Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
STOOL EXAMINATION
Presented by:
Dr. Priyanka Buragohain
Guided by:
Dr. Hemen Kalita
Deptt. Of Roga Nidan. Govt. Ayurvedic ...
DEFINITION
• Human feces is called as stool.
• faeces / feces is plural of latin term faex
meaning RESIDUE.
• It is the wa...
COMPOSITION
• ¾ water, ¼ solid
• Undigested and unabsorbed food
• Intestinal secretions, mucous
• Bile pigments and salts
...
PRECAUTION BEFORE COLLECTION
• Patient should avoid the following things for at
least 48 hours before collection of stool:...
COLLECTION
• Universal precautions
• Pt. is asked to pass stool in a clean container.
• Stool should be collected in a ste...
COLLECTION CONTD...
• 3 samples of stool within 10 days to exclude
false negatives.
• 2 samples to be examined on alternat...
7
Stool examination by Dr. Priyanka
Buragohain
TYPES OF EXAMINATION
• PHYSICAL EXAMINATION: colour, volume,
consistency, odour, mucus, pus, concreations,
helminths.
• CH...
Physical examination
• AMOUNT
• CONSISTENCY
• COLOUR
• ODOUR
• REACTION
• MUCUS
• CONCRETION
• BLOOD
• PUS
• FOOD REMNANT
...
MACROSCOPIC EXAMINATION
AMOUNT
• Normal is 150 g to 200 g/day
• Increased in steatorrhoea, diarrhoea, indigestion
of carbo...
CONSISTENCY OR FORM
• Normal is soft but formed
• Excessively hard/scybala- habitual constipation
• Flattened or ribbon li...
Stool examination by Dr. Priyanka Buragohain
12
Colour
• Dark Grey- excessive cocoa or chocolate
ingestion
• Reddish or blackish brown- large amount of
fruits
• Green – i...
• Clay – obstructive jaundice, barium meal x-ray
• Tarry black – haemorrhage in stomach/upper
intestine
• Dark brown to br...
Odour
• Normal odour is aromatic due to indole and
skatole
• Increased- excessive protein ingestion
• Sour rancid- fatty a...
Reaction
• Normal is neutral
• Ph varies from 6.9 to 7.2
• pH is dependent on bacterial fermentation
and putrefaction in t...
Mucus
• Small quantity of mucin is normal
• Small quantity – faeces from small gut
• Excessive quantity – infection of int...
Concretion
• In infants whitish curds may be found
• Gall bladder stones may be rarely found
Stool examination by Dr. Priy...
Blood
• Absent in normal faeces
• Formed stool with streaks of blood – lesion in
sigmoid colon, rectum or anal canal
• Liq...
Pus
• Normally absent
• Pus with blooded mucus- ulcerative colitis,
bacillary dysentery, ulcerative carcinoma
Stool examin...
• GROSS FOOD REMNANTS MAY IN NORMAL
STOOL
• UNDIGESTED TABLETS MAY BE FOUND
Stool examination by Dr. Priyanka
Buragohain
21
CHEMICAL EXAMINATION
Stool examination by Dr. Priyanka
Buragohain
22
Chemical Examination Of Stool
• Acidity/basicity
• Fats
• Nitrogen
• Stercobilinogen
• Coproporphyrin
• Occult blood
• Red...
FATS
• Normally upto 20% of total solids
• Lipids are measured as fatty acids:2-5 gm/24 hrs
• Known dietary intake and tim...
Titrimetric method
• Boil with alcoholic potassium hydroxide to
convert fats and fatty acid into soap
• cool
• HCl is adde...
Electrical capacitance methods
• Fecal suspension is extracted with solvent
specially with chlorinated benzene
• Extract i...
Interpretation
• Fecal fat increase in
• enteritis and pancreatic disease (lack of lipase)
• Surgical removal of a section...
Nitrogen
• Varies with the amount and nature of diet
• Normal is 1 to 1.5 gm /day
• Increase in azotorrhoea, pancreatic ac...
Stercobilinogen
• Normal is 40 to 280 mg/day
• Average is 150 mg/day
• Dependent on amount of bilirubin passing to
intesti...
Coproporphyrin
• Normal is 300 to 1100 mg/ day
• Type 1 – 70%
• Type 3 – 10 to 30%
• Abnormally increased in congenetial
p...
Occult blood
• Detect blood which is present in amount or form
not visible macroscopically
• Normally nil
• Abnormal prese...
BENZIDINE TEST
• 4 gm benzidine in 100 ml of glacial acetic acid
• Emulsify pea sized bit of faeces in 5 ml of
water.
• Mi...
• Trace- faint blue colour after 1
min
• 1+ - definite blue green slowly
• 2+ - green blue rapidly
• 3+ - blue almost imme...
GUAIAC TEST
• Less sensitive
• With loss of 20 to 30 ml of
blood all test will be positive
• Guaiac reagent consist of 1 g...
• Trace- faint blue green in 1 min
• 1+ light blue slowly
• 2+ clear blue rapidly
• 3 + deep blue almost immediately
• 4+ ...
ORTHOTOLIDINE TEST
• Intermediate sinsitivity
• Smear the stool on a filter paper with an
applicator
• Pipette a few drops...
Interpretation
• Gastric disease eg chronic ulcer and
malignancy
• Intestinal diseases eg dysentery, typhoid fever,
carcin...
Faecal reducing substance test
• To diagnose lactose intolerance
• Sample of 5 gm stool is needed
• Sample needs to be del...
Interpretation
• Negative/ trace- < 0.25 g/dl
• Suspicious(grade 1) – 0.25-0.5 g/dl
• Abnormal(grade 2-4)->0.5 g/dl
• Foun...
MICROSCOPIC
EXAMINATION
Stool examination by Dr. Priyanka
Buragohain
40
NEED FOR MICROSCOPIC EXAMINATION
• For the diagnosis of microscopic elements.
• Trophozoites and its movements are better ...
Stool examination by Dr. Priyanka
Buragohain
42
Need of concentration technique
• To see whether treatment of parasite is
successful
• To find ova of S. Mansoni or Taenia...
Stool examination by Dr. Priyanka
Buragohain
44
FLOATATION TECHNIQUE
• Use solutions which have highier specific
gravity(zinc sulphate or Sheather’s sugar) than
the organ...
SEDIMETATION TECHNIQUE
• Use solutions of lower specific
gravity than the parasitic
organisms(formalin ethyl
acetate techn...
Sedimentation techniques
• Mix a small piece of stool with 10 ml of water or saline in a tube/ bottle
• Sieve the suspensi...
Stool examination by Dr. Priyanka
Buragohain
48
Stainning methods
Wet mount
normal saline
Iodine solution
Buffered methylene blue solution
Eosin solution
Stainning ...
Microscopic examination of wet mount
Stool examination by Dr. Priyanka
Buragohain
50
Saline wet mount
Stool examination by Dr. Priyanka
Buragohain
51
Iodine wet mount
• Iodine kills the organisms, therefore
motility is lost.
• Used mainly to stain nuclei and
glycogen mass...
Lugol’s iodine
• Its very strong
• Must be diluted about 5 times with distilled water
• Stain deteriorates quickly hence t...
Buffered methylene blue wet mount
• Stains only trophozoites of
amoeba
• It does not stain amoebic
cyst or trophozoites an...
Eosin wet mount
• Detection of trophozoites
and cyst
• They can be much more
easily detected against
the pink- red backgro...
