Stool analysis
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Waste residue of indigestible material (cellulose during the previous 4 days). 2. Bile pigments and salts. 3. Intestinal secretions, including mucus. 4. Leukocytes that migrate from the bloodstream.

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Stool Analysis

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Stool analysis

  • Waste residue of indigestible material (cellulose during the previous 4 days)

2. Bile pigments and salts

3. Intestinal secretions, including mucus

4. Leukocytes that migrate from the bloodstream

6. Bacteria and Inorganic material(10-20%) chiefly calcium and phosphates. Undigested and unabsorbed food.

Stool Analysis

What is the stool or feces?

5. Epithelial cells that have been shade


Random collection

Random Collection

  • 1.Universal precaution

  • 2.Collect stool in a dry,clean container

  • uncontaminated with urine or other body secretions, such as menstrual blood

  • 4.Collect the stool with a clean tongue blade or similar object.

  • 5.Deliver immediately after collection


Ova and parasites collection

Ova and parasites collection

  • Warm stools are best for detecting ova or parasites.

  • Do not refrigerate specimen for ova or parasites.

  • If the stool should be collect in 10 % formalin or PVA

  • fixative, storage temperature is not critical.

  • Because of the cyclic life cycle of parasites, three

  • separate random stool specimens are recommended.


Enteric pathogen collection

Enteric pathogen collection

  • Some coliform bacilli produce antibiotic substances that

  • destroy enteric pathogen.Refrigerate specimen immediately.

  • 2.A diarrheal stool will usually give accurate results.

  • 3.A freshly passed stool is the specimen of choice.

  • Stool specimen should be collected before antibiotic therapy, or

  • as early in the course of the disease.

  • If blood or mucous is present, it should be included in the

  • specimen


Interfering factors

Interferingfactors

  • Patients receiving tetracyclines, anti-diarrheal drugs, barium, bismuth, oil, iron , or magnesium may not yield accurate results.

  • 2.Bismuth found in toilet tissue interferes with the results.

  • 3.Do not collect stool from the toilet bowl.A clean, dry bedpan is the best.

  • 4. Lifestyle, personal habbits, environments may interfere with proper sample procurement.

บิสมัส เตตร้า เหล็กทำให้อีเปลี่ยนสี, น้ำมันทำให้เกิด false steatorrhea

Anti-diarrheal drug ทำให้ลักษณะของ stool เปลี่ยนจากจริง


Normal values in stool analysis

Normal values in stool Analysis

Macroscopic examination Normal value

Amount100-200 g / day

ColourBrown

OdourVaries with pH of stool and depend on bact-erial fermentation

ConsistencyPlastic, not unusual to see fiber, vegetable skins.

Size and shape Formed

Gross blood,Mucous,Pus, Parasites None

มีความยืดหยุ่น


Normal values in stool analysis1

Normal values in stool analysis

Microscopic examination Normal values

Fat (Colorless, neutral fat (18%)and fatty acid crystals and soaps)

Undigested food None to small amount

Meat fibers, Starch, TrypsinNone

Eggs and segments of parasitesNone

YeastsNone

LeukocytesNone


Normal values in stool analysis2

Normal values in stool analysis

Chemical examinationNormal values

WaterUp to 75 %

pH6.5-7.5

Occult bloodNegative

Urobilinogen50-300 g/24hr

PorphyrinsCoporphyrins:400-1200g/24hr

Uroporphyrins:10-40 mg/24hr

Nitrogen<2.5 g/24hr


Normal values in stool analysis3

Normal values in stool analysis

Chemical examinationNormal values

BileNegative in adults:positive in children

Trypsin20-950 units/g( positive in small amounts in adults; present in greater amounts in normal children.

Osmolarityused 200-250 mOsm with serum osmol-arity to calculate osmotic gap

Sodium 5.8-9.8 mEq / 24hr


Normal values in stool analysis4

Normal values in stool analysis

Chemical examinationNormal values

Chloride2.5-3.9 mEq / 24 hr

Potassium15.7-20.7 mEq /24 hr

Lipids ( fatty acid) 0-6 g / 24 hr


Clinical implications

Clinical Implications

1.Fecal consistency may be altered in various disease states

  • Diarrhea mixed with mucous and red blood cells is associated with

  • 1. Typhus2. Typhoid3. Cholera

  • 4. Amebiasis5. Large bowel cancer

ไข้ไทฟอยด์

อหิวาตกโรค

อมีบาฝังตัวในลำไส้

มะเร็งทางเดินอาหารขนาดใหญ่


Clinical implications1

Clinical Implications

b. Diarrhea mixed with mucus and white blood cells is associated with

1. Ulcerative colitis2. Regional enteritis

3. Shigellosis 4. Salmonellosis

5. Intestinal tuberculosis

โรคทางเดินอาการอักเสบประจำถิ่น

แผลในโคลอน (ขอบเรียบ)

