1. STOOL EXAMINATION DR RONALDA DE LACY

2. WHY IS IT DONE? • Colour • Consistency • Frequency • Blood • Bacteria • Viruses • Parasites • Fungal • Pancreatic function • Intestinal malabsorption • Inflammatory markers

3. STOOL COLOUR

5. STOOL CONSISTENCY

6. STOOL FREQUENCY • Breastfed infants – stool after every breastfeed - once to twice a week • Children on average 1 to 2 stools per day • Some children might have a stool every 2nd day

7. BLOOD FRESH BLOOD • Lower GIT bleed - anal fissure - rectal haemorrhoids - polyps - inflammatory bowel disease - infections i.e. Shigella, salmonella - meckel’sdiverticulum - intussception - NEC

8. BLOOD ALTERED BLOOD (MALAENA) • Upper GIT bleed - oesophagitis - mallory-weiss tear - gastritis - ulcers–gastric, duodenal, small bowel - vascular malformations - anastomotic sites

9. BACTERIA SHIGELLA • Gram-negative rod • Nonspore forming, non-motile • Four serogroups - S. Dysenteriae (12 serotypes) - S. Flexeneri (6 serotypes) - S. Boydii (18 serotypes) - S. Sonnei (1 serotype) • S. Flexeneri most frequently isolated in developing world – 60% of cases • S. Sonneimost frequently isolated in developed world – 77% of cases

10. SHIGELLA

11. BACTERIA SALMONELLA • Gram-negative rod • Nonspore forming, motile • Many serotypes

12. SALMONELLA

13. BACTERIA CHOLERA • Only infects humans • Transmission by faecal contamination of water and food • Organism secretes an enterotoxin • Results in watery diarrhoea

14. CHOLERA

15. BACTERIA CAMPYLOBACTER • Gram-negative rod- comma or S-shaped • Transmission is faecal-oral • Cattle, chickens and dogs are sources

16. CAMPYLOBACTER LIFECYCLE

17. BACTERIA YERSINIA ENTEROLITICA • Gram-negative oval rod • Contaminated food • Enterocolitis

18. BACTERIA CLOSTRIDIUM DIFFICILE • Antibiotic use • Fresh stool sample

19. BACTERIA MYCOBACTERIA Tuberculosis • Transmission by respiratory droplets • Mainly respiratory disease • Dissemination can result in intestinal involvement Bovis • Transmission by unpasteurised cow’s milk • Intestinal involvement • Difficult to culture from stool-need tissue

20. VIRUS ROTAVIRUS • RNA virus • Most common cause for diarrhoea • Vaccine available • Diagnosis antigen testing on the stool

21. ROTAVIRUS

22. VIRUS ADENOVIRUS • DNA virus • 31 antigenic types • High swinging fevers • Pneumonia • Conjunctivitis • Diarrhoea • Diagnosis – antigen testing on the stool

23. ADENOVIRUS

24. PARASITES ENTEROBIUS VERMICULARIS • Pinworm infection • Lifecycle confined to humans • Eggs recovered from peri-anal area with tape • Adult worms may be found in the stool

25. ENTEROBIUS VERMICULARIS

26. ENTEROBIUS VERMICULARIS(PINWORM)

27. PARASITES ASCARIS LUMBRICOIDES • Transmission-eating eggs in contaminated soil • Diagnosis- oval eggs in the stool or adult worms seen

28. ASCARIS LUMBRICOIDES EGG

29. ASCARIS LUMBRICOIDES LIFECYCLE

30. PARASITES TRICHURIS TRICHURIUM • Whipworm infection • Transmission-eating eggs in contaminated soil • Diagnosis- barrel-shaped eggs in the stool

31. TRICHURIS TRICHIURA EGGS

32. TRICHURIS TRICHURIUM LIFECYCLE

33. PARASITES TAENIA SOLIUM • Ingestion of larvae in undercooked pork • Diagnosis- proglottids in stool gravid proglottids have 5-10 primary uterine branches TAENIA SAGINATA • Ingestion of larvae in undercooked beef • Diagnosis- gravid proglottids have 15-20 primary uterine branches

34. TAENIA EGG

35. TAENIA SAGINATA FOUR SUCKERS NO HOOKS

36. TAENIA SOLIUM FOUR SUCKERS DOUBLE ROW OF HOOKS

37. TAENIA LIFECYCLE

38. PARASITES-PROTOZOA GIARDIA LAMBLIA • Flagellated protozoan • Waterborne transmission • Faecal-oral route • Infects the small intestine • Difficult to isolate, need minimum of 3 stool specimens • Diagnosis - trophozoites or cysts in diarrhoeal stools - trophozoites- pear-shaped, 2 nuclei, 4 pairs of flagella, suction disk

39. GIARDIA LAMBLIATROPHOZOITE

40. PARASITES-PROTOZOA CRYPTOSPORIDIUM • Coccidian protozoa • Waterborne transmission • Direct person to person contact • Immunocompromised patients • Diagnosis- oocysts in faecal smears

41. CRYPTOSPORIDIUM OOCYSTS

42. CRYPTOSPORIDIUM OOCYSTS-EM

44. PARASITES-PROTOZOA ENTAMOEBA HISTOLYTICA • Transmission-faecal-oral route, contaminated food and water • Diagnosis - trophozoites in diarrhoeal stools - cysts in formed stools – 4 nuclei

45. ENTAMOEBA HISTOLYTICACYST

46. PARASITES-PROTOZOA ISOSPORA BELLI • Faecal-oral transmission • Immunocompromised patients • Diagnosis-oocysts in faecal specimen

47. ISOSPORA BELLI OOCYSTS

49. FUNGAL CANDIDA ALBICANS • Part of normal gut flora • Overgrowth in diabetes, immunocompromised patients and prolonged antibiotic use. • Diagnosis- oval yeast with a single bud in the stool

50. CANDIDA ALBICANS