its diagnosis / Ed. S.A. Lebedeva. - Rostov-on-Don: Antey, 2009. - 533 p.

Lebedeva S.A., Trukhachev A.L., Ivanova V.S., Arutyunov Yu.I. et al. Diversity of plague infectious agent and problems of its diagnostics / Ed. by S.A. Lebedeva. -Rostov-on-Don: Antei, 2009. - 533 p. (in English)

6. Menshikov V.V. et al. Laboratory research methods in the clinic. - M.: Medicine, 1987. - 365 p.

Menshikov V.V. et al. Laboratory methods of research in clinic. - Moscow: Medicina, 1987. - 365 p. (in English)

peritoneal fluid is a lubricating fluid (produced and absorbed by the peritoneum) found in the abdominal cavity. The abdomen is the space between the abdominal organs (such as the stomach, spleen, liver, and gallbladder) and the membrane that lines the abdominal wall.

Peritoneal fluid is a clear, sterile fluid composed primarily of water and small amounts of white blood cells, antibodies, electrolytes, and other biochemicals. The main function of peritoneal fluid is to reduce friction caused by the movement of the abdominal organs.

Reasons for analysis

In healthy people, the abdominal cavity contains a small amount of peritoneal fluid. But certain problems can lead to its excessive accumulation. This fluid, also called ascitic fluid, can lead to a condition called ascites. This is one of the complications caused by cirrhosis.

Some infections and microorganisms can also cause peritonitis, an inflammation of the peritoneal membrane.

In this case, culture of peritoneal fluid is performed. It is needed in order to diagnose the problem and begin treatment.

Culture of peritoneal fluid

This is a laboratory test in which a sample of fluid is taken from the abdominal cavity, which is then examined for microorganisms, bacteria and fungi that can cause infection.

Procedure

Some peritoneal fluid will be removed from the abdomen and sent to the laboratory for culture and gram staining. The sampling procedure is called .

Training

Before starting a laparocentesis, it is necessary to empty the bladder.

The puncture site will be cleaned with an antiseptic.

Anesthetize (using local anesthesia).

They will insert a needle (or a trakar with a canula, for which they may make a small incision) and remove a sample of fluid.

When extracting a large volume of fluid, the patient may feel slightly dizzy.

Risks associated with the procedure

There is a small risk that the needle will pierce the bladder, intestines, or blood vessel. This can lead to perforation and bleeding or infection of the intestine.

Ovarian and cervical cancer are the leading cancers leading to death in women. The insidiousness of these diseases is that they often do not manifest themselves in any way or have mild symptoms. Because of this, the tumor can grow to a serious size before it is detected. Cytological examination of the peritoneal fluid can be very helpful in detecting cancer cells or other genetic abnormalities of the ovaries and cervix at an early stage.

peritoneal fluid normally provides uniform lubrication of the surface of the abdominal organs and reduces friction between them. They are transparent and absolutely sterile - there are no bacteria in it. The amount is minimal - 5-20 ml. Consists of water, a minimum amount and trace elements.

Peritoneal fluid is formed during blood filtration and returns back to the same through the lymph. The balance of formation and reabsorption of peritoneal fluid keeps its constant amount in the abdominal cavity.

Various diseases lead to an increase in the volume of peritoneal fluid, in which case it is called ascitic.

Ascitic fluid - an indicator of pathology, the inability to maintain a balance between the formation and reabsorption of peritoneal fluid.

Peritoneal fluid is normal

• quantity - up to 50 ml
• color - from transparent to pale yellow
• and - normal values ​​depend on blood levels
• - the same level as in the blood
• cells - in a small amount

Analysis of ascitic fluid is

several types of studies aimed at diagnosing the causes of ascites - excessive accumulation of fluid in the abdominal cavity.

The procedure for taking ascitic fluid for analysis is called paracentesis.

Causes of ascites

• increased pressure in the vessels of the liver - cirrhosis of the liver, chronic heart failure
• inflammation of the peritoneum as a result of its damage - infection, tumors (stomach cancer, intestinal cancer, primary peritoneal cancer, lymphoma), pancreatitis, autoimmune diseases

The nature of the ascitic fluid will indicate the type of pathological process and help in choosing the best method of treatment.

Types of analyzes of peritoneal and ascitic fluid

• external assessment of ascitic fluid - quantity, color, smell
• biochemical analysis - LDH, total protein, albumin gradient calculation, glucose,
• sediment microscopy - to detect abnormal tumor cells
• sediment staining by the Gram method - allows you to see bacteria in a microscope
• bakposev on nutrient media with the determination of sensitivity to antibiotics

Types of ascitic fluid

• transudate
• exudate

transudate

transudate appears with increased pressure in the vessels of the liver and seepage of fluid into the space of the peritoneum, as well as a low level of albumin protein in the blood, which normally retains water inside the vessels.

Transudate occurs in chronic heart failure, nephrotic syndrome, cirrhosis of the liver.

