Analisis_feces.pdf

4/11/2016

Clinical Chemistry

Stool Analysis Sumarheni Faculty of Pharmacy 2016

Formation of Feces/stool • Waste residue of undigested materials (fibre/cellulose) + excretory product (bile pigments and salts, epithelial cells, intestinal mucus, leukocytes) + bacteria + Undigested and unabsorbed food+water  enter colon (peristalsis) • 90% of water + minerals are absorbed into the bloodstream  faecal material becomes more solid = faeces.

1

4/11/2016

Defaecation : the elimination of faeces from the body through anus

Faeces is stored temporarily in rectum full  sphincter muscles relax  rectal wall contracts  the faeces ejected via the anus.

Problem related GI tract

 Constipation  Haemorrhoids (piles)  Colon cancer  Malabsorption syndrome 2

4/11/2016

Problem related GI tract • The difficulty or infrequent evacuation of the bowels (elimination of feces). • Feces becomes dry & hard  difficult to eliminate.

Constipation

Problem related GI tract  Swollen veins in the rectum or anus.  Constipation  EXCESSIVE pressure exerted on the veins.  Itchiness, pain & rectal bleeding when the veins rupture.

Haemorroids (Piles)

3

4/11/2016

Problem related GI tract  Develops gradually.  A cell divides actively  form a polyp  malignant (month  years later).  Symptoms : change in frequency of bowel movement, blood in faeces, abnominal pain, discomfort, weight loss.

Colon cancer

Stool Examination • Determining the cause of symptoms affecting the digestive tract, including prolonged diarrhea, bloody diarrhea, an increased amount of gas, nausea, vomiting, loss of appetite, bloating, abdominal pain and cramping, and fever. • Primary screening for some types of digestive system malignancy : colon cancer

Diagnosing condition

4

4/11/2016

Stool Examination • Detecting the presence of digestive system infectious diseases: parasites, bacteria, fungus or virus • Detecting poor absorption of nutrients by the digestive tract (malabsorption syndrome) • Diagnosing diseases of the digestive tract, liver, and pancreas (enzymes such as trypsin or elastase) or some types of anemia

Diagnosing condition

Stool Examination Examination of fresh specimens permits the observation of motile trophozoites, but this must be carried out without delay. • Liquid specimens contain trophozoites  30 min • soft specimens contain both trophozoites and cysts  1 hr. If delays cannot be avoided, the specimen should be preserved (overnight refrigeration) No preservative is added to the feces

Specimen prep.

5

4/11/2016

STOOL EXAMINATION

Micros.

Macros.

•Consistency • Colour, weight, shape, odor •adult parasites

Composition

blood, fat, permanent Fibers, lWBC direct saline smear

others

•Chemical •Culture •Cellophane tape •Baeremann tech •etc

Paracites

temporary

Iodine smear

Conc. technique

Sedimentation

Floatation

Macroscopic Examination • Stool changes color with changes in diet and various medical conditions. • Normal color of stool from : a) Urobilin and stercobilin derived from reduction of bilirubin through the action of intestinal bacteria  yellow to dark brown b) nature of the diet ex. Pigmented diet- green vegetables, meat, blood  dark c) Drugs ex. calomel  green bismuth  black Santonin  yellow rifampisin  dark red

Color

6

4/11/2016

Studying stool color • indication of digested blood in the stool -

Very dark stools may indicate an ulcerative lesion in the higher digestive tract. Red stool indicates lower GI bleeding

• iron deficiency anemia, cirrhosis, colorectal cancer, disseminated intravascular coagulation, peptic ulcer, or stomach cancer. Note: False (+)  licorice, iron pills, pepto-bismol, blueberry Should be tested for the presence of hidden blood.

Dark to Black-colored stool

Studying stool color • May be seen in hepatitis, gallbladder disorders, or malabsorption conditions. • Malabsorption problems can cause undigested fat in the stool (steatorrhea) which is characterized by foul smelling, light yellow to gray, greasy or frothy stools. This may also be caused by low bile output.

