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STOOL EXAMINATION. DR RONALDA DE LACY. WHY IS IT DONE?. Colour Consistency Frequency Blood Bacteria Viruses Parasites Fungal Pancreatic function Intestinal malabsorption Inflammatory markers. STOOL COLOUR. STOOL CONSISTENCY. STOOL FREQUENCY.

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stool examination

STOOL EXAMINATION

DR RONALDA DE LACY

why is it done
WHY IS IT DONE?
  • Colour
  • Consistency
  • Frequency
  • Blood
  • Bacteria
  • Viruses
  • Parasites
  • Fungal
  • Pancreatic function
  • Intestinal malabsorption
  • Inflammatory markers
stool frequency
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
blood
BLOOD

FRESH BLOOD

  • Lower GIT bleed - anal fissure

- rectal haemorrhoids

- polyps

- inflammatory bowel disease

- infections i.e. Shigella, salmonella

- meckel’sdiverticulum

- intussception

- NEC

blood1
BLOOD

ALTERED BLOOD (MALAENA)

  • Upper GIT bleed - oesophagitis

- mallory-weiss tear

- gastritis

- ulcers–gastric, duodenal, small bowel

- vascular malformations

- anastomotic sites

bacteria
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
bacteria1
BACTERIA

SALMONELLA

  • Gram-negative rod
  • Nonspore forming, motile
  • Many serotypes
bacteria2
BACTERIA

CHOLERA

  • Only infects humans
  • Transmission by faecal contamination of water and food
  • Organism secretes an enterotoxin
  • Results in watery diarrhoea
bacteria3
BACTERIA

CAMPYLOBACTER

  • Gram-negative rod- comma or S-shaped
  • Transmission is faecal-oral
  • Cattle, chickens and dogs are sources
bacteria4
BACTERIA

YERSINIA ENTEROLITICA

  • Gram-negative oval rod
  • Contaminated food
  • Enterocolitis
bacteria5
BACTERIA

CLOSTRIDIUM DIFFICILE

  • Antibiotic use
  • Fresh stool sample
bacteria6
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
virus
VIRUS

ROTAVIRUS

  • RNA virus
  • Most common cause for diarrhoea
  • Vaccine available
  • Diagnosis antigen testing on the stool
virus1
VIRUS

ADENOVIRUS

  • DNA virus
  • 31 antigenic types
  • High swinging fevers
  • Pneumonia
  • Conjunctivitis
  • Diarrhoea
  • Diagnosis – antigen testing on the stool
parasites
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
parasites1
PARASITES

ASCARIS LUMBRICOIDES

  • Transmission-eating eggs in contaminated soil
  • Diagnosis- oval eggs in the stool or adult worms seen
parasites2
PARASITES

TRICHURIS TRICHURIUM

  • Whipworm infection
  • Transmission-eating eggs in contaminated soil
  • Diagnosis- barrel-shaped eggs in the stool
parasites3
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

taenia saginata
TAENIA SAGINATA

FOUR SUCKERS

NO HOOKS

taenia solium
TAENIA SOLIUM

FOUR SUCKERS

DOUBLE ROW OF HOOKS

parasites protozoa
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

parasites protozoa1
PARASITES-PROTOZOA

CRYPTOSPORIDIUM

  • Coccidian protozoa
  • Waterborne transmission
  • Direct person to person contact
  • Immunocompromised patients
  • Diagnosis- oocysts in faecal smears
parasites protozoa2
PARASITES-PROTOZOA

ENTAMOEBA HISTOLYTICA

  • Transmission-faecal-oral route, contaminated food and water
  • Diagnosis - trophozoites in diarrhoeal stools

- cysts in formed stools – 4 nuclei

parasites protozoa3
PARASITES-PROTOZOA

ISOSPORA BELLI

  • Faecal-oral transmission
  • Immunocompromised patients
  • Diagnosis-oocysts in faecal specimen
fungal
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
pancreatic function
PANCREATIC FUNCTION

Faecal elastase

  • >200ug/g faeces - normal
  • Low in chronic diarrhoea
  • <15ug/g indicates pancreatic insufficiency-cystic fibrosis
intestinal malabsorption
INTESTINAL MALABSORPTION

CARBOHYDRATE MALABSORPTION

  • Faecal reducing substances – positive – osmotic diarrhoea
  • Faecal osmolar gap (FOG) – serum osmolarity-2x(faecal sodium + potassium concentration)
  • FOG >100 mosm/l – osmotic diarrhoea
  • FOG <100 mosm/l – secretory diarrhoea
  • Need a liquid stool
intestinal malabsorption1
INTESTINAL MALABSORPTION

PROTEIN MALABSORPTION

  • Stool alpha 1 anti-trypsin
  • Need a pre-weighed container
  • Clearance rate 0.8-5.4ml/24hrs
intestinal malabsorption2
INTESTINAL MALABSORPTION

FAT MALABSORPTION

  • 3 day faecal fat measurement
  • Histology- free fat
  • Steatocrit-not specific for free fat
inflammatory markers
INFLAMMATORY MARKERS

COLPROTECTIN

  • Calcium and zinc binding protein
  • Accounts for 30-40% of neutrophilcytosol
  • Resistant to enzymatic degradation
  • Strongly correlated with 111-indium labelled leucocytes
  • References range- upper limit

2-9yrs – 166ug/g faeces

10-59yrs- 51 ug/g faeces