Transudate properties

• ascitic fluid is clear or slightly straw-coloured
• total protein less than 3g/dl
• albumin - reduced, gradient over 1.1 g/dl
• LDH gradient blood/ascitic fluid - less than 0.6
• glucose - equal to the level in the blood
• sediment microscopy - a small number of lymphocytes
• specific gravity - less than 1.015

Exudate

Exudative ascitic fluid- the result of damage to the peritoneum by bacteria, malignant neoplasms, enzymes (for example, the pancreas), rupture of the abdominal organs (gall bladder with cholelithiasis or pancreatic cysts).

Properties

• color - from yellow to greenish
• total protein in ascitic fluid more than 3 g/dl
• albumin elevated, gradient less than 1.1 g/dl
• LDH gradient over 0.6
• glucose - below 3.3 mmol / l
• increased number of leukocytes, mainly in the sediment
• specific gravity - 1.015

Peritoneal fluid in normal and diseased conditions

External parameters

• normal peritoneal fluid is clear, slightly yellowish in color
• yellow color - with liver pathology with elevated levels of bilirubin
• milky color - blockage of the lymphatic vessels
• greenish - the presence of bile, which directly indicates a rupture of the bile ducts
• when blood enters, ascitic fluid becomes red, which happens with trauma and tumors
• turbidity - when bacteria multiply in the abdominal cavity

Biochemical analysis of ascitic fluid

• Normally, glucose in ascitic fluid is equal to the level in the blood
• amylase is examined only if inflammation of the pancreas (parcteratitis) is suspected
• tumor markers - to determine the type and possible primary localization of the tumor
• LDH - an indicator of cell decay

Sediment microscopy

Microscopy of the sediment of ascitic fluid is done if an infection or neoplasm is suspected. Under normal conditions, the sediment is extremely scarce, single leukocytes (mainly lymphocytes) are found in it, and there are no bacteria.

• neutrophils (a subspecies of leukocytes) are increased with bacterial lesions of the peritoneum, and lymphocytes - with peritoneal tuberculosis
• abnormal cells (irregular in shape, large size and atypical coloration) occur when the tumor spreads through the peritoneum

Tests for infections

• Gram stain - the precipitate is applied to a glass slide and stained according to the Gram, which allows the detection of bacteria and fungi
• bakposev on nutrient media with the cultivation of culture for several days and the determination of its sensitivity to antibiotics
• adenosine deaminase - protein, significantly increased in peritoneal tuberculosis

Analysis of peritoneal and ascitic fluid - the norm and changes in diseases was last modified: December 6th, 2017 by Maria Bodyan

The accumulation of free fluid in the abdominal cavity occurs as a result of an inflammatory reaction, a violation of the outflow of lymph and blood circulation due to various reasons. A similar condition is called ascites (dropsy), its appearance can lead to the development of serious consequences for human health.

The fluid accumulated in the peritoneum is an ideal habitat for pathogenic microflora, which is the causative agent of peritonitis, hepatorenal syndrome, umbilical hernia, hepatic encephalopathy and other equally dangerous pathologies.

To diagnose ascites, one of the safest and most non-invasive, but highly accurate methods is used - a study using ultrasound waves. Detection of the presence of fluid in the abdominal cavity by ultrasound is carried out as prescribed by the attending physician on the basis of existing clinical signs of the pathological process.

The abdominal cavity is a separate anatomical zone, which constantly releases moisture to improve the sliding of the visceral sheets of the peritoneum. Normally, this effusion is able to be dynamically absorbed and not accumulate in areas convenient for it. In our article, we want to provide information about the causes of abnormal fluid reserve, the diagnosis of a pathological condition on ultrasound, and effective methods for its treatment.

Why does free fluid accumulate in the abdominal cavity?

Ascites develops as a result of various kinds of pathological processes in the pelvic organs. The initially accumulated transudate is not inflammatory in nature, its amount can range from 30 ml to 10-12 liters. The most common causes of its development are a violation of the secretion of proteins that provide impermeability to tissues and pathways that conduct lymph and circulating blood.

This condition can be provoked by congenital anomalies or development in the body:

• cirrhosis of the liver;
• chronic heart or kidney failure;
• portal hypertension;
• protein starvation;
• lymphostasis;
• tuberculous or malignant lesions of the peritoneum;
• diabetes;
• systemic lupus erythematosus.

Often, dropsy develops during the formation of tumor-like formations in the mammary glands, ovaries, digestive organs, serous membranes of the pleura and peritoneum. In addition, free fluid can accumulate against the background of complications of the postoperative period, pseudomyxoma of the peritoneum (an accumulation of mucus that undergoes reorganization over time), amyloid dystrophy (disturbances in protein metabolism), and hypothyroid coma (myxedema).

The mechanism for the formation of dropsy is leakage into the abdominal cavity of fluid from the main lymphatic ducts, blood vessels and organ tissues.

Signs of ascites

In the early stages of the development of this condition, patients do not have any complaints, the accumulation of free fluid can only be detected using ultrasound. Visible symptoms appear when the amount of transudate exceeds one and a half liters, a person feels:

• an increase in the abdominal part of the abdomen and body weight;
• deterioration in general well-being;
• feeling of fullness in the abdominal cavity;
• swelling of the lower extremities and scrotum tissues (in men);
• belching
• heartburn;
• nausea;
• difficulty breathing;
• flatulence;
• tachycardia;
• protrusion of the umbilical node;
• discomfort and pain in the abdomen;
• stool and urinary disorders.