Stool examination by Dr. Priyanka
Buragohain
56
Stool examination by Dr. Priyanka
Buragohain
57
Stool examination by Dr. Priyanka
Buragohain
58
Stool examination by Dr. Priyanka
Buragohain
59
Cover with a cover slip
Stool examination by Dr. Priyanka
Buragohain
60
Stool examination by Dr. Priyanka
Buragohain
61
microscopic examination findings
• REMNANTS OF FOOD
• vegetable cells
• Muscle fibres
• Starch granules
• Fat globules
• C...
Vegetable cell
• Sometimes causes
confusion with ova,
eggs, cyst or cell bodies
• IRREGULAR OUTER
MARGIN
Excess quantity i...
Muscle fibres
• May confuse with Tinea segments
• Excess protein intake or indigestion
• Its excess excretion is called
Cr...
Starch granules
• Variable in size, round to
polygonal in shape,
colourless, circular or Y
shaped dot in the centre
• Conf...
Fat globules
• Appear similar to parasitic
cyst or cell bodies
• Emulsifying agents are
used to eliminate
confusion
• Conf...
Connective tissue/elastic fibres
• Confused with tinea
segments
• Signify indigestion
Stool examination by Dr. Priyanka
Bu...
Mineral oil/ castor oil globules
• When taken as purgative
• May be confused with ova of helminthes
Stool examination by D...
Epithelial cells
• Excess presence due to
inflammatory
conditions of colon,
rectum, anal canal
Stool examination by Dr. Pr...
Pus cells
• Commonly found in
normal stool, help to ease
the passage of stool
• Normally not visible to
human eye.
• If vi...
Macrophages
• Large mononuclear cells
with vesicular nucleus
and ingested materials
including RBC
• Confused with E.
Histo...
Ghost cells
• Degerative form of
macrophages, epithelial
cells
• Its an enlarged/swollen
eosinophilic epithelial
cell with...
Pyknotic bodies
• Nuclear remains of
tissue cells and
leucocytes
• Characteristic of acute
amoebic dysentery
Stool examina...
Eosinophils
• In intestinal allergy
• Diluting fluid used- Randolph’s diluting
fluid,Pilot’s stain
• Carbol chromotrope te...
RBCs
• seen in cases of ulcrative lesions of gut
• in bacillary dysentery – yellowish discrete
• Amoebic dysentery – green...
Crystals
• Fatty acid crystals
• Calcium oxalate crystals
• Triple phosphate crystals
• Charcot Leyden crystals
• Haemotoi...
• Charcot Leyden crystal:
• Slender and pointed at both ends,
Hexagonal bipyramidal structures
localised in the primary gr...
• Haematoidin crystals:
• Ironless pigment derived from
haemoglobin and formed within
tissues(reticuloendothelial cells)
b...
Yeast and molds
• Yeast are normally
present
• Excess in cases of AIDS
• Molds are rare but may
be seen in
immunodeficienc...
Parasites
Stool examination by Dr. Priyanka Buragohain 80
Stool examination by Dr. Priyanka
Buragohain
81
Stool examination by Dr. Priyanka
Buragohain
82
Stool examination by Dr. Priyanka
Buragohain
83
protozoa
Entamoeba histolytica
TROPHOZOITE STAGE
• Identified by motility and
presence of ingested RBC
• Shape : constantly changin...
Stool examination by Dr. Priyanka
Buragohain
85
RBC appear yellowish green inside the
endoplasm
Nucleus is not visible but...
PRE CYSTIC STAGE
• Size :small in size,10 to 20
µm
• Shape :round or slightly
ovoid with blunt
pseudopodium
• Free from in...
CYSTIC STAGE
• Size : 6 to 9 µm / 12 to 15
µm
• Shape : round, surrounded
by a highly refractile
membrane called cyst wall...
Stool examination by Dr. Priyanka
Buragohain
88
•Iodine mounting
•Body of the parasite stains yellow to light
brown
•Nucle...
Entamoeba coli
TROPHOZOITE STAGE
• Largest amoeba 20-40 µm in diameter
• Sluggishly motile
• Cytoplasm not clearly defined...
• CYST
• 15- 20 µm in diameter
• Rounded body
• Octanucleate
• Largen glycogen mass in
binucleate stage
• Chromatoid body ...
Endolimax nana
• Commensal in large intestine of
man
• Trophozoites are smaller in
size(8-9 µm in diameter)
• Sluggish in ...
CYST
• Cyst are oval
• Same size as the
trophozoites
• Number nuclei are 1-4
• Mature cyst are
quadrinucleate
• Chromatoid...
Difference between different trophozoites
Stool examination by Dr. Priyanka
Buragohain
93
Difference between different cyst
Stool examination by Dr. Priyanka
Buragohain
94
Stool examination by Dr. Priyanka
Buragohain
95
OTHER NON PATHOGENIC AMOEBIDA SPECIES
Trophozoite of E. hartmani
Trophozoi...
Stool examination by Dr. Priyanka
Buragohain
96
Balantidium coli
•Largest protozoal parasite
•Pig is the common reservoir
...
CYST
• Smaller than trophic, 50-60
µm in diameter
• Cytoplasm is granular
contains the macronucleus,
micronucleus, refract...
Giardia lambia
• TROPHOZOITE
• Flat view: a tennis or badminton racket
• Side view: longitudinally split pear
• Dorsal sur...
CYST
• Oval in shape
• Size is 12 × 7 µm
• Axostyle lie diagonally like dividing wall
within the cyst wall
• 4 nuclei lie ...
Stool examination by Dr. Priyanka
Buragohain
100
What we can see in microscopic
examination of stool ?
Stool examination by Dr. Priyanka
Buragohain
101
ADULT WORM
LARVA
OV...
Stool examination by Dr. Priyanka
Buragohain
102
HELMINTHES
PLATYHELMINTHES NEMATHELMINTHES
CESTODE
TREMATODE
NEMATODE
TAP...
ADULT WORM
• TAENIA SAGINATA/SOLIUM
• DIPHYLLOBOTHRIUM
• HYMENOLEPIS
• DYPILIDIUM
LARVAL STAGE
• ECHINOCOCCUS: Hydatid
cys...
Taenia solium
• Segments of Tape worm or single
segment may be found
• White in colour, semi transparent.
• May be 3 – 10 ...
Eggs of T. saginata
• Spherical and brown in colour
• 31-43µm in diameter
• Thin outer transparent
shell(remnants of yolk ...
Taenia solium
• 2-3 metres long(800-900
proglottides)
• Scolex is 1mm in diameter,
globular in outline, 4 circular
suckers...
• EGGS
• Same as T. Solium
• 30x40 µm sized egg
• Pale yellow
• Thick radially striated
embryophore with 6
hooklets inside...
Echinococcus granulosus
• Commonly called dog
tapeworm/ hydatid worm
• Man harbours the larval form,
not the adult
• Larva...
Stool examination by Dr. Priyanka
Buragohain
109
Hymenolepis diminuta
Gastrodiscoides hominis
• Prevalent in Assam and Bengal
• Pyriform in shape
• Measures 5-10 mm × 4-6 mm
• Body has 2 parts...
Fasciola hepatica
• Eggs
• Large, operculated, ovoid , brownish
yellow(bile stained)
• Size is 140× 80 µm
• Contains a lar...
Fasciola buski
• Reported in Assam, bengal,
china, thailand and other
oriental regions
• Largest trematode(2-7.5 length,
8...
