Stool examination

Stool/feces is the end product of digestive system of the body. Following digestion and absorption of the essential food ingredients in the stomach and intestine, the undigested food and unabsorbed secretions of stomach, liver, pancreas and intestine appear in stool.

1. STOOL EXAMINATION Ms Ankita R Bhatiya Assistant Professor SHREE P.M.PATEL COLLEGE OF PARAMEDICAL SCIENCE N TECHNOLOGY

2. STOOL EXAMINATION It include: 1.What is Stool? 2.Composition of Stool. 3.Collection of Stool. 4. Examination of Stool.

3. STOOL Introduction: Stool/feces is the end product of digestive system of the body. Following digestion and absorption of the essential food ingredients in the stomach and intestine, the undigested food and unabsorbed secretions of stomach, liver, pancreas and intestine appear in stool.

4. STOOL Clinical significance : Gastrointestinal disease Diarrhea Dysentery Parasitic infection Gastrointestinal bleeding Peptic ulcer Carcinoma and malabsorption syndrome including steatorrhea

5. STOOL Composition of stool: ¾ Water, ¼ Solid –Undigested and Unabsorbed food –Intestinal secretions, Mucous –Bile pigments and Salts –Bacteria and Inorganic material –Epithelial cells, Leukocytes

6. STOOL Collection of stool: For stool analysis the morning specimen (at least about 5 to 6 ml capacity) is collect in dry container. Container type: 1. Dry and disposable wide mouth plastic bottle or glass bottle 2. Waxed cardboard box 3. Glass jar with fitting lid.

7. STOOL Preservation: Foe the preservation of the sample formalin saline reagent can be used. Formal saline: Formaldehyde 25 ml, normal saline 75 ml. Mix and store in a clean & dry container. Use: Mix 3 parts of formal saline with one part of stool . Importance: The preservative preserve protozoan morphology & further development of certain helminthes eggs.

8. STOOL Precaution: Universal Precautions The container should be labeled, indicating identification number. The name of patient, date and time of specimen collection are entered in the register. Stool specimen should not be left uncovered, If is necessary to prevent drying effect. Always a fresh sample should be tested. Stool should be collected in a dry, sterilized, wide mouthed container. It should be uncontaminated with Urine or any other body secretions. Specimen should be disposed after examination.

9. Stool Examination Examination of Stool: Physical examination: Chemical examination: Microscopic examination:

10. Stool Examination Physical examination of Stool: 1.Quantity: Normally:15-60 gm Abnormally: More than 60 gm Condition: Steatorhea (due to high lipid in fecal) Ingestion of carbohydrate Diarrhea 2.Colour: Normal: yellowish brown (due to combination of bile and bilirubin ) Abnormal: Black colour : Bleeding in upper gastrointestinal tract, Iron administration Bright red: Bleeding in lower gastrointestinal tract, piles, contamination with menstrual blood. White color: After taking barium meal Green color: Because of presence of Pseudomonas bacteria

11. Stool Examination 3.Consistency: Normal: Soft and Formed Abnormal: Hard: Because of constipation Watery: Due to bacterial infection Rice- watery: Due to cholera Flattened & Ribbon : Obstruction in lumen of bowel Pale, bulky: Due to poor fat digestion

12. Stool Examination 4 . Presence of Mucus: Normally: Absent in adult Abnormally: Presence in children Small quantity of mucin is normal Small quantity – faeces from small gut Excessive quantity – infection of intestine Entirely mucus with little or no faeces and streaks of blood- dysentery, ileo colitis.

13. Stool Examination 5.Odour: Normal: Aromatic (due to indole and sketole ) Increased: excessive protein ingestion Sour rancid: fatty acid in milk indigestion (in children and adults), normal in infants Putrid: severe diarrhoea of malignancy, gangrenous dysentery. 6.Blood: Normally: absent 7.Parasite: Presence of adult worms or their mature segments can be observed by naked eye and they are tape worm, hook worm, ring worm and round worm etc.

14. Stool Examination Chemical examination of Stool: 1.PH: Normal is neutral (5.8 to 7.5) pH is dependent on bacterial fermentation and putrefaction in the bowel. Alkaline: Excess protein ingestion, Antibiotic use, colitis. Acidic: Excess carbohydrate ingestion, Fat malabsorption .