When a large amount of effusion accumulates in the peritoneum, a person can hear a characteristic splash of fluid and feel a wave.

If an ultrasound examination of the abdominal cavity showed the presence of excess moisture, the attending physician needs to accurately establish the root cause of the pathological condition. Pumping out accumulated transudate is not an effective treatment for ascites.

Preparation for ultrasound and its course

This study does not have any contraindications or restrictions; in emergency cases, it is carried out without prior preparation of the patient. A planned procedure requires improved visualization of pathological changes in organs. The patient is recommended to exclude foods containing a large amount of fiber and increasing gas formation from the diet 3 days before the study.

On the eve of the study, drink a laxative or make a cleansing enema. To reduce the accumulation of gases in the intestines on the day of the ultrasound, you need to take Mezim or activated charcoal. Modern methods of ultrasound diagnostics make it possible to determine the most probable areas of accumulation of free fluid in the abdominal cavity.

That is why qualified specialists examine the following anatomical zones:

• The upper "floor" of the peritoneum, which is located under the diaphragm. Of particular diagnostic importance are the spaces located under the liver and formed by the main section of the small intestine - the ascending and descending parts of the colon. Normally, the so-called lateral channels do not exist - the covers of the peritoneum fit snugly against the intestine.
• The small pelvis, in which, with the development of pathological processes, effusion can accumulate, flowing from the lateral canals.

The physical features of the moisture accumulated in the peritoneum for any reason do not allow the ultrasonic wave to be reflected, this phenomenon makes the diagnostic procedure as informative as possible. The presence of effusion in the studied anatomical spaces creates a dark moving focus on the monitor of the apparatus. In the absence of free fluid, diagnostics last no more than 5 minutes.

To detect excess moisture, the probe of the ultrasound device is moved along the anterior and middle axillary lines on both sides of the patient's body from top to bottom of the abdomen.

If it is not possible to detect a transudate, indirect signs may indicate its presence:

• displacement of the colon loops;
• change in sound during percussion (tapping) - tympanic in the upper parts of the peritoneum, blunt in the lower.

Types of abdominal dropsy on ultrasound

The international classification of diseases does not single out ascites as a separate disease - this condition is a complication of the last stages of other pathological processes. According to the brightness of clinical symptoms, the following forms of ascites are distinguished:

• initial - the amount of water accumulated inside the abdomen reaches 1.5 liters;
• with a moderate amount of liquid- manifested by swelling of the legs, a noticeable increase in the size of the chest, shortness of breath, heartburn, constipation, a feeling of heaviness in the abdomen;
• massive (the volume of effusion is more than five liters) - a dangerous condition characterized by tension in the walls of the abdominal cavity, the development of insufficiency in the function of the cardiac and respiratory systems, and infection of the transudate.

In bacteriological evaluation of the quality of the free fluid, which is produced under special laboratory conditions, a distinction is made between sterile (absence of pathogenic microorganisms) and infected (presence of pathogenic microbes) dropsy.

According to diagnostic predictions, there is ascites, which is amenable to drug therapy, and a stable pathological condition (its recurrence or not amenable to treatment).

What is done after confirmation of the pathology by ultrasound?

The course of therapeutic measures depends on what disease caused the accumulation of excess moisture in the peritoneum. To accurately diagnose the pathological process, practitioners conduct a comprehensive examination of the patient, including:

• biochemical and general clinical blood and urine tests;
• study of oncological markers and indicators of electrolyte metabolism;
• survey radiography of the chest and abdominal cavities;
• coagulogram - evaluation of the parameters of the coagulation system;
• angiography of blood vessels, which allows to assess their condition;
• MRI or CT scan of the abdomen;
• hepatoscintigraphy - a modern technique for examining the liver using a gamma camera, which allows visualizing the organ;
• diagnostic laparoscopy with therapeutic puncture of ascitic fluid.

To pump out the transudate from the abdominal cavity, the method of therapeutic laparocentesis is used - a puncture is made in the anterior wall of the abdomen, through which excess fluid is removed

In patients with cirrhosis of the liver, an intrahepatic portosystemic shunt is recommended, the technique of which is to place a metal mesh stent, to create an artificial connection between the collar and hepatic veins. In severe cases, an organ transplant is necessary.

In conclusion of the above information, I would like to emphasize once again that the accumulation of free fluid in the abdominal cavity is considered an unfavorable manifestation of the complicated course of the underlying disease. The development of ascites can provoke a violation of the functional activity of the heart and spleen, internal bleeding, peritonitis, cerebral edema.

The mortality rate of patients with a massive form of abdominal dropsy reaches 50%. Measures that prevent the occurrence of this pathological condition are the timely treatment of infectious and inflammatory processes, proper nutrition, refusal to drink alcohol, moderate exercise, preventive examinations of medical specialists and the exact implementation of their recommendations.