Clonorchis sinensis
EGGS
• Yellowish brown
• Flask shaped
• Operculated
• Possess a terminal hook like
spine(resembling an...
Paragonimus westermani
• Golden brown in colour
• Oval in shape with flattened
opercula
• 80- 55 µm
• Each egg contains an...
Ascaris lumbricoids
• Large round worms may
be males and females
or both
• Pinkish in colour
• 0.3-0.4 cm in thickness
• 1...
• UNFERTILISED EGGS
• Do not float on floatation method
• Size- 40×70 µm
• Yellow in colour
• Elongated
• Mammilated thin ...
Enterobius vermicularis
• Small round worm or thread
like worm or pin
worm(spindle shaped)
• White coloured
• 0.5-1 cm lon...
• EGGS
• Colourless(not bile
stained)
• 20×50 µm
• Assymetrical, Oval
planoconvex,
• thin transparent
shelled,
• contain c...
Ancylostoma duodenale
• Hook worm
• Small greyish white or pink
coloured cylindrical
• 1-1.5 cm long
• One end is curved l...
EGGS
• Oval or elliptical in shape
• 40x60 µm sized egg
• Colourless(not bile
stained)
• Surrounded by a
transparent hyali...
Trichuris trichiura
• Whip worm
• Looks like a tiny whip
with a handle and a lash
• 3-5 cm in length
• White coloured
Stoo...
• 25x50 µm sized egg
• Brown coloured
• Double shelled, outer
one is bile stained
• Thick shelled, barrel
shaped with mucu...
Strongyloids stercoralis
• Adult worm:
• Females are readily
discovered than males
• 2.5mm ×40-50 µm
(females)
• Posterior...
• Eggs
• Eggs are conspicuous within the body in a
single line
• 55-30µm
• Thin shelled
• Transparent, oval
• Contain larv...
• Rhabditiform larvae
• Develop directly from
gravid females
• Short mouth, double-
bulb oesophagus
• Filariform larvae
• ...
Stool examination by Dr. Priyanka
Buragohain
126
Helminthes that float/do not float on
saturated solution of saline
Eggs that float
• A. Duodenale
• N. Americanas
• E. Ver...
Stool examination by Dr. Priyanka
Buragohain
128
Stool examination by Dr. Priyanka
Buragohain
129
Stool examination by Dr. Priyanka
Buragohain
130
Stool examination by Dr. Priyanka
Buragohain
131
Plant hairs can be confused for larvae
oh hookworm or Strongyloides sterc...
Stool examination by Dr. Priyanka
Buragohain
132
Parasite of earth worm
Pollen grain resemblening to
fertile egg of A. lum...
Stool examination by Dr. Priyanka
Buragohain
133
STOOL CULTURE
• Used to detect the presence of disease
causing(pathogenic )bacteria
• Help to diagnose an infection of dig...
Most common bacteria for culture of stool
• Campylobacter species
• Salmonella species
• Shigella species
• Yersinia speci...
Collection
• Specimen collected via rectal swab(in infants)
• Sterile collection container not required
• No detergent or ...
Medias used commonly
• MacConkey agar- Salmonella species, shigella
species
• Eosin methylene blue agar
• Triple sugar iro...
Summary
• Definition of stool
• Composition of stool
• Precaution and collection of
sample
• Physical examination
• Chemic...
THANK YOU !!!Stool examination by Dr. Priyanka
Buragohain
139
Upcoming SlideShare
Loading in …5
×

of

Routine examination of stool Slide 1 Routine examination of stool Slide 2 Routine examination of stool Slide 3 Routine examination of stool Slide 4 Routine examination of stool Slide 5 Routine examination of stool Slide 6 Routine examination of stool Slide 7 Routine examination of stool Slide 8 Routine examination of stool Slide 9 Routine examination of stool Slide 10 Routine examination of stool Slide 11 Routine examination of stool Slide 12 Routine examination of stool Slide 13 Routine examination of stool Slide 14 Routine examination of stool Slide 15 Routine examination of stool Slide 16 Routine examination of stool Slide 17 Routine examination of stool Slide 18 Routine examination of stool Slide 19 Routine examination of stool Slide 20 Routine examination of stool Slide 21 Routine examination of stool Slide 22 Routine examination of stool Slide 23 Routine examination of stool Slide 24 Routine examination of stool Slide 25 Routine examination of stool Slide 26 Routine examination of stool Slide 27 Routine examination of stool Slide 28 Routine examination of stool Slide 29 Routine examination of stool Slide 30 Routine examination of stool Slide 31 Routine examination of stool Slide 32 Routine examination of stool Slide 33 Routine examination of stool Slide 34 Routine examination of stool Slide 35 Routine examination of stool Slide 36 Routine examination of stool Slide 37 Routine examination of stool Slide 38 Routine examination of stool Slide 39 Routine examination of stool Slide 40 Routine examination of stool Slide 41 Routine examination of stool Slide 42 Routine examination of stool Slide 43 Routine examination of stool Slide 44 Routine examination of stool Slide 45 Routine examination of stool Slide 46 Routine examination of stool Slide 47 Routine examination of stool Slide 48 Routine examination of stool Slide 49 Routine examination of stool Slide 50 Routine examination of stool Slide 51 Routine examination of stool Slide 52 Routine examination of stool Slide 53 Routine examination of stool Slide 54 Routine examination of stool Slide 55 Routine examination of stool Slide 56 Routine examination of stool Slide 57 Routine examination of stool Slide 58 Routine examination of stool Slide 59 Routine examination of stool Slide 60 Routine examination of stool Slide 61 Routine examination of stool Slide 62 Routine examination of stool Slide 63 Routine examination of stool Slide 64 Routine examination of stool Slide 65 Routine examination of stool Slide 66 Routine examination of stool Slide 67 Routine examination of stool Slide 68 Routine examination of stool Slide 69 Routine examination of stool Slide 70 Routine examination of stool Slide 71 Routine examination of stool Slide 72 Routine examination of stool Slide 73 Routine examination of stool Slide 74 Routine examination of stool Slide 75 Routine examination of stool Slide 76 Routine examination of stool Slide 77 Routine examination of stool Slide 78 Routine examination of stool Slide 79 Routine examination of stool Slide 80 Routine examination of stool Slide 81 Routine examination of stool Slide 82 Routine examination of stool Slide 83 Routine examination of stool Slide 84 Routine examination of stool Slide 85 Routine examination of stool Slide 86 Routine examination of stool Slide 87 Routine examination of stool Slide 88 Routine examination of stool Slide 89 Routine examination of stool Slide 90 Routine examination of stool Slide 91 Routine examination of stool Slide 92 Routine examination of stool Slide 93 Routine examination of stool Slide 94 Routine examination of stool Slide 95 Routine examination of stool Slide 96 Routine examination of stool Slide 97 Routine examination of stool Slide 98 Routine examination of stool Slide 99 Routine examination of stool Slide 100 Routine examination of stool Slide 101 Routine examination of stool Slide 102 Routine examination of stool Slide 103 Routine examination of stool Slide 104 Routine examination of stool Slide 105 Routine examination of stool Slide 106 Routine examination of stool Slide 107 Routine examination of stool Slide 108 Routine examination of stool Slide 109 Routine examination of stool Slide 110 Routine examination of stool Slide 111 Routine examination of stool Slide 112 Routine examination of stool Slide 113 Routine examination of stool Slide 114 Routine examination of stool Slide 115 Routine examination of stool Slide 116 Routine examination of stool Slide 117 Routine examination of stool Slide 118 Routine examination of stool Slide 119 Routine examination of stool Slide 120 Routine examination of stool Slide 121 Routine examination of stool Slide 122 Routine examination of stool Slide 123 Routine examination of stool Slide 124 Routine examination of stool Slide 125 Routine examination of stool Slide 126 Routine examination of stool Slide 127 Routine examination of stool Slide 128 Routine examination of stool Slide 129 Routine examination of stool Slide 130 Routine examination of stool Slide 131 Routine examination of stool Slide 132 Routine examination of stool Slide 133 Routine examination of stool Slide 134 Routine examination of stool Slide 135 Routine examination of stool Slide 136 Routine examination of stool Slide 137 Routine examination of stool Slide 138 Routine examination of stool Slide 139
Upcoming SlideShare
Coprología examen de heces
Next
Download to read offline and view in fullscreen.

