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PATHOPHYSIOLOGY OF

BODY FLUIDS

Mansyur Arif, MD, PhD


Dept. of Clinical Pathology
Faculty of Medicine - Hasanuddin University
URINE
 Normal Adult  ±1200 ml/min of blood perfuses the
kidney (25% of CO).
 Blood  afferent arterioles  ultrafiltrate on Glomeruli
 Bowman’s space  tubules  reabsorption or
secretion and concentration on collecting ducts.
 Original glomerular filtrate vol. = 180 L in 24hrs
reduced 1-2L, depending on status of hydration.
 Urine formed in the kidney passes from collecting
ducts  renal pelvis  ureters  bladder  urethra
 voided.
 Through glomerular filtration and tubular secretion,
numerous waste products are eliminates from
body, including :
– Nitrogenous products
– Organic acids and bases
– Inorganic acids and bases.
 The kidney provide important hormonal regulation
with erythropoietein and renin prod., as well as
vitamin D activation.
 Derangement of renal function  chemically or
cytologically alteres urine.
Cerebrospinal Fluid (CSF)
 In adults, ±500ml of CSF produced each day (0.3-
0.4 mL/min).
 Total vol. = 90-150mL  25mL in ventricles and
the remainder in subaracnoid space (SAS).
 Total CSF vol. replaced every 5-7hrs.
 70% of CSF derived by ultrafiltration and secretion
through the choroid plexuses.
 Ventricular ependymal lining and cerebral SAS
account for the remainder.
 CSF leaves the ventricular syst. Through medial and lateral
foramina, flowing over the brain and spinal cord surface
within SAS.
 Arachnoid villi  CSF resorption, along the superior
sagittal sinus.
 Blood-brain barrier (BBB) derived from dye-exclusion
studies.
 Consists of 2 morphologically distinct comp. :
– A unique capillary endothelium held together by intercellular
tight junctions
– The choroid plexus, a single layer of specialized choroidal
ependyma cells connected by tight junctions overlies
fenestrated capillaries.
 CSF Major functions :
– Provides physical support
– Confers a protective effect against sudden
changes in acute venous and arterial blood
pressure
– Provides an excretory waste function
– Pathway whereby hypothalamus releasing factors
are transported to the cells of median eminence
– Maintains central nervous system ionic
homeostasis.
 CSF ionic components (e.g. H+, K+, Ca2+, Mg2+ ,
bicarbonate, etc)  tightly regulated by specific
transport systems, whereas glucose, urea, and
creatinine diffuse freely but require 2 or more
hours to equilibrate.
 Proteins cross by passive diffusion at a rete
proportional to their molecular weight and
hydrodinamic vol.
 BBB maintains the relative homeostasis of the
central nervous systems environment during acute
perturbations of plasma comp.
SYNOVIAL FLUID (SF)
 Synovium  tissue lining synovial tendon sheaths,
bursae, and disarthrodial joints except articular
surface.
 Composed 1-3 cell layers  form
discontinuous surface overlying fatty, fibrous,
or periosteal joint tissue.

 SF is an imperfect ultrafiltrate of blood


plasma combined with hyaluronic acid
produced by synovial cells.
 Small ions and molecules readily pass into the
joint space and similar concentration to plasma.

 Resorption by lymphatics and is not size


dependent.

 SF acts as a lubricant and adhesive, and provide


nutrients for the avascular articular cartilage.
PLEURAL FLUID
 The pleural cavity is a potential space lined by
mesothelium of the visceral and parietal pleura.

 The pleural cavity normally contains a small


amount of fluid that facilitates movement of 2
membranes against each other.

 This fluid is a plasma filtrate derived from capillary


of the parietal pleura.
 It’s produced continuously at a rate dependent on
capillary hydrostatic pressure, plasma oncotic
pressure, and capillary permeability.
 Pleural fluid is reabsorbed through the lymphatics
and venules of visceral pleura.
 An accumulation of fluid  effusion  imbalance
of fluid production and reabsorption.
 This fluid accumulation in the pleural, pericardial,
and peritoneal cavities known as serous effusion.
PERICARDIAL FLUID
 From 10-50 mL of fluid is normally present in the
pericardial space, produced by transudative
process ≈ pleural fluid.
 Pericardial effusions are most often caused by
viral infection, enterovirus being the most
common.
 They may also develop as a result of bacterial,
tuberculous or fungal infections, autoimmune
disorders, renal failure, myocardial infarctions,
mediastinal injury, the effects of various drug or
idiopathic.
PERITONEAL FLUID
 Ascites is the pathologic accumulation of
excess fluid in the peritoneal cavity.
 Up to 50 mL of fluid is normally present in
the mesothelial-lined space.
 As with pericardial and pleural fluids, it’s
produced as an ultrafiltrate of plasma
dependent on vascular permeability, and
hydrostatic and oncotic starling forces.