Stool Analysis and Other Body Fluid Analysis
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Stool Analysis and Other Body Fluid Analysis
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Stool Analysis
Fecal : end product of body metabolism Early detection of gastrointestinal bleeding,
liver and biliary duct disorders, malabsorption syndromes, & detection parasites
Normal contains bacteria, cellulose & undigested foodstuffs, GI secretions, bile pigments, cells from intestinal walls, electrolytes & water
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Fecal Specimen Collection
Clean, dry, widemouth, leakproof, tight-fitting lid
Not contaminated with urine or water Within 2 hours after collection
Name:
Date :
Time:
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Macroscopic Examination of Feces
1. Inspection lead a diagnosis: parasitic infestation obstructive jaundiceDiarrheaMalabsorptiongastrointestinal bleeding etc
2. Noted: quantity, form, consistency, color, parasites, mucus and pus
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Normal 100-200 g/ day Diarrhea: watery Steatorrhea: mushy, foul-smelling, gray stool
floats on the water Constipation: small, firm, scybala Bleeding from upper GIT: black, tarry
consistency Bleeding from lower GIT: red
Macroscopic Examination of Feces
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Macroscopic Examination of FecesAppearance Possible cause
Black Upper GIT bleeding, iron th/,bismuth (antacids)
Red Lower GIT, beets & food coloring, rifampin
Pale yellow, white, gray
Bile duct obst, barium
Yellow Rhubarb
Green Biliverdin, green vegetables, antibiotics
Bulky Steatorrhea
Ribbonlike Intestinal constriction
Mucus Constipation, malignancy, colitis
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Mucus:
Translucent gelatinous: constipation or colitis
Bloody mucus: neoplasm or inflammatory process
Mucus + pus and blood: ulcerative collitis, bacillary dysentry, ulcerating diverticulitis and intestinal TB
Macroscopic Examination of Feces
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Pus:Chronic ulcerative colitisChronic bacillary dysenteryAbscessesAmebic colitis
ParasitesHelminths: Ascaris lumbricoides
Macroscopic Examination of Feces
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Fat
Sudan III, Sudan IV, Oil Red O Stain
Specimen + 2 drops 95% ethanol + stain
Fatty acid: lightly stained flakes or needle like crystal (not stained)
Neutral fats: large orange or red droplets
Soap: not stained well-defined amorphous flakes or rounded mass or coarse crystal
Microscopic Examination of Feces
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A. CARBOHYDRATE : LUGOL AMYLUM / CH + IODIUM BLUE
B. 30 % ACETIC ACID RED MUSCLE
DEXTRINDEXTRIN
REAGENS
VEGETABLE
CONECTIVE TISSUE
C. FAT SUDAN III RED BALL STRUCTURE
VV
KK
LLEE
(BACKGROUND : RED COLOUR)
AMOEBAERY / LEUKO
COLOURLESS
Microscopic Examination of Feces
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Meat fiberSpecimen + 10% alcohol solution of eosin, wait 3 minmuscle fiber: rectangular fibers with clearly evident cross-striation
LeukocytesSpecimen + Loeffler methylene blue, wait 3 minutes>3 neuthropil/HPF: invasive contion
Microscopic Examination of Feces
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Parasites
S. haematobiumS. mansoni
Microscopic Examination of Feces
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Ascaris
Enterobius
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TaeniaS. japonicum Trichiuris
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Stool for Occult Blood
Simple, inexpensive screening test for colorectal cancers
Microscopic bleeding in the intestine cannot detected by naked eye.