245 Likes

Share

Download to read offline

Routine examination of stool

Download to read offline

Routine examination of stool

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

Routine examination of stool

  1. 1. STOOL EXAMINATION Presented by: Dr. Priyanka Buragohain Guided by: Dr. Hemen Kalita Deptt. Of Roga Nidan. Govt. Ayurvedic College
  2. 2. DEFINITION • Human feces is called as stool. • faeces / feces is plural of latin term faex meaning RESIDUE. • It is the waste residue of indigestible materials of an animal’s digestive tract expelled through the anus during defecation. • Meconium is newborn’s first feces. • SCATOLGY or CAPROLOGY is the study of feces. Stool examination by Dr. Priyanka Buragohain 2
  3. 3. COMPOSITION • ¾ water, ¼ solid • Undigested and unabsorbed food • Intestinal secretions, mucous • Bile pigments and salts • Decomposed products • Bacteria and inorganic material • Epithelial cells, leukocytes. Stool examination by Dr. Priyanka Buragohain 3
  4. 4. PRECAUTION BEFORE COLLECTION • Patient should avoid the following things for at least 48 hours before collection of stool: • Mineral oils, bismuth, non absorbable anti diarrhoeal drugs, antimalarial drugs, antibiotics, etc • Pt. Should not have barium swallow examination before stool R/E • Avoid iron containing drugs, meat, fish etc for atleast 48 hours before stool for occult blood. • In constipated patients use only non residual purgative Stool examination by Dr. Priyanka Buragohain 4
  5. 5. COLLECTION • Universal precautions • Pt. is asked to pass stool in a clean container. • Stool should be collected in a steralized, wide mouthed container. • Loose/last/portion containing mucus, blood etc is to be collected in a wide mouthed bottle. • Should be uncontaminated with urine or any other body secretions. • >2gm is required. • Properly named and always a fresh sample should be tested. • Liquid stool to be examined within ½ hour • Solid stool to be examined within 1 hour. • If delayed store in a refrigerator. Stool examination by Dr. Priyanka Buragohain 5
  6. 6. COLLECTION CONTD... • 3 samples of stool within 10 days to exclude false negatives. • 2 samples to be examined on alternate days after normal defaecation and 1 sample after a purgative for certain worms. • Formalin is the best preservative. It kills the bacteria but ptreserves the protozoa and helminthes. • For culture no preservatives to be used Stool examination by Dr. Priyanka Buragohain 6
  7. 7. 7 Stool examination by Dr. Priyanka Buragohain
  8. 8. TYPES OF EXAMINATION • PHYSICAL EXAMINATION: colour, volume, consistency, odour, mucus, pus, concreations, helminths. • CHEMICAL EXAMINATION: reactions, occult blood, fat, carbohydrate, protein, etc • MICROSCOPIC EXAMINATION: remnants of food, pus cells, macrophages, RBCs, crystals, bacteria, yeasts, molds, protozoa, helminths. • STOOL CULTURE: Stool examination by Dr. Priyanka Buragohain 8
  9. 9. Physical examination • AMOUNT • CONSISTENCY • COLOUR • ODOUR • REACTION • MUCUS • CONCRETION • BLOOD • PUS • FOOD REMNANT • UNDIGESTED TABLETS Stool examination by Dr. Priyanka Buragohain 9
  10. 10. MACROSCOPIC EXAMINATION AMOUNT • Normal is 150 g to 200 g/day • Increased in steatorrhoea, diarrhoea, indigestion of carbohydrate. Stool examination by Dr. Priyanka Buragohain 10
  11. 11. CONSISTENCY OR FORM • Normal is soft but formed • Excessively hard/scybala- habitual constipation • Flattened or ribbon like-intake of excess of mineral oil, carcinoma of rectum, stricture of rectum • Soft, mushy, liquid and voluminous- diarrhoea, intake of purgatives • Small numerous, largely mucus and blood with small amount of stool- dysenteries • Rice watery without fecal matter- Cholera Stool examination by Dr. Priyanka Buragohain 11
  12. 12. Stool examination by Dr. Priyanka Buragohain 12
  13. 13. Colour • Dark Grey- excessive cocoa or chocolate ingestion • Reddish or blackish brown- large amount of fruits • Green – ingestion of green leafy vegetables, administration of calomel due to biliverdin • Red – Beat ingestion fresh blood • Yellow – rhubarb or senna ingestion, normal stool Stool examination by Dr. Priyanka Buragohain 13
  14. 14. • Clay – obstructive jaundice, barium meal x-ray • Tarry black – haemorrhage in stomach/upper intestine • Dark brown to bright red – bleeding in rectum or sigmoid colon • Red streaks of blood on the surface of faeces- haemorrhoids, fissures, carcinoma ,ulcerative colitis Stool examination by Dr. Priyanka Buragohain 14
  15. 15. Odour • Normal odour is aromatic due to indole and skatole • Increased- excessive protein ingestion • Sour rancid- fatty acid in milk indigestion (in children and adults), normal in infants • Putrid- severe diarrhoea of malignancy, gangrenous dysentry Stool examination by Dr. Priyanka Buragohain 15
  16. 16. Reaction • Normal is neutral • Ph varies from 6.9 to 7.2 • pH is dependent on bacterial fermentation and putrefaction in the bowel. • Alkaline – excess protein ingestion • Acidic – excess carbohydrate ingestion Stool examination by Dr. Priyanka Buragohain 16
  17. 17. Mucus • 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, intussusception Stool examination by Dr. Priyanka Buragohain 17
  18. 18. Concretion • In infants whitish curds may be found • Gall bladder stones may be rarely found Stool examination by Dr. Priyanka Buragohain 18
  19. 19. Blood • Absent in normal faeces • Formed stool with streaks of blood – lesion in sigmoid colon, rectum or anal canal • Liquid stool with bright red blood, pus and mucus- bacillary dysentery, ulcerative colitis • Semi formed stool with deep tarry black blood- melena • Loose stool with deep cherry red blood- melena Stool examination by Dr. Priyanka Buragohain 19
  20. 20. Pus • Normally absent • Pus with blooded mucus- ulcerative colitis, bacillary dysentery, ulcerative carcinoma Stool examination by Dr. Priyanka Buragohain 20
  21. 21. • GROSS FOOD REMNANTS MAY IN NORMAL STOOL • UNDIGESTED TABLETS MAY BE FOUND Stool examination by Dr. Priyanka Buragohain 21
  22. 22. CHEMICAL EXAMINATION Stool examination by Dr. Priyanka Buragohain 22
  23. 23. Chemical Examination Of Stool • Acidity/basicity • Fats • Nitrogen • Stercobilinogen • Coproporphyrin • Occult blood • Reducing substances • N. B : most commonly used chemical examination of stool is pH, occult blood and reducing substances Stool examination by Dr. Priyanka Buragohain 23
  24. 24. FATS • Normally upto 20% of total solids • Lipids are measured as fatty acids:2-5 gm/24 hrs • Known dietary intake and timed stool collection. • Take diet containing 100 gm of fat daily, 3 day stool collection. • >6 gm/day is abnormal • Quantitative or semiquantitative methods:  Gravimetric method  Isotopic techniques(radio-isotopes)  Electrical capacitance method  Titrimetric method of Van de Kamer Stool examination by Dr. Priyanka Buragohain 24
