Stool examination dr.vinutha
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Transcript of Stool examination dr.vinutha
WELCOME
STOOL EXAMINATIONPresented by
Dr.Vinutha.M.GIII PG Scholar,
Dept of Roga NidanaGAMC, Bangalore
CONTENTSINTRODUCTIONCOMPOSITIONCOLLECTIONPRECAUTIONPRESERVATIONMACROSCOPIC EXAMINATIONCHEMICAL COMPOSITIONMICROSCOPIC EXAMINATIONSTOOL CULTUREMALA/PURISHA
INTRODUCTION Human feces - STOOL.Faeces / Feces- Plural-latin term- faex-
RESIDUE.Waste residue of indigestible materials of an
animal digestive tract expelled through the anus during defecation.
Meconium
SCATOLOGY or CAPROLOGY -study of feces.
COMPOSITION• ¾ Water, ¼ Solid• Undigested and Unabsorbed food• Intestinal secretions, Mucous• Bile pigments and Salts• Bacteria and Inorganic material• Epithelial cells, Leukocytes
COLLECTION• Universal Precautions• Dry, sterilized, wide mouthed container
(50 ml).• Plastic/waxed cardboard box/match box• Uncontaminated with Urine or any other
body secretions.• Properly named• Always a fresh sample -tested • Morning specimen-5 to 6 ml
PRECAUCTION• Labeled specimen • Contamination • Specimen should not be left uncovered
(Prevent drying) • Examined within 1 hr of collection • Disposed properly after examination
PRESERVATIONVarious preservativesAq. 10% formalinMIF-merthiolate iodine formaldehydeLV-PVA-low viscocity polyvinyl alcoholSAF-sodium acetate acetic acid formalinSchaudinn’s fixativeModified PVA Cu and ZnOne vial fixative-ECOFIX,PARASAFE,UNIFIX
Contd..CONSISTENCY AND FORMNormal- Well formed-Semisolid
Abnormal: conditionPale, Bulky, Frothy
Hard
Flattened and Ribbon
Watery
Rice water-
Steatorrhea
Constipation
Obstruction in lumen- Bowel
Bacterial infection
Cholera
COLOUR Normal- Light to dark brown
Color Condition
• Yellow- • Black-
• Bright red/ Hematochezia-• Fresh Blood-• Pale/ Gray-
• White-
• Blue-
• Silver-Aluminium paint
• Violet/ Purple-
Giardiasis, GERD, Gilbert’s syndromeBleeding in the upper GIT, Iron administration, bismuth subsalicylate, BeetrootBleeding in the lower GITAmebic dysentry Cholecystitis, Gallstones, Hepatitis, Chronic pancreatitis, Cirrhosis. After barium meal, Biliary obstruction.RADIOTHERAPY, cesium & Thallium poisoning.Carcinoma of ampulla of vater
Symptom in porphyria.
Infant stages color
• Exclusively breast fed infants-
• Infants fed on cow’s milk preparations-
• Babies fed on newer modified cow’s milk-
• Some healthy children
loose and green or pasty and yellow stools.paler yellow colour and of a much firmer consistency. Clay coloured or greenish stools.
pass frequent, loose stools containing undigested vegetable matter called as Toddler’s diarrhoea.
Contd..ODOURDepends on- PH of stool Methyl sulfidesBenzopyrrole volatiles(indole and sketole)
& Hydrogen sulphidesubstances that produce normal odour-
Intestinal bacterial fermentation and putrefaction.
Odour Condition
• Foul odour-
• Sickly sweet odour-
• Increased odor-
Degradation of undigested protein and excessive carbohydrate intake.
Undigested Lactose.
Celiac disease, Crohn’s disease, Ulcerative colitis, Chronic Pancreatitis, Cystic fibrosis,.
PARTS OF PARASITE AND ADULT PARASITEWorms and their parts• Round worm• Hook worm• Tape worm• Pin worm• Whipworm
C H E M I C A L E X A M I N A T I O N
NORMAL
• Water –
• pH –
• Occult blood- • RS –
• Bile –
• Sodium –
• Chlorides –
• Potassium –
• Lipids / Fatty acids –
• Nitrogen -
Upto 75%
5.8 to 7.5
NegativeNegative
Negative in Adults
5.8 to 9.8 mEq/24hrs
2.5 to 3.9 mEq/24hrs
15.7 to 20.7 mEq/24hrs
0 to 6 gms/24hrs
<2.5g/24hrs
PHProcedure Increased pH-
ALKALINEDecreased pH-ACIDIC
• Atleast ½ ml of faeces -collected.
• Patient shouldn’t receive any antibiotics.
• Strip of nitrazine paper – dipped in sample.
• Colitis
• Antibiotic use
• Villous adenoma
• Excess Protein in diet.
• Carbohydrate Malabsorption- Lactose intolerance
• Fat Malabsorption
• Disaccharidase defficiency
• Contagoin- E.Coli, rotavirus.
OCCULT BLOOD:Principle Method Intpretation
Benzidine test-Perioxidase
+hemoglobin in blood converts
hydrogen peroxide
water and nascent oxygen
oxygen oxidises
benzidine in acidmedium
green to blue coloured complex.