วัณโรคลงทางเดินอาหาร/ ฝีในท้อง


Clinical implications2

Clinical Implications

C. ”Pasty” stool is associated with a high fat content in the stool:

1. A significant increase of fat is usually detected on gross examination

2. With common bile duct obstruction, the fat gives the stool a putty- like appearance.

3. In cystic fibrosis, the increase of neutral fat gives a greasy, “butter stool” appearance.

มีพังผืดเกิดขึ้นในถุงน้ำดี


Stool odor

Stool Odor

  • Normal valueVaries with pH of stool and diet. Indole and sketole are the substances that produce normal odor formed by intestinal bacteria putrefaction and fermentation.

  • Clinical implication.

  • A foul odor is caused by degradation of undigested protein.

  • A foul odor is produced by excessive carbohydrate ingestion.

  • A sickly sweet odor is produced by volatile fatty acids and undigested lactose


Stool ph

Stool pH

Normal value : Neutral to acid or alkaline

Clinical implication

1. Increased pH ( alkaline)

a. protein break downb. Villous adenoma

c.Colitisd.Antibiotic use

2. Decreased pH ( acid)

a. Carbohydrate malabsorption

b. Fat malabsorption

c. Disaccharidase deficiency

สลายโปรตีนมากๆ จะมียูเรียและแอมโมเนียทำให้เป็นด่าง

มะเร็งต่อมเมือกที่วิลไล

ทางเดินอาหารส่วนปลายอักเสบ

มีการหมักคาร์โบไฮเดรตโดยแบคทีเรียได้กรดแลกติก

มีการย่อยไขมัน หมักกรดไขมันได้กรดคีโตนส์

ทำนองเดียวกับคาร์บมาลแอบสอร์บ


Stool color

Stool color

Normal value : Brown

Clinical implication:

1. Yellow to yellow-green: severe diarrhea

2. Green: severe diarrhea เขียวเพราะน้ำดีดูดกลับไม่ทัน ไม่มีเวลาให้แบคทีเรียย่อย bile

Black: resulting from bleeding into the upper gastrointestinal tract (>100 ml blood) การที่มีเลือดออกในทางเดินอาหารส่วนบนเหล็กจะถูกกรดออกซิไดซ์ได้สีดำ

3. Tan or Clay colored : blockage of the common bile duct.

4. Pale greasy acholic (no bile secretion) stool found in pancreatic insufficiency.

การบลอกทำให้ไม่มีน้ำดี สีอึเลยไม่มีสี

แสดงถึงการที่ไขมันไม่ถูกย่อย


Stool color con

Stool color(con)

4. Maroon-to-red-to-pink : possible result of bleeding from the lower gastrointestinal tract (eg. Tumors, hemorrhoids, fissures,inflammatory process)

5. Blood streak on the outer surface of usually indicates hemorrhoids or anal abnormalities.

6. Blood in stool can arise from abnormalities higher in the colon. In some case the transit time is rapid blood from stomach or duodenum can appear as bright or dark red or maroon in stool.

เนื้องอก, ริดสีดวง, ร่องตูดแหก, มีการอักเสบ

ริดสีดวง, รูก้นผิดปกติ


Blood in stool

Blood in Stool

Normal value : Negative

Clinical Implication :

1. Dark red to tarry black indicates a loss of 0.50 to 0.75 ml of blood from the upper GI tract.

2. Positive for occult blood may be caused by

a. Carcinoma of colonb. Ulcerative colitis

c. Adenoma d. Diaphramatic hernia

e. Gastric carcinomaf. Diverticulitis

g. Ulcers

มะเร็งของโคลอนแผลขอบเรียบที่โคลอน

ใส้เลื่อนที่กระบังลม

มะเร็งกระเพาะอาการลำไส้พันกันทำให้เน่าตาย


Mucous in stool

Mucous in Stool

Normal value : Negative for mucous

Clinical Implication:

