Stool analysis
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Transcript of Stool analysis
PRESENTED BYSYED BASHEER UDDIN
STOOL ANALYSIS
• A Stool analysis is a series of test done on a stool (feces) sample for differential diagnosis of certain diseases of digestive system.
• Stool analysis procedure is divided into: Physical Examination Chemical Examination Microscopic Examination
STOOL ANALYSIS• Physical Examination:-
A - Color: Normal feces has a dark brown color (Bilitubin in
the presence of bacteria will be oxidised to urobilin which give stool its color)
Abnormal color: Black color indicates blood of upper GIT origin.
Iron administration (in iron deficincy anemia) Bright Red color indicates blood of lower GIT
origin, Bleeding piles and Contamination with menstrual blood.
STOOL ANALYSIS Fresh blood & mucus: Amoebic dysentery
Bacillary dysentery Clay colored: Post hepatic jaundice , obstruction to
the
jaundice, obstruction to the flow of bile to intestine White color indicates yeast fermentation (Candida) and
after barium meal. Very pale color indicates biliary obstruction.
STOOL ANALYSIS Consistency and Forms:
Normal: Well formed Abnormal:
1. Pale, bulky, frothy - Steatorrhea (poor fat digestion)
2. Hard – Constipation
3. Flattened and ribbon like - Obstruction in the lumen of
the bowel.
4. Semi solid - Mild diarrhea, After taking laxatives &
Digestive upsets.
STOOL ANALYSIS 5. Watery - bacterial infection & purgatives
6. Rice water stools (Copious, thin with white flakes) Cholera • Chemical examination:
Determination of pH:1. Normal stool is slightly acidic, neutral or slightly alkaline.2. The pH values may range from 5.8 – 7.53. Strongly acidic stools (pH below 5.5)
Non-pathologic - Excess of carbohydrates in dietPathologic – Fermentation, may be due to lactose intolerance
4. Strongly alkaline stools (pH more than 7.5)Non-pathologic – Excess protein in the diet.
• Procedure: Dip pH paper in small quantity of the fecal material. Observe the color. Compare with the color chart and record the pH.
STOOL ANALYSIS• Microscopic Examination:
Saline specimen preparation:
1. Label the glass slide with a patient’s ID No.
2. Place a drop of isotonic saline on a glass slide.
3. Take a little fecal material with an applicator
stick and mix with the drop of isotonic saline.
4. Place a cover slip over it. Avoid formation of air
bubbles below the cover slip.
STOOL ANALYSIS Iodine specimen preparation:
1. Place a drop of Lugol’s iodine on the other side of the slide.
2. Mix little fecal material with the drop of iodine.
3. Place a cover slip over it.
4. Examine both the preparations under the high power of the microscope.
Note: The iodine stains the cysts (especially the
nuclear structure)
INTESTINAL PROTOZOA
INTESTINAL PROTOZOA
STOOL ANALYSIS
STOOL ANALYSIS
PLATYHELMINTHS
ROUND WORMS
OOL WORLD HOOK WORM
PIN WORMS
NEMATOHELMINTHS
RESULTS & INTERPRETATIONS. No Detection of Normal findings Abnormal findings Pathological
conditions
Cell identification
1. Cells
Pus cells Present-few
Present many Bacillary dysentery
Ulcerative colitis
Epithelial cells -do- -do- Inflammation of the
bowel
Macrophages (Large Polymorphonuclear phagocytic
cells)
Occasional Many Bacillary dysentery,
ulcerative colitis
Erythrocytes Absent Present Lesion is in the
colon, rectum or
anus. They clump in
amoebiasis.
2. Crystals
Triple phosphate and calcium oxalate Present due to
ingestion of certain
food i.e. spinach,
berries, tomatoes
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Charcot-Leyden crystals (pointed needle like) Absent Present Ulcerative
conditions,
amoebiasis.