Benzidine – Glacial acetic acid – Hydrogen peroxide – Over stool in slide – Colour change.
Ulcers,Diverticullitis,Ulcerative Collitis,Diaphragmatic Hernia,Adenoma,CA Colon, Gastrium
FATMicroscopic examination:
Quantitative fecal fat test:
Interpretation
•Random faeces stained with Sudan staining ( Sudan III or IV)•Visible amounts of fat
•Done over a period of 3 days•In a container all faeces collected•Thoroughly mixed to homogenize•Small sample is obtained•Fat content extracted with solvents•Measured by saponification
• Malabsorption Syndrome
• Obstructive Jaundice
• Non tropical sprue/Coeliac Sprue
• Crohn’s disease• Cystic Fibrosis• Whipple’s disease• Enteritis and
Pancreatic diseases
Contd..REDUCING SUBSTANCESScreening test -carbohydrate
malabsorbtion disorders -lactose intolerance or disaccharidase deficiency,
Stool - positive for RS -Rota viral Infection in Infants.
Materials: Reagents: Procedure:
•Wooden applicator sticks•Plastic transfer pipette, 6 inches16 x 125 mm test tubes•Clinitest color reaction chart•Vortex mixer
•Clinitest tablets •Type I water•MAS Urinalysis Abnormal Level 1 control•Normal Urinalysis Control
•1 volume of stool (approximately “pea” size) to a 16 x 125 mm test tube. •Add 2 volumes of type I water. •Mix thoroughly using a vortex mixer • centrifuge for 5 minutes at 2000 rpm (full speed).•Using a plastic (uniform drop) pipette, transfer 15 drops of this suspension to a clear test tube (16 x 125). •Add one Clinitest tablet.•end of this 15 second waiting period•Compare the color of the liquid
Contd.. Warning: This is an exothermic reaction
and the test tube will become very hot. Keep hands and face away from the test tube opening.
Note: Ignore sediment that may form in the bottom of the test tube and changes after the 15 second waiting period.
ResultsCLINITEST % REPORTING
SYSTEMCOLOUR
0.0 N -Normal BLUE
0.25 T-Nomal Blue to green
0.5 1+ Suspicious Shades of green
0.75 2+ To Brown
1.0 3+ to
2.0 4+ Orange
>2 >4+ greenish-brown
M I C R O S C O P I C E X A M I N AT I O N O F T E M P O R A R Y M E T H O D
RequirementsMicroscope slidesCover slipsSodium chloride solutionLugol’s Iodine SolutionWooden applicatorFresh stoolGloves
Method:A drop of warm Saline or Lugol’s Iodine is placed
over a clean microscopic slide.• About 2mg of stool sample should be taken and
mixed with soln placed over the slide.• Coverslip is placed avoiding air bubbles.• Examined under Microscope.
STOOL EXAMINATIONTemporary
Scanty infectionConcentration techniques
Saline sedimentation
Formol Ether Sed. Conc.
Baermann’s technique
Permanent Stained smearsIron haematoxylin stainTrichrome stain Modified Ziehl Neelsen stain (Crypto.)
Iron haematoxylin stainFecal smear- fixed in Schaudinn’s solution-15minImmersed 2-5 min 70%alcohol70%alcohol having trace of iodine50% alcohol for 2-5minWashed in H2o-5-10minImmersed in 2%aqeous ferric ammonium sulphateWashed in H2o 3-5 min & stained by 0.5% aqueous hematoxylin
5-15minWashed 2-5 min & differentiated in saturated aq. Picric acid 10-
15minWashed 10-15min & dehydrated by passing through increasing of
alcoholCleared in toulene /xylol and mounted
Trichrome stain
Quicker & simplerSmear is fixed in Schaudinn’s solutionTaken up by alcohol Trichrome stain- applied-5-10minDifferentiated in acid-alcohol Dehydrated ClearedMounted
Normal
• Undigested food materials – None to small amount
• Starch – None• Eggs, Cysts, Parasitic fragments – None• Yeasts – None• Leukocytes – None
ABNORMALABNORMAL IMPLICATION
Large amounts of leukocytes Chronic Ulceratice Collitis, Chronic Bacillary Dysentry, Localised Abscess, Fistulas.
Mononuclear Leukocytes Typhoid
Polymorphonuclear Leukocytes
Shigellosis, Salmonellosis, Invasice E. coli diarrhoea, Ulceratice Collitis.
EGG COUNTING METHODSSemi quantitative assessmentStandard Wet mountModified Kato thick smear techniqueMc. Master’s methodStoll’s dilution techScotch tape method- Enterobius vermicularisBell’s dilution-filtration count- schistosome eggs
STANDARD WET MOUNT
Thick smear-Kato technique
MC. MASTER’S METHODChamber
Eggs in 20mg
Salt floatation
Concentration
Square grid on the roof of
chamber
Stoll’s technique
Scotch tape methodApp. 4inch cellophane
tape
Sticky side of tape pressed against
the skin across the anus
Sticky side of tape placed
on glass slide
Drop of toulene/xylol
betW. Tape & slide
3 consecutive days @ early
morning
STOOL CULTURE
Gram –ve - E. coli, Enterobacter, Proteus, Pseudomonas aeruginosa, Bacteroides.