Principle:
Hb H2O2 Benzidine O-tolidineguaiac
Pseudo-peroxidase Blue color
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Not specific for blood Peroxidase enzyme (horseradish and
turnips): false positive result Blood in red meat: positive result Cimetidine (blue pigment): confusion Vitamin C: false negative result
Stool for Occult Blood
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Physiologic system to supply nutrients to nervous tissue, move metabolic waste & mechanical barrier to cushion the brain & spinal cord against trauma
Produce 500 ml/day Ultrafiltration and secretion through the choroid
plexus Obtained by lumbar puncture, cisternal puncture,
lateral cervical puncture or ventricular cannulas
Cerebrospinal Fluid
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Formation of Cerebrospinal Fluid
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Specimen Collection
Routinely by lumbar puncture between 3rd, 4th or 5th vertebrae
Collected in 3 sterile tubes:
1. Tube 1: chemical & serologic tests
2. Tube 2: microbiology
3. Tube 3: cell count Examination should be performed immediately
(<1 hr)
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Gross Examination
Normal CSF:clear and colorlessviscosity similar to water
Turbidityleukocyte >200cells/µLerithrocyte > 400cells/µL
Clot formationtraumatic tap, complete spinal block, suppurative and tuberculous meningitis
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Viscousmetastatic mucin-producing adenomacarcinomascryptococcal adenocarcinomas
Xanthochromiapink, orange or yellowdue to RBC lysis or Hb breakdownbilirubin, protein >150mg/dL, carotinoids, melanin, rifampicin therapi, contamination of detergent or methiolate disinfectan
Gross Examination
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Microscopic Examination
Total Cell Count Leukocyte: normal 0-5 cells/µL Use Improve Neubauer counting chamber
Differential Count Performed on a stained smear Normal: primarily lymphocytes & monocytes
adult: lymphocytes : monocytes = 70:30children: monocytes more prevalent
Neutrophilia: bacterial meningitis
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Chemical Analysis
Total ProteinDerived from plasma, concentration<1% blood level (15-45 mg/dL)elevated CSF protein:Increased permeability of BBB (meningitis, hemorrhage)Decreased resorption at arachnoid villi Mechanical obstruction (tumor)Increase intrathecal immunoglobulin synthesis (Guillain-Barre synd, multiple sclerosis)
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Glucose
derived from blood glucose
fasting CSF glucose 50-80mg/dL
60% plasma values
Hypoglycorrhacia:
bacterial, tuberculous and fungal meningitis
Chemical Analysis
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Enzymes
1. Lactate Dehydrogenase (LDH)
Normal < 40U/L
elevated in bacterial meningitis
2. Creatine Kinase (CK)
Normal < 5 U/L
elevated in demyelinating disease, seizures, stroke, malignant tumors, meningitis & head injury
Chemical Analysis
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Microbiological Examination
Gram stain Bacterial Meningitis
group B Streptococcus and Gram negative rods Viral meningitis
Enteroviruses (polioviruses) Fungal meningitis
Cryptococcus (in AIDS patients) Tuberculous meningitis
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Differential Diagnosis of MeningitisBacterial Viral Tubercular Fungal
WBC count elevated elevated elevated Elevated
Cell present neutrophil Lymphocytes Lymphocytes & monocytes
Lymphocytes & monocytes
Protein elevated
marked moderate Moderate to marked
Moderate to marked
Glucosa decreased normal decreased Normal to decrease
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Synovial Fluid
Viscous liquid found in the joint cavities Ultrafiltrate of plasma combined with
hyaluronic acid produced by the synovial cell Normal: < 3.5mL Functions:1. Acts as lubricant and adhesive2. Provides nutrients for the avascular articular
cartilage
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Synovial Fluid
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Specimen Collection
Arthrocentesis Steril, disposable needles and plastic syringe Specimen:
1. EDTA: cell count & diff count
2. Na-Heparinized : chemical & immunologic test
3. Plain: microbiologic test & crystal examination Oxalate, Li-heparin and EDTA avoided
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Gross Examination
Color evaluated in a clear glass tube against a white
background Normal: colorless to pale yellow noninflammatory/ inflammatory dis: straw to yellow
(xanthochromia) Septic: yellow, brown, green
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Clarity Related to the number and type of particles
within synovia Normal: transparent Translucent: leukocytes Opaque: massive crystals Milky opalescent: abundance of cholesterol
crystal
Gross Examination
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Microscopic Examination
Total Cell Count 1 hour after arthrocentesis Hemacytometer or automated cell counter Incubated with hyaluronidase Normal: <150-200/ µL