Hematoidin crystals (Yellowish rhombic) - Present Intestinal
hemorrhage
RESULTS & INTERPRETATIONS. No Detection of Normal findings Abnormal findings Pathological conditions
3 Vegetable matter
Vegetable cells, spiral, fibres, hairs etc Present, residual
constituents
- -
4 Animal matter
Connective tissue, muscle fibres and elastic
tissue
Present, residual contents
or undigested fibres
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5 Undigested ingredients
Starch Absent Present in high proportion Indigestion
Fat Absent Present in high proportion Indigestion
6 Other findings
Yeast cells Present especially
Blastocystis hominis.
Also present sometimes in
cases of mild diarrhea and
abdominal distension
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Bacteria Constitute about one third
of the weight of dried feces
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Organism Type Microscopic observation (under high power) Identify the cellsEntamoeba Histolytica, cysts
Pathogenic Size 12 – 15 µm
Shape Round
Nuclei 1 – 4 nuclei
Membrane Thin, regular circular
Karyosome Small, compact central dot
Cytoplasm Yellowish-grey (in iodine olution)
Chromatoid bodies Oblong, rounded at ends
Vacuole Large glycogen vacuole (stained reddish-brown by iodine solution)
Entamoeba coli, cysts Non-Pathogenic Size 12 – 20 µm
Shape Round, oval, or irregular
Nuclei 1 – 8 nuclei
Membrane Irregular,thick in parts
Cytoplasm Pale yellow (in iodine solution)
Chromatoid bodies Sharp or needle shaped ends
Vacuole Sometimes a very large vacuole
Giardia intestinal, cysts
Pathogenic Size 8 – 12 µm
Shape Oval, appears with a double wall, one pole is more rounded then other.
Nuclei 2 – 4 oval nuclei
Membrane Very fine
Cytoplasm Refractile, clear, pale yellow when stained in iodine solution.
Fibril Refractile, hair like line, placed length wise in S shape.
Trichuris trichiura (whip worm)
Pathogenic
- OvaSize 50 µm
Shape Barrel type
Shell Thick, smooth, two layers
Content Uniform granular massOther feature At each pole a rounded transparent plug
Ascaris lumbricoides (round worms)
Pathogenic
Fertilized egg with double shell Size About 70 µm
Shape Oval
Shell External: rough, brown covered with little lumpsInternal: Smooth, thick colorless
Color External : Shell : BrownContent: Pale yellow
Unfertilized egg with double shell
Size 80 – 90 µm
Shape Elliptical, elongatedShell External: Brown with jagged lumps
Internal: ThinContent Full of round refractile granules
Semi-decorticated fertilized egg without external shell
Shell Single, thick colorlessContent Round, colorless granular central mass
Semi-decorticated fertilized egg
Shell Single, smooth, thin, double lined colorless
Content Large, round, refractile, granules
1) Taenia Saginata2) Taenia solium
(Tape worms)
Pathogenic Note OvaThe eggs of these tape worms are identical
Size 30 – 40 µm
Shape Round
Shell Thcik, smooth, transverse lnes
Color Yellowish-brown
Content Round granular mass, enclosed by fine membrane3 pairs of refractile, lancet shaped hooklets
Ancylostoma duodenale (hook worm)
Pathogenic Ova
Size 50 – 60 µm
Shape Oval, flattened poles
Shell Very thin
Color Cell in side (turn) dark brown in iodine solution otherwise pale grey
Content Varies according to maturity (four cells)
Enterobius vermicularis (pinworm)
Pathogenic Ova
Size 50 – 60 µm
Shape Oval, asymmetrical
Shell Smooth, thin, double line
Content Small granularMassEmbryo, curled up larva
Color Transparent, colorless
Note: The egg (ova) is usually found in the folds of the skin round the anus.
Plant cells
Air bubblePlant hairs
Plant fibre
Pollen grains
Non-human coccidial oocysts Fat droplets
Soapy plaquesStarch cell Charcot leyden crystals Muscle fibers
Fatty acids MacrophageEpithelial cells
THANK YOU
SYED BASHEER UDDIN