Gram +ve - Clostridia, Lactobacilli, Enterococci, Anaerobic streptococci.
Contd..Culture media -
AGAR and is done aerobically.
XLD Agar media – Salmonella,
Shigella.
TCBS Agar media– Cholera.
MacConkey media – Yersinia
enterocolitica
Campylobacter culture media - Campylobacter
species.
Hanging drop test:
Drop stool -centre of a coverslip.
Drop of water / vaseline- each corner of the coverslip.
Invert a slide -central depression over the coverslip.
The coverslip -stick to the slide
Inverted the drop of bacterial culture-suspended in the central depression
of the slide.
Examine microscopically (X100) -motile organisms.
Cultures
Harada mori filter paper strip culture
S.StercoralisTrichostrongylus
Agar plate cultureS.Stercoralis
sensitive Charcoal culture
Contd..HARADA MORI FILTER PAPER STRIP
CULTURE:
AGAR PLATE CULTURE
App. 2g• Inoculated• Agar plates
SealedRoom
temperature
2 daysLarva crawl over
agar
CHARCOAL CULTURE
Softened faeces
Mixed 5-10 parts of moistened charcoal granules
Covered, stored-7-10 days, larvae
Contd..Wet film- microscopyCulture on selective media- salmonella, shigella &
Camphylo bacter spp.,etcMolecular genetics-PCR probes- detect Shiga toxin-
E.coliEIA- detection of rotavirus & adeno virus-
childrenDiarrhoel outbreaks- Norovirus-PCR/electron
microscopyOutbreaks of viral meningitis/encephalitis-
viral culture
INTESTINAL PARASITESEntamoeba histolytica- Pathogenic
Entameoba coli-Non pathogenic
Endolimax nana- Non pathogenic
Iodamoeba buetschlii –Non pathogenic
Balantidium coli-Pathogenic
Giardia lamblia-Pathogenic
Trichomonas vaginalis- Pathogenic
Cryptosporidium parvum-Pathogenic
Ascaris lumbricoides- Large round worm
Contd..
Enterobius vermicularis-pin worm
Contd..
Trichuris trichura- Whipworm
Necator americanus and Ancylostoma duodenale- Hookworm
Necator americanus and Ancylostoma duodenale
Strongyloides stercoralis-Threadworm
Taenia solium- Tape worm
Taenia solium- Tape worm
M A L A / P U R I S H A
Dosha dhathu mala moolam hi ….Synonyms:- Shakrit, Upveshana, Vit,
Gutha,Varcha
Formation of purisha“Pakwashya Tu Prapatasya
ShoshyemanasyeVahinna Paripinditpakavasye VayuSyat Katubhavata” [Charak Chikitsa
Sthana15/11]“Kittam Annasye Vinmutram”. [CharakChikitsa Sthana 15/18]
Panchbhautika constitution of purishaPurisha predominantly consists of agni andvayu mahabhuta.“Purisham parthivam” (Bhanumati onSushruta sutrasthan15/8)
Site of formation“Purishvahanam srotsam pakvashyo
mulamsthulgudam” (Charak vimansthana5/8)“Tatra vatvaschonirasnam
sthulantrapratibaddamgudam naam marmamch”(Sushruta
sharirsthana 6/25)
Purishadhara kala“Panchmi purishdharanam,ya Ante
kosthemalam Abhivibhajyte pakvashyastha”
[SushrutaShareer Sthana 4/16] “Yakrit samantat koshte ch tathaantrani
Samashrita Undukastham vibhajte Malam Maladharakala” [Sushruta shareer Sthana 4/17]
Quantity- Functions of purisha“Sapta Anjali purishasye” [Charak
shareerSthana 7/15]“Avshtambh purishasye” [Ashtang HridyaSutrasthana Sthana 11/5]
ASHTA STHANA PARIKSHA
•Mala swaroopaArishta
•Ati krishna, atishubra•Atipeeta, Aruna
Mruthyu karaka
•Excess ushnaAvashya mruthyu karaka
Mala pareeksha Contd..Condition Lakshana
Saama mala Guru, Durgandhi, Apsu nimajjathi
Nirama mala Laghu, Na Apsu nimajjathi
Kamala Tila pista Nibha
Atisara Bahu drava
Pravahika Kapha yukta mala
Grahani Muhur baddam, muhur dravam
PURISHAJA KRIMI
Sthana• Pakvashaya
Akruty• Sookshma
(minute),Vritha (round), Deergha (long)
• Sthoola(big), Prithavapucksa (flat tail) and Tanu(thin)
Varna• Shweta(white),
Shyava (pale), Neela (blue),
• Harita (green), Peeta (yellow).
Kakeruka –highly motile Makeruka – shape of MudrikaSausrada- shelters on fermented materialsLeliha- continuously licks/feeds and consume
Dhatus (seven tissue elements of the body)Sashoolika -causing pain in the host.21
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