  25. 25. Titrimetric method • Boil with alcoholic potassium hydroxide to convert fats and fatty acid into soap • cool • HCl is added to convert soap to fatty acid • Fatty acid extracted with petroleum ether • Aliquot is evaporated, taken up in neutral alcohol • Ttitrate with sodium hydroxide • Fatts are calculated as fatty acids Stool examination by Dr. Priyanka Buragohain 25
  26. 26. Electrical capacitance methods • Fecal suspension is extracted with solvent specially with chlorinated benzene • Extract is filtered • Electrical capacitance is measured and compared with standard of triolein simillarly treated Stool examination by Dr. Priyanka Buragohain 26
  27. 27. Interpretation • Fecal fat increase in • enteritis and pancreatic disease (lack of lipase) • Surgical removal of a section of intestine • Mal absorption syndrome • Chronic pancreatic disease(> 10 gm / 24 hr) • Neutral fat increase in • Use of rectal suppositories • Ingestion of castor oil or mineral oil • Ingestion of dietetic low calories mayonnaise • Tropical sprue Stool examination by Dr. Priyanka Buragohain 27
  28. 28. Nitrogen • Varies with the amount and nature of diet • Normal is 1 to 1.5 gm /day • Increase in azotorrhoea, pancreatic achylia, pancreatogenous fatty diarrhoea, idiopathic steatorrhoea Stool examination by Dr. Priyanka Buragohain 28
  29. 29. Stercobilinogen • Normal is 40 to 280 mg/day • Average is 150 mg/day • Dependent on amount of bilirubin passing to intestine(jaundice) Stool examination by Dr. Priyanka Buragohain 29
  30. 30. Coproporphyrin • Normal is 300 to 1100 mg/ day • Type 1 – 70% • Type 3 – 10 to 30% • Abnormally increased in congenetial porphyria • Abnormallly decreased i9n liver disease like cirrochis, hepattitis, passive4 venous congestion, metastatic carcinoma in liver Stool examination by Dr. Priyanka Buragohain 30
  31. 31. Occult blood • Detect blood which is present in amount or form not visible macroscopically • Normally nil • Abnormal presence in condition of occult haemorrhage in the GI tract • BENZIDINE TEST • GUAIAC TEST • ORTHOTOLIDINE TEST • Most commonly used test is benzidine test Stool examination by Dr. Priyanka Buragohain 31
  32. 32. BENZIDINE TEST • 4 gm benzidine in 100 ml of glacial acetic acid • Emulsify pea sized bit of faeces in 5 ml of water. • Mix 1 ml emulsion and 1 ml of reagent in test tube • Add several drops of 35 H2O2 • Blue colour indicates positive reaction Stool examination by Dr. Priyanka Buragohain 32
  33. 33. • Trace- faint blue colour after 1 min • 1+ - definite blue green slowly • 2+ - green blue rapidly • 3+ - blue almost immediately • 4+ - dark blue immediately Stool examination by Dr. Priyanka Buragohain 33
  34. 34. GUAIAC TEST • Less sensitive • With loss of 20 to 30 ml of blood all test will be positive • Guaiac reagent consist of 1 gm Guaiac in 5 ml of 95% ethanol. • Make a small smear of feces on a filter paper • Add 2 to 3 drops of gum guaiac solution + 2 to 3 drops of glacial acetic acid + 2 to 3 drops of 3% H2O2 Stool examination by Dr. Priyanka Buragohain 34
  35. 35. • Trace- faint blue green in 1 min • 1+ light blue slowly • 2+ clear blue rapidly • 3 + deep blue almost immediately • 4+ deep blue immediately Stool examination by Dr. Priyanka Buragohain 35
  36. 36. ORTHOTOLIDINE TEST • Intermediate sinsitivity • Smear the stool on a filter paper with an applicator • Pipette a few drops of the reagent on to the filter paper(orthotolidine barium peroxide 200 mg+ glacial acetic acid 5 ml) • After 30 sec examine for a blue colour • Blue green colour within 30 sec means positive test Stool examination by Dr. Priyanka Buragohain 36
  37. 37. Interpretation • Gastric disease eg chronic ulcer and malignancy • Intestinal diseases eg dysentery, typhoid fever, carcinoma • Haemorrhoids • During instrumentation Stool examination by Dr. Priyanka Buragohain 37
  38. 38. Faecal reducing substance test • To diagnose lactose intolerance • Sample of 5 gm stool is needed • Sample needs to be delivered to the laboratory as soon as possible, preferably within 1 hr , cause lactose in the stool will normally be broken down by chemical processes within 2-4 hrs after the specimen is produced. Stool examination by Dr. Priyanka Buragohain 38
  39. 39. Interpretation • Negative/ trace- < 0.25 g/dl • Suspicious(grade 1) – 0.25-0.5 g/dl • Abnormal(grade 2-4)->0.5 g/dl • Found in Carbohydrate malabsorption • Tropical sprue Stool examination by Dr. Priyanka Buragohain 39
  40. 40. MICROSCOPIC EXAMINATION Stool examination by Dr. Priyanka Buragohain 40
  41. 41. NEED FOR MICROSCOPIC EXAMINATION • For the diagnosis of microscopic elements. • Trophozoites and its movements are better seen in unstained preparation of a fresh material. • Cystic forms &Nuclear character are better seen in stained preparation(iodine) • Gycogen mass- stained with iodine • Chromatoid bars- unstained preparation • N.B – Both stained and unstained materials are to be prepared Stool examination by Dr. Priyanka Buragohain 41
  42. 42. Stool examination by Dr. Priyanka Buragohain 42
  43. 43. Need of concentration technique • To see whether treatment of parasite is successful • To find ova of S. Mansoni or Taenia if few or other ova and cyst are not seen in routine examination • To examine stool specimens from patients who do not come from an area where a particular parasite is found Stool examination by Dr. Priyanka Buragohain 43
  44. 44. Stool examination by Dr. Priyanka Buragohain 44
  45. 45. FLOATATION TECHNIQUE • Use solutions which have highier specific gravity(zinc sulphate or Sheather’s sugar) than the organisms to be floated so that the organisms rise to the top and the debries sink to the bottom. • Advantage – produce a cleaner material than the sedimentation technique • Disadvantage – walls of eggs and cyst will often collapse, hindering identification. • Some parasite eggs do not float. Stool examination by Dr. Priyanka Buragohain 45
  46. 46. SEDIMETATION TECHNIQUE • Use solutions of lower specific gravity than the parasitic organisms(formalin ethyl acetate technique) • Recommended for general diagnostic laboratories due to easy to perform and less prone to technical error. Stool examination by Dr. Priyanka Buragohain 46
  47. 47. Sedimentation techniques • Mix a small piece of stool with 10 ml of water or saline in a tube/ bottle • Sieve the suspension into a beaker through a strainer with small holes. • Pour the contents into a centrifuge tube • Centrifuge at 2000-3000/rpm for 1 min • Pour off the supernatant part • Resuspend the deposit in clean water and add enough water to fill the tube. • Mix well and recentrifuge • Pour off the supernatant part • Resuspend in zinc sulphate solution, fill the tube with the solution • Centrifuge at high speed for 1 min • Transfer the contents from the surface of the tube to a slide, using a bacteriological wire loop • Add small drops of saline and mix • Cover with a cover slip • Examine under 10x and 40x objectives Stool examination by Dr. Priyanka Buragohain 47