Gray-pale-putty or clay colored stool

7

4/11/2016

Studying stool color Green stools may be bacteria or a green or blue food eaten. Orange stools may be due to certain medications: - Beta-carotene (a form of vitamin A) - antacids containing aluminum hydroxide - barium from recent barium enema test - hepatitis

Green or orange colored stool

Studying stool consistency • Normal : solid to semi solid (depending on diet) • 80-170 g/day • Hard stool indicates constipacy • Liquid stool indicates diarrhea (gastroenteritis)

8

4/11/2016

Studying stool odor • stools normally have an unpleasant odor  'typical'. • an extremely bad, out- of-the-ordinary odor may be associated with certain medical conditions, notably diet • Extremely foul smelling stools can be due to : - bacteria overgrowth which produce H2S or ammonia - the putrifying debris in the gut. - foods containing sulfur and have a yeast problem. - supplements reported to produce a smell when not absorbed and metabolized well are selenium and glutathione (sometimes also bad body odor and bad breathe even shortly after taking a shower or brushing teeth.

Microscopic Examination Materials : • Microscope slides • Cover slips • Sodium chloride solution in small • bottle with pipette • Wooden stick • Fresh stool • Gloves

Fresh stool exam. by wet-mount smear

9

4/11/2016

Microscopic Examination • Used Cleaned microscope slides

• Place a drop of saline

Fresh stool exam. by wet-mount smear

Microscopic Examination • Take a small amount of stool with a wooden stick

Mistake

Fresh stool exam. by wet-mount smear

10

4/11/2016

Microscopic Examination • Mix stool with saline

• Place coverslip and avoid air bubbles

Fresh stool exam. by wet-mount smear

Microscopic Examination • Examination of helminth ova or larva : use 110x objective

Schistosoma mansoni (lateral 'rose-thorn' spine on egg)

Tape-worm (hexacanthoembryonated ova)

Fresh stool exam.

11

4/11/2016

Microscopic Examination

Eggs (micro)

Macro

Mouth part (micro)

Ascaris lumbricoides

Paracite exam.

Microscopic Examination

Tail part (micro) Mouth part (micro)

Macro

Paracite exam.

Egg & larvae (micro)

Ancylostoma duodenale (hook worms)

12

4/11/2016

Microscopic Examination

Makcro

Eggs (micro)

Macro

Trichuris trichiura

Paracite exam.

Parasite setup Procedure http://www.practicalscience.com/stoolsetup.html

13

4/11/2016

Microscopic Examination • Examination of amoebae • Press cover slip slightly, remove excess liquid with paper towel

• Use 50x objective with oil immersion Entamoeba coli

Fresh stool exam.

Microscopic Examination The main pathogens that are commonly looked for in feces include: • Salmonella and Shigella • Yersinia • Campylobacter • Aeromonas • Candida (if the patient is immunosuppressed e.g. AIDS or cancer treatment) • E. coli O157 (if blood is visible in the stool sample.)

Fresh stool exam.

14

4/11/2016

Chemical Examination • The pH : normal 7.0 – 7.5 • Contents: - sugar : normal less than 0.25 g/dL or 13.9 mmol/L Lactose intolerance  elevated > 0.5 g/dL - Fat : normal  2-7 g/24 hrs steatorrhea (pacreatitis, gluten allergy)  >> • Blood

Fecal Occult Blood

• Approximately 10g of freshly collected faeces, from 3 successive bowel motions, collected in separate containers. • based on the catalyst activity of Haem in the oxidation of aguaiaconic acid by hydrogen peroxide • Red meat, aspirin. Vit.C interfere the test

Screening for colorectal cancer or gastroenteritis

15

4/11/2016

Quantitative Fecal Fat Test • For metabolic balance studies, collections of stool are usually made over a 72-hour period. • When the collection is complete, the container and feces are weighed, and the mass of excreted feces is calculated. • In the infant, fecal material for these tests is usually recovered from the child's diaper.

Metabolic Balance Studies

Routine Check-up Can Prove To Be Lifesavers

Thank you

16