Changes

==Description==

==Introduction==

Modified transudates are a type of effusion whose cell count and protein content are intermediate between a [[Transudate|transudate]] and an [[Exudate|exudate]].  In some cases, modified transudates may represent a transitional stage before the development of an exudate (as with uroabdomen, which begins as a modified transudate but develops into a chemical exudative peritonitis over time).  Modified transudates arise as a result of disruptions to the endothelium or imbalances in the '''Starling forces'''.  Common causes include:

Modified transudates are a type of effusion whose cell count and protein content are intermediate between a [[Transudate|transudate]] and an [[Exudate|exudate]].  In some cases, modified transudates may represent a transitional stage before the development of an exudate (as with uroabdomen, which begins as a modified transudate but develops into a chemical exudative peritonitis over time).  Modified transudates arise as a result of disruptions to the endothelium or imbalances in the [[Blood Pressure Physiology#Capillary Fluid Shift Mechanism |'''Starling forces''']].  Common causes include:

*'''Increased vascular hydrostatic pressure''' resulting from inappropriate activation of the renin-angiotensin-aldosterone system (RAAS) in '''portal hypertension''' or '''congestive heart failure'''.

*'''Increased vascular hydrostatic pressure''' resulting from inappropriate activation of the renin-angiotensin-aldosterone system (RAAS) in '''portal hypertension''' or '''congestive heart failure'''.

*'''Vasculitis''', caused by '''[[Feline Infectious Paritonitis|feline infectious peritonitis virus]]''' (FIPV) or '''neoplasia'''.  For further discussion of the effusion encountered with FIP, see [[Feline Infectious Peritonitis|here]].

*'''Vasculitis''', caused by '''[[Feline Infectious Peritonitis|feline infectious peritonitis virus]]''' (FIPV) or '''neoplasia'''.  ([[Feline Infectious Peritonitis|Further discussion of the effusion encountered with FIP.]])

*'''Strangulation of abdominal or thoracic organs''' may lead to the production of a modified transudate (which will develop into an exudate if untreated).  This may occur with '''lung lobe torsion''', '''torsion of the spleen''' or of a liver lobe or if part of the liver becomes strangulated within a [[Diaphragmatic Rupture|'''diaphragmatic rupture''']].  

*'''Strangulation of abdominal or thoracic organs''' may lead to the production of a modified transudate (which will develop into an exudate if untreated).  This may occur with '''lung lobe torsion''', '''torsion of the spleen''' or of a [[Liver Torsion|liver lobe]] or if part of the liver becomes strangulated within a [[Diaphragmatic Rupture|'''diaphragmatic rupture''']].  

*'''[[Chylous Effusion|Chylous effusions''']] are sometimes considered to be a type of modified transudate.  

*'''[[Chylous Effusion|Chylous effusions''']] are sometimes considered to be a type of modified transudate.

==Diagnosis==

==Diagnosis==

===Clinical Signs===

===Clinical Signs===

Effusions may occur in any of the major body cavities, causing ascites, hydrothorax or pericardial effusion.  '''Ascites''' is often of a high volume. An abdominal fluid thrill will often be palpable and the abdomen may appear to be grossly swollen.

Effusions may occur in any of the major body cavities, causing ascites, hydrothorax or [[Pericardial Effusion|pericardial effusion]].  '''Ascites''' is often of a high volume. An abdominal fluid thrill will often be palpable and the abdomen may appear to be grossly swollen.

'''Hydrothorax''' will cause coughing, tachypnoea and dyspnoea if severe. Dullness will be evident on thoracic percussion if a pleural effusion has developed and the heart sounds will be muffled on auscultation.

'''Hydrothorax''' will cause coughing, tachypnoea and dyspnoea if severe. Dullness will be evident on thoracic percussion if a pleural effusion has developed and the heart sounds will be muffled on auscultation.

'''Pericardial effusion''' may be sufficiently severe to cause cardiac tamponade and right-sided heart failure. The heart sounds will be muffled on auscultation and there may be hepatojugular reflux, a jugular pulse or signs of left-sided forward failure.  In horses and cattle, '''ventral oedema''' is much more likely to be encountered than ascites in animals with congestive heart failure.

'''Pericardial effusion''' may be sufficiently severe to cause [[Cardiac Tamponade|cardiac tamponade]] and [[Heart Failure, Right-Sided|right-sided heart failure]]. The heart sounds will be muffled on auscultation and there may be hepatojugular reflux, a jugular pulse or signs of left-sided forward failure.  In horses and cattle, '''ventral oedema''' is much more likely to be encountered than ascites in animals with congestive heart failure.

===Diagnostic Imaging===

===Diagnostic Imaging===

|-

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| Nucleated cells  

| Nucleated cells  

| 0.3 - 5.5 x10e9/L (up to 7 x 10e9/L), of which the majority are [[Mesothelial cells|mesothelial cells]], [[Macrophages|macrophages]], non-degenerate neutrophils and small [[Lymphocytes|lymphocytes]]

| 0.3 - 5.5 x10e9/L (up to 7 x 10e9/L), of which the majority are [[Mesothelial cells|mesothelial cells]], [[Macrophages|macrophages]], non-degenerate neutrophils and small [[Lymphocytes - Introduction|lymphocytes]]

|}

|}

The presence of neoplastic cells in an effusion should prompt further investigation through diagnostic imaging or exploratory surgery.

The presence of neoplastic cells in an effusion should prompt further investigation through diagnostic imaging or exploratory surgery.

[[Category:Effusions]]

[[Category:Effusions]]

[[Category:To_Do_-_James]]

[[Category:Expert_Review]]

[[Category:To_Do_-_Review]]