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Differential CountNormal: Neutrophils 20% Lymphocytes 15% Monocytes & macrophages 65% Eosinophilia 2%Elevated: Neutrophils: inflammatory, Gout & RA Lymphocytes: early RA, chronic infection Monocytes: viral arthritis Eosinophilia: RA, metastatic carcinoma, parasitic inf
Microscopic Examination
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Crystal Examination Gout: crystal deposition in articular tissue 1. monosodium urate monohydrate (MSU)
2. calcium pyrophosphate dihydrate (CPPD)3. apatite4. basic calcium phosphate (BCP)
Polarized light microscope 1. MSU: Gout, septic arthritis
2. CPPD: degenerative arthritis, hypo-Mg, hemochromatosis
Microscopic Examination
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Synovial Fluid CrystalCrystal Shape
Monosodium urate Needles
Ca pyrophosphate Rods
cholesterol Notched rhombic plates
apatite Small needles
coricosteroid Flat, variable shape plates
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Chemical Analysis
GlucoseNormal: <10 mg/dL
ProteinNormal: 1.38 g/dL
Uric acid Lipids:
1. cholesterol-rich psedochylous: chronic RA2. lipid droplets: trauma3. chylous effusion: RA, SLE, filariasis,
pancreatitis, trauma
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Immunologic & Microbiological Examination
1. Immunologic studies Rheumatoid Factor (RF) Complement
2. Microbiological Examination Gram’s stin Ziehl-Neelson Culture
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Pleural Fluid
Pleural cavity: between mesothelium of visceral and parietal pleura
Normal: small amount of fluid Plasma filtrate derived from capillaries of the parietal
pleura, reabsorbed through the lympatics and venules of the visceral pleura
Effusion: accumulation of fluid Specimen collection: Thoracentesis In EDTA tube: cell counts & differential
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Transudates & Exudates
Transudates: increased hydrostatic pressure or decreased oncotic pressure
Congestive heart faillure Hepatic cirrhosis HypoproteinemiaExudates:
Increase capillary permeability or decreased lymphatic resorption
Infections: Tb, bacterial, viral pneumonia Neoplasms: metastatic Ca Extrapleural sources: pancreatitis, ruptured esophagus
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Gross Examination
Transudates Exudates
Color Pale yellow to straw
Turbidity Clear Turbid/milky/ bloody
Odor - Fecalent: anaerobic inf
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Microscopic ExaminationTransudates Exudates
Cell counting < 1000/µL > 1000/µL
Differential count :Mesothelial cell
Neutrophilia (>50%)
Lymphocytosis (>50%)
Eosinophilic (>10%)
negative
10% case
30% case
Cong heart failure, trauma
Tb, empiema, rheumatoid Bacterial pneu, pancreatitisTb, viral inf, malignancy, SLEparasitic/fungal inf, drug rx, rheumato
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Chemical Analysis
Transudates Exudates
Protein <3.0 g/dL >3.0 g/dL
Glucose = serum =serum
LDH PF/S <0.6
<200 IU/L
PF/S >0.6
>200 IU/L
Amylase ≤ serum ≤ serum
pH >7.4 >/<7.3
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Pericardial Fluid
Normal: 10-50 mL Produced by transudative process Effusion: Inflammatory, malignant,
hemorrhagic processes Obtained: pericardiotomy,
pericardiocentesis
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Pericardial Fluid
Gross Examination Normal: pale yellow and clear Infection: turbid effusion Uremia: clear & straw colored effusion Chylous effusion: milky appearance
Microscopic Examination Leukocyte count:
>10 000/µL: bacterial, TB, malignant
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Chemical Analysis Protein
>3.0g/dL: exudates Glucose
<40mg/dL: bacterial, TB, malignant pH
<7.10: rheumatic & purulent condition7.20-7.40: malignant, uremia, TB
EnzymesLD >300U/dL & fluid/serum LD ratio>0.6: exudates
Pericardial Fluid
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Peritoneal Fluid
Ultrafiltrate of plasma Peritoneal effusion: ascites Normal: <50mL Specimen collection:EDTA
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Gross Examination Transudates: pale yellow & clear Exudates: cloudy/ turbid Acute pancreatitis & cholecystitis: green Malignancy & TB: bloody Chylous & pseudochylous: milky fluid
Peritoneal Fluid
Microscopic Examination Bacterial peritonitis:
leukocyte >500/µL, >50% neutrophil Eosinophilia (>10%): chronic inflammatory process
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Chemical Analysis Protein: little value Low glucose: TB peritonitis & malignancy Elevated amylase: pancreatitis, gastrointestinal
perforation Elevated alkaline phosphatase: intestinal
perforation Elevated urea/ creatinine: ruptured bladder
Peritoneal Fluid
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References
1. Clinical Diagnosis and Management by Laboratory Methods.Henry JB. 20th ed. 2001. WB Saunders co: Philadelphia London
2. Urinalysis and Body Fluid. Strasinger SK. 2nd ed.1989. F.A. Davis Co: Philadelphia
3. Basic Medical Laboratory Techniques. Estridge BH, Reynolds AP, Walters NJ. 4th ed. 2000. Delmar: Africa Australia