  48. 48. Stool examination by Dr. Priyanka Buragohain 48
  49. 49. Stainning methods Wet mount normal saline Iodine solution Buffered methylene blue solution Eosin solution Stainning for permanent preparation Schaudinn’s fluid Heidenhain’s Haematoxilin method Trichome stain Stool examination by Dr. Priyanka Buragohain 49
  50. 50. Microscopic examination of wet mount Stool examination by Dr. Priyanka Buragohain 50
  51. 51. Saline wet mount Stool examination by Dr. Priyanka Buragohain 51
  52. 52. Iodine wet mount • Iodine kills the organisms, therefore motility is lost. • Used mainly to stain nuclei and glycogen mass if present. • Flagella becomes recognisable. • Cyst can usually be specifically identified in this method. • Lugol’s iodine solution is used. Stool examination by Dr. Priyanka Buragohain 52
  53. 53. Lugol’s iodine • Its very strong • Must be diluted about 5 times with distilled water • Stain deteriorates quickly hence to be prepared every 2 weeks • Contains: Iodine crystals(powdered): 5 g Potassium iodide :10 g Distilled water : 10 • Potassium iodide is dissolved in distilled water and iodine crystals are slowly added. Solution is filtered and kept in a stoppered bottle of amber colour Stool examination by Dr. Priyanka Buragohain 53
  54. 54. Buffered methylene blue wet mount • Stains only trophozoites of amoeba • It does not stain amoebic cyst or trophozoites and cyst of flagellates. • Nucleus and the inclusions such as RBC or yeast cells stain dark blue • Cytoplasm stains light blue Stool examination by Dr. Priyanka Buragohain 54
  55. 55. Eosin wet mount • Detection of trophozoites and cyst • They can be much more easily detected against the pink- red background of eosin preparation Stool examination by Dr. Priyanka Buragohain 55
  56. 56. Stool examination by Dr. Priyanka Buragohain 56
  57. 57. Stool examination by Dr. Priyanka Buragohain 57
  58. 58. Stool examination by Dr. Priyanka Buragohain 58
  59. 59. Stool examination by Dr. Priyanka Buragohain 59 Cover with a cover slip
  60. 60. Stool examination by Dr. Priyanka Buragohain 60
  61. 61. Stool examination by Dr. Priyanka Buragohain 61
  62. 62. microscopic examination findings • REMNANTS OF FOOD • vegetable cells • Muscle fibres • Starch granules • Fat globules • Connective tissue/ elastic fibres • Mineral oil or castor oil globules • CELLS • Epithelial cells • Pus cells • Macrophages • Ghost cells • Pyknotic bodies • Eosinophills • RBC • Crystals • Yeasts and molds • Protozoa • Helminthic parasites Stool examination by Dr. Priyanka Buragohain 62
  63. 63. Vegetable cell • Sometimes causes confusion with ova, eggs, cyst or cell bodies • IRREGULAR OUTER MARGIN Excess quantity is seen in excess intake of vegetables or indigestion Stool examination by Dr. Priyanka Buragohain 63
  64. 64. Muscle fibres • May confuse with Tinea segments • Excess protein intake or indigestion • Its excess excretion is called Creatorrhoea(flesh-flow) Stool examination by Dr. Priyanka Buragohain 64
  65. 65. Starch granules • Variable in size, round to polygonal in shape, colourless, circular or Y shaped dot in the centre • Confused with ova of helminths • Found in carbohydrate dyspepsia • Better seen in iodine preparation Stool examination by Dr. Priyanka Buragohain 65
  66. 66. Fat globules • Appear similar to parasitic cyst or cell bodies • Emulsifying agents are used to eliminate confusion • Confused with ova of helminths • Found in fat dyspepsia Stool examination by Dr. Priyanka Buragohain 66
  67. 67. Connective tissue/elastic fibres • Confused with tinea segments • Signify indigestion Stool examination by Dr. Priyanka Buragohain 67
  68. 68. Mineral oil/ castor oil globules • When taken as purgative • May be confused with ova of helminthes Stool examination by Dr. Priyanka Buragohain 68
  69. 69. Epithelial cells • Excess presence due to inflammatory conditions of colon, rectum, anal canal Stool examination by Dr. Priyanka Buragohain 69
  70. 70. Pus cells • Commonly found in normal stool, help to ease the passage of stool • Normally not visible to human eye. • If visible indicates disease • Bacillary dysentery, UC, acute Amoebic dysentery, malignancy of rectum, drug induced enterocilitis Stool examination by Dr. Priyanka Buragohain 70
  71. 71. Macrophages • Large mononuclear cells with vesicular nucleus and ingested materials including RBC • Confused with E. Histolytica cyst or E. Coli cyst • Excess in Amoebic or bacillary dysentery Stool examination by Dr. Priyanka Buragohain 71
  72. 72. Ghost cells • Degerative form of macrophages, epithelial cells • Its an enlarged/swollen eosinophilic epithelial cell with only eosinophilic cytoplasmic outline but without a nucleus • Characteristic of bacillary dysentery Stool examination by Dr. Priyanka Buragohain 72
  73. 73. Pyknotic bodies • Nuclear remains of tissue cells and leucocytes • Characteristic of acute amoebic dysentery Stool examination by Dr. Priyanka Buragohain 73
  74. 74. Eosinophils • In intestinal allergy • Diluting fluid used- Randolph’s diluting fluid,Pilot’s stain • Carbol chromotrope technique • A measured quantity of the deposit is taken and diluted with the diluting fluid 1:10 or 1: 20 according to the concentration of the residue and counted in haemocytometer. • Increased in allergic conditions, parasitic infestation and drug allergy, ulcerative colitis Stool examination by Dr. Priyanka Buragohain 74
  75. 75. RBCs • seen in cases of ulcrative lesions of gut • in bacillary dysentery – yellowish discrete • Amoebic dysentery – greenish and in clumps Stool examination by Dr. Priyanka Buragohain 75
  76. 76. Crystals • Fatty acid crystals • Calcium oxalate crystals • Triple phosphate crystals • Charcot Leyden crystals • Haemotoidin crystals • Crystals of drugs Stool examination by Dr. Priyanka Buragohain 76
  77. 77. • Charcot Leyden crystal: • Slender and pointed at both ends, Hexagonal bipyramidal structures localised in the primary granues of cytoplasm of eosinophils and basophils • Evidence of parasitic infiltrate eg amoeba, ascaris, hookworm, fasciola • diamond shaped or whetstone shaped crystals • Normally colourless, stained purplish- red by trichome • Vary in size and may be as large as 50 µm in length • Found in UC, dysentery, malignant ulcers, schistosomiasis etc Stool examination by Dr. Priyanka Buragohain 77
  78. 78. • Haematoidin crystals: • Ironless pigment derived from haemoglobin and formed within tissues(reticuloendothelial cells) but found extracellularly after 5-7 days in foci of previous haemorrhage. • Occurs as refractile, yellow- brown and orange-red granules • Characteristically as rhomboid plates arranged in a radial pattern, so called hematoidin burrs. Stool examination by Dr. Priyanka Buragohain 78
  79. 79. Yeast and molds • Yeast are normally present • Excess in cases of AIDS • Molds are rare but may be seen in immunodeficiency conditions Stool examination by Dr. Priyanka Buragohain 79
  80. 80. Parasites Stool examination by Dr. Priyanka Buragohain 80
  81. 81. Stool examination by Dr. Priyanka Buragohain 81
  82. 82. Stool examination by Dr. Priyanka Buragohain 82
  83. 83. Stool examination by Dr. Priyanka Buragohain 83 protozoa
  84. 84. Entamoeba histolytica TROPHOZOITE STAGE • Identified by motility and presence of ingested RBC • Shape : constantly changing position • Size :ranges from 18 to 40 µm ,average being 20 to 20 µm • Cytoplasm :divisible in two portion • Nucleus :spherical in shape Stool examination by Dr. Priyanka Buragohain 84
  85. 85. Stool examination by Dr. Priyanka Buragohain 85 RBC appear yellowish green inside the endoplasm Nucleus is not visible but a faint outline may be detected Endoplasm shows bluish or ground glass appearance Eccentric nucleus with karyosome (a small dot at the centre surrounded by a clear halo), nuclear membrane, Linen network having a spoke like radial arrangement
  86. 86. PRE CYSTIC STAGE • Size :small in size,10 to 20 µm • Shape :round or slightly ovoid with blunt pseudopodium • Free from ingested RBC and other materials • Nucleus : large nucleus • Retains the characteristics of trophozoite. Stool examination by Dr. Priyanka Buragohain 86
  87. 87. CYSTIC STAGE • Size : 6 to 9 µm / 12 to 15 µm • Shape : round, surrounded by a highly refractile membrane called cyst wall • Nucleus :quadrinucleate • Clear and hyaline cytoplasm • Nuclear structure retainning the character of trophozoite Stool examination by Dr. Priyanka Buragohain 87
  88. 88. Stool examination by Dr. Priyanka Buragohain 88 •Iodine mounting •Body of the parasite stains yellow to light brown •Nucleus is clearly seen with a karyosome •Cytoplasm is smooth and hyaline appearance •Glycogen mass stains brown Saline mounting •Chromatid bodies are seen as round refracile bars •Cyst wall smooth and thin •Glycogen bar not visible •Outlines of nuclei may be visible Iron haematoxillin stain •Chromatid body and nucleus stain jet black •Cytoplasm stains bluish or greyish •Glycogen mass gets dissolved in the process of stainning and remains as a vacuole
  89. 89. Entamoeba coli TROPHOZOITE STAGE • Largest amoeba 20-40 µm in diameter • Sluggishly motile • Cytoplasm not clearly defined • Opaque endoplasm packed with food vacuoles with bacteria and others but no RBC • Nucleus visible in unstainned preparation • In stainned prep nucleus shows large eccentric karyosome surrounded by broader halo and coarse chromatin ranules linning nuclear membrane Stool examination by Dr. Priyanka Buragohain 89
  90. 90. • CYST • 15- 20 µm in diameter • Rounded body • Octanucleate • Largen glycogen mass in binucleate stage • Chromatoid body if present are in slender filaments or pointed threads • Glycogen mass and chromatoid bodies are absent in mature cyst Stool examination by Dr. Priyanka Buragohain 90
  91. 91. Endolimax nana • Commensal in large intestine of man • Trophozoites are smaller in size(8-9 µm in diameter) • Sluggish in motility • Cytoplasmic inclusions contain bacteria and food particles but no RBC • Nucleus has irregular karyosome, eccentric and in contact with nuclear membrane Stool examination by Dr. Priyanka Buragohain 91
  92. 92. CYST • Cyst are oval • Same size as the trophozoites • Number nuclei are 1-4 • Mature cyst are quadrinucleate • Chromatoid bodies and glycpgen mass are not seen Stool examination by Dr. Priyanka Buragohain 92
  93. 93. Difference between different trophozoites Stool examination by Dr. Priyanka Buragohain 93
  94. 94. Difference between different cyst Stool examination by Dr. Priyanka Buragohain 94
  95. 95. Stool examination by Dr. Priyanka Buragohain 95 OTHER NON PATHOGENIC AMOEBIDA SPECIES Trophozoite of E. hartmani Trophozoite of Iodamoeba butschlii Cyst of blastocystis hominis
  96. 96. Stool examination by Dr. Priyanka Buragohain 96 Balantidium coli •Largest protozoal parasite •Pig is the common reservoir •Two stages •Trophozoite and encysted stage TROPHOZOITE •Oval body •60-70 µm in length and 40-50 µm breadth •Body is covered with a delicate pellicle showing longitudinal striations •Cilia are short and delicate, of uniform length, on mouth are longer called adoral cilia •Thin layer of ectoplasm and granular endoplasm •Groove at the anterior end(peristome) leading to a mouth(cytostome) terminating in a short funnel shaped gullet(cytopharynx) extending upto 1/3rd of the body •At the posterior part permanent anus called cytophage is situated •2 nuclei: kidney shaped macronucleus, round micronucleus in the concavity of micronucleus •2 contractile vacuole, many food vacuole
  97. 97. CYST • Smaller than trophic, 50-60 µm in diameter • Cytoplasm is granular contains the macronucleus, micronucleus, refractile body • Contractile vacuole • Thick transparent double layered wall Stool examination by Dr. Priyanka Buragohain 97
  98. 98. Giardia lambia • TROPHOZOITE • Flat view: a tennis or badminton racket • Side view: longitudinally split pear • Dorsal surface is convex and the ventral surface in concave with a sucking disc • Size is 14 × 7 µm • Anterior end is broad and rounded, posterior end tapers to a sharp point • Bilaterally symmetrical and all organs are paired. • 2 axostyles, 2 nuclei, 4 pairs of flagella Stool examination by Dr. Priyanka Buragohain 98 Exist in 2 phase: trophozoite and cyst
  99. 99. CYST • Oval in shape • Size is 12 × 7 µm • Axostyle lie diagonally like dividing wall within the cyst wall • 4 nuclei lie clustered at one end, lie in pairs at opposite poles • Remains of flagella and sucking disc may be seen in cytoplasm • Acid causes the parasite to encyst Stool examination by Dr. Priyanka Buragohain 99
  100. 100. Stool examination by Dr. Priyanka Buragohain 100
  101. 101. What we can see in microscopic examination of stool ? Stool examination by Dr. Priyanka Buragohain 101 ADULT WORM LARVA OVA CYST
  102. 102. Stool examination by Dr. Priyanka Buragohain 102 HELMINTHES PLATYHELMINTHES NEMATHELMINTHES CESTODE TREMATODE NEMATODE TAPEWORM Taenia solium Taenia saginata ECHINOCOCCUS G. Hominis F. Buski F. Hepatica C. Sinensis P. westermani • A. Lumbricoids • T. Trichiura • A. Duodenale • E. Vermicularis •S. Stercoralis
  103. 103. ADULT WORM • TAENIA SAGINATA/SOLIUM • DIPHYLLOBOTHRIUM • HYMENOLEPIS • DYPILIDIUM LARVAL STAGE • ECHINOCOCCUS: Hydatid cyst • SPIROMETRA • HYMENOLEPIS • TAENIA SOLIUM • MULTICEPS: Stool examination by Dr. Priyanka Buragohain 103
  104. 104. Taenia solium • Segments of Tape worm or single segment may be found • White in colour, semi transparent. • May be 3 – 10 m long/ 1-3 cm segments maybe upto 24 m • Variable length(1000-2000 proglottids) • When stool is allowed to dry up the pieces of segments will roll upand appear as round worm, moistening the segments will restore the shape • Head is quadrate in outline, has 4 circular suckers • Head is absent of rostellum/hooklets Stool examination by Dr. Priyanka Buragohain 104
  105. 105. Eggs of T. saginata • Spherical and brown in colour • 31-43µm in diameter • Thin outer transparent shell(remnants of yolk mass), causes egg to clump together • Inner embryophore is brown, thick walled, radially striated • Contains an oncosphere(14- 20µm), with 3 pairs of hooklets • Doesnot float in saturated solution of common salt Stool examination by Dr. Priyanka Buragohain 105
  106. 106. Taenia solium • 2-3 metres long(800-900 proglottides) • Scolex is 1mm in diameter, globular in outline, 4 circular suckers, • Head with rostellum armed with a double row of alternating large and small hooklets, shaped like daggers or Arabian poniards • Segments are shed in chains of 5-6 at a time, not single. Stool examination by Dr. Priyanka Buragohain 106
  107. 107. • EGGS • Same as T. Solium • 30x40 µm sized egg • Pale yellow • Thick radially striated embryophore with 6 hooklets inside Stool examination by Dr. Priyanka Buragohain 107
  108. 108. Echinococcus granulosus • Commonly called dog tapeworm/ hydatid worm • Man harbours the larval form, not the adult • Larva found wiyhin the hydatid cyst, scolex of the future adult worm remains invaginated within a vesicular body. Stool examination by Dr. Priyanka Buragohain 108
  109. 109. Stool examination by Dr. Priyanka Buragohain 109 Hymenolepis diminuta
  110. 110. Gastrodiscoides hominis • Prevalent in Assam and Bengal • Pyriform in shape • Measures 5-10 mm × 4-6 mm • Body has 2 parts: anterior conical and posterior hemispherical portion which is hollowed out ventrally to form a concave disc • Acetabulum is postero terminal, situated ventrally • Notch at posterior end • Eggs are ovoid, operculated, 130×60 µm, immature when oviposited Stool examination by Dr. Priyanka Buragohain 110
  111. 111. Fasciola hepatica • Eggs • Large, operculated, ovoid , brownish yellow(bile stained) • Size is 140× 80 µm • Contains a large unsegmentad ovum in a mass of yolk cells • Excreted with bile into duodenum and then passed out along with the faeces • Does not float in saturated common salt sol. • Can develop only in water Stool examination by Dr. Priyanka Buragohain 111
  112. 112. Fasciola buski • Reported in Assam, bengal, china, thailand and other oriental regions • Largest trematode(2-7.5 length, 8-20 mm bredth, 0.5-3 mm thickness) • Elongated and oval in shape • Resembles F. Hepatica but does not possess any cephalic cone • Each worm lay 25,000 eggs per day • Eggs are indistinguishable from F. hepatica Stool examination by Dr. Priyanka Buragohain 112
  113. 113. Clonorchis sinensis EGGS • Yellowish brown • Flask shaped • Operculated • Possess a terminal hook like spine(resembling an electric bulb) • Small in size(35×20µm) • Ciliated embryo (oviposited stage) • Do not float in saturated solution of common salt Stool examination by Dr. Priyanka Buragohain 113
  114. 114. Paragonimus westermani • Golden brown in colour • Oval in shape with flattened opercula • 80- 55 µm • Each egg contains an unsegmented ovum surrounded by yolk cells • Prevalent in Assam • Found in sputum and faeces Stool examination by Dr. Priyanka Buragohain 114
  115. 115. Ascaris lumbricoids • Large round worms may be males and females or both • Pinkish in colour • 0.3-0.4 cm in thickness • 15-25 cm long • Males are shorter than females • Have curved tapering tail Stool examination by Dr. Priyanka Buragohain 115
  116. 116. • UNFERTILISED EGGS • Do not float on floatation method • Size- 40×70 µm • Yellow in colour • Elongated • Mammilated thin shell, ovum containing refractile yolk globules occupying the whole inside space • May be confused with veg cell • FERTILISED EGGS • Float on floatation method • Size- 40×70 µm • Yellow in colour • Oval or round • Thick mammillated coat and single celled ovum inside Stool examination by Dr. Priyanka Buragohain 116
  117. 117. Enterobius vermicularis • Small round worm or thread like worm or pin worm(spindle shaped) • White coloured • 0.5-1 cm long • Tail pointed • Males smaller than females and posterior body is curved and sharply truncated(found only after purgation) Stool examination by Dr. Priyanka Buragohain 117
  118. 118. • EGGS • Colourless(not bile stained) • 20×50 µm • Assymetrical, Oval planoconvex, • thin transparent shelled, • contain coiled tadpole likelarva inside • Floats in saturated salt solution Stool examination by Dr. Priyanka Buragohain 118
  119. 119. Ancylostoma duodenale • Hook worm • Small greyish white or pink coloured cylindrical • 1-1.5 cm long • One end is curved like a hook • 6 teeth, 4 hook like on ventral surface and 2 knob like on the dorsal surface Stool examination by Dr. Priyanka Buragohain 119
  120. 120. EGGS • Oval or elliptical in shape • 40x60 µm sized egg • Colourless(not bile stained) • Surrounded by a transparent hyaline shelled membrane • Contains 4 segmented ovum inside. • Floats on saturated solution of salt Stool examination by Dr. Priyanka Buragohain 120
  121. 121. Trichuris trichiura • Whip worm • Looks like a tiny whip with a handle and a lash • 3-5 cm in length • White coloured Stool examination by Dr. Priyanka Buragohain 121
  122. 122. • 25x50 µm sized egg • Brown coloured • Double shelled, outer one is bile stained • Thick shelled, barrel shaped with mucus plug at both pole • Single ovum • floats in saturated solution of common salt Stool examination by Dr. Priyanka Buragohain 122
  123. 123. Strongyloids stercoralis • Adult worm: • Females are readily discovered than males • 2.5mm ×40-50 µm (females) • Posterior extrimity is pointed • Males are shorter and broader than females Stool examination by Dr. Priyanka Buragohain 123
  124. 124. • Eggs • Eggs are conspicuous within the body in a single line • 55-30µm • Thin shelled • Transparent, oval • Contain larva ready to hatch. It is the larva not the eggs are found in stool. Stool examination by Dr. Priyanka Buragohain 124
  125. 125. • Rhabditiform larvae • Develop directly from gravid females • Short mouth, double- bulb oesophagus • Filariform larvae • Longer and slender • Short mouth and cylindrical oesophagus Stool examination by Dr. Priyanka Buragohain 125
  126. 126. Stool examination by Dr. Priyanka Buragohain 126
  127. 127. Helminthes that float/do not float on saturated solution of saline Eggs that float • A. Duodenale • N. Americanas • E. Vermicularis • H. Nana • A. Lumbricoids • T. Trichuria • H. Diminuta