15. Stool Examination 2.Occult Blood : Detect blood which is present in amount or form not visible macroscopically Normal: Nil Abnormal presence in condition of occult haemorhage in the GI tract. Methods: Take a pinch of Benzidine power in a small test tube. Acidify it with 2-3 drops of glacial acid and mix well. Add about 1-2 drop of H2O2 and mix well. Place small quantity of stool specimen on a clean & dry glass slide. Found positive in… Ulcers, Diverticulitis, Ulcerative Colitis, Diaphragmatic Hernia, Adenoma, CA Colon

16. Stool Examination 3 . Benzidine Test: Principle : Perioxidase action of hemoglobin in blood converts hydrogen peroxide to water and nascent oxygen. This oxygen oxidizes benzidine in acid medium to form green to blue coloured complex. Interpretation: Trace- faint blue colour (after 1 minute) + : Definite blue green (slowly) + + : Green blue (rapidly) + + + : Blue (almost immediately) + + + + : dark blue (immediately)

17. Stool Examination 4. RSS: Reducing sugar substance in stool. Stool for infants with diarhoea are some time tested for reducing substance and Ph. Reducing sugar are lactose, maltose, galactose , fructose, sucrose, mannose etc. Bededict’s test: Principle: When Benedict's qualitative reagent is heated with small amount of stool, glucose present in stool reduce cupric ions present to cuprous ions. Alkaline medium is provided to the reaction by sodium carbonate present in the reagent. The original colour of Benedict's is blue. It changes to green, orange, yellow or red, according to the concentration of glucose present in urine.

18. Stool Examination Procedure: Pipette 5 ml of benedict’s reagent in a test tube. By using applicator stick add small amount of stool. Heat carefully on the flame of a gas burner or place in a boiling water for 5 to 10 min. Cool under tap water. Interpretation: Blue clr : Negetive Green clr with yellow ppts : + Yellow green clr with yellow ppts :++ Yellow n orange ppts :+++ Orange n orange ppts : ++++

19. Stool Examination 4.Lactic acid: Routinely carried out in infants with chronic diarrhea. To diagnose lactose intolerance. Method: In a clean dry test tube mix small amount of stool sample with Fecl3. & observe the color change. If color changes to lemon yellow that indicate presence of lactic acid in stool. Result can be confirmed by matching the test tube with black Fecl3.

20. Stool Examination Microscopic examination of Stool: This examination is done by two methods. Cover slip preparation method (Normal saline – iodine specimen preparation) Concentration method

21. Stool Examination 1.Cover slip preparation method (Normal saline – iodine specimen preparation): On a clean and dry slide add one drop each of normal saline and iodine solution. By using a stick take a small portion of fecal material. Mix the sample with the drop of sodium chloride & iodine on the slide and mix it well. Place a cover slip over each drop and avoid formation of air bubbles. Observe the slide under low power then under high power. Note: Iodine stain the cyst especially the nuclear

22. Stool Examination 2. Concentration method: Mainly performed to differentiate parasitic eggs from debris. It makes eggs more visible by removing organic and inorganic elements of stool. Floatation Method It is easy to perform. These method use the high specific gravity of a solution to float the lighter ova and cyst. Sedimentation Method Sedimentation process enable the concentration of parasitic eggs in sediment of procedure.

23. Stool Examination Saturated Sodium Chloride Solution Method: Boil granular sodium chloride in excess in water to produce a saturated solution which when cooled has a specific gravity of 1.18 - 1.2. Half fill a wide- mounted flat bottomed container with the saturated salt solution. Emulsify 1gm of feces in the solution and strain it to remove the debris from the surface. Pour the filtrate into meniscus and fill it to the top with saturated salt solution. Lay a glass slide over the top, avoiding any bubbles being trapped. Leave for 20 min before quickly inverting the slide. Scan for ova using the 10x objectives.

24. Stool Examination We can also observe the cell, crystal of different types and matters and other finding under high power of microscope. 1. Cells : They are of following types: Pus cell: Normally few present. Abnormally present or many. Condition: Bacillary dysentery, Ulcerative colitis. 2. Epithelial cell: Normally few present. Abnormally many present. Condition: Inflammation of the bowel

25. Stool Examination 3. Macrophage: Normally occasional findings. Abnormally many in number. Condition: Bacillary dysentery, Ulcerative colitis. 4. Erythrocyte: Normally they are absent Abnormally present in stool. Condition: lesion in the colon rectum or anus

26. Stool Examination 2.Crystal : Triple phosphate and calcium oxalate: Normally present. Due ingestion of certain food i.e. spinach, berries and tomatoes etc.

27. Stool Examination Charcot- leyden : Normally absent. Abnormally present. They are pointed needle like in shape. Condition: ulcerative condition, amebiasis . Haematoidin crystals: Normally absent. Abnormally present. Condition: Instetinal hemorrhage

28. Stool Examination 3.Vegetable matter: Normally present. They are vegetable cells, spirals, fibers and hairs etc. 4.Animal matter: Normally present. They are connective tissue .muscle fibers and elastic tissue .

29. Stool Examination 5.Undigestable ingredients: 1.Starch: Normally they are absent. Abnormally present in high proportion due to indigestion. 2.Fat: Normally they are absent. Abnormally present in high proportion due to indigestion 6.Other findings : 1. Yeast cells: Normally present. Blastocystis hominis . 2. Bacteria; Normally present. Abnormally gram positive is suggestive of intestinal ulceration.

30. Stool Examination