1. Translucent gelatinous mucous clinging to the surface of formed stool occurs in

a. Spastic constipationb. Mucous colitis

c. Emotionally disturbed patients

d. Excessive straining at stool

2. Bloody mucous clinging to the surface suggests

a. Neoplasm b. Inflammation of the rectal canal

เบ่งแรงๆเมือกจากการอักเสบ

อารมย์

เก็บอึนานไป ไม่ชอบถ่าย

เนื้องอกภาวะอักเสบที่ไส้ตรง


Mucous in stool con

Mucous in Stool (con)

3. Mucous with pus and blood is associated with

a. Ulcerative colitisb. Bacilliary dysentery

c. Ulcerating cancer of colond. Acute diverticulitis

e. Intestinal tuberculosis

ติดเชื้อแบซิไล

แผลที่เกิดจากมะเร็งโคลอนลำไส้พันกันเฉียบพลัน


Fat in stool

Fat in Stool

Normal value : fat in stool will account for up to 20 % of total solids. Lipids are measured as fatty acids (0-6.0 g/24hr)

Clinical Implication :

1. Increased fat or fatty acids is associated with the malabsorption syndromes

a. Nontropical sprueb. Crohn’s disease

c. Whipple’s diseased. Cystic fibrosis

e. Enteritis and pancreatic diseases

f. Surgical removal of a section of the intestine

ลำไส้ตีบตันเนื่องจากผนังหนาขึ้นและ

มีเยื่อมีเซนทรีมากขึ้น


Urobilinogen in stool

Urobilinogen in Stool

  • Normal value :125-400 Ehrlich units / 24 hr

  • 75-350 Ehrlich units/100 g

  • Clinical Implication:

  • Increased values are associated with Hemolytic anemias

  • Decreased values are associated with

  • a. Complete biliary obstruction

  • b. Severe liver disease, infectious hepatitis

  • c. Oral antibiotic therapy that alters intestinal bacteria flora

  • d. Infants are negative up to 6 months of age


Bile in stool

Bile in Stool

Normal value : Adults –negative

: Children may be positive

Clinical Implication:

1. Bile may be present in diarrheal stools.

2. Increased bile levels occur in Hemolytic anemia


Trypsin in stool

Trypsin in Stool

  • Normal value: Positive in small amounts in 95 % of normal persons.

  • Clinical Implication : Decreased amounts occur in

  • Pancreatic deficiency

  • Malabsorption syndromes

  • Screen for cystic fibrosis


Leukocytes in stool

Leukocytes in Stool

Normal value : Negative Clinical Implication

1. Large amounts of leukocytes

a. Chronic ulcerative colitisb. Chronic bacilliary dysentery

c. Localized abscess

d. Fistulas of sigmoid rectum or anus

2. Mononuclear leukocytes appear in Typhoid

ท้องเสียเรื้อรังจากการติดแบซิไล

แผลลำไส้อักเสบเรื้อรัง

มีฝีหนอง

ลำไส้กลืนกันบริเวณซฺกมอยด์โคลอน หรือที่ทวาร


Leukocytes in stool con

3. Polymorphonuclear leukocytes appear in

a. Shigellosisb. Salmonellosis

c. Yersiniad. Invasive Escherichia coli diarrhea

e. Ulcerative colitis

4. Absence of leukocytes is associated with

a. Cholerab. Non specific diarrhea

c. Viral diarrhead. Amebic colitis

e. Noninvasive E.coli diarrhea

f. Toxigenic bacteria Staphylococci spp., Clostidium Cholera

g. Parasites-Giardia,

Leukocytes in Stool (con)


Porphyrins in stool

Porphyrins in Stool

  • Normal value : Coproporphyrin 400-1200 g / 24hr

  • Urophorphyrin 10-40 g / 24 hr.

  • These values vary from Lab to Lab.

  • Clinical Implication:

  • Increased fecal coproporphyrin is associated with

  • a. Coproporphyria (hereditary)b. Porphyria variegata

  • c. Protoporphyria d. Hemolytic anemia

  • 2. Increased fecal protoporphyrin is associated with

  • a. Porphyria veriegata b. Protoporphyria

  • c. Acquired liver disease


Stool electrolytes

Stool Electrolytes

  • Normal values : Sodium 5.8-9.8 mEq / 24 hr

  • Chloride 2.5-3.9 mEq / 24 hr

  • Potassium 15.7-20.7 mEq /24 hr

  • Clinical Implication :

  • Idiopathic proctocolitis Sodium and Chloride Normal Potassium

  • Cholera Sodium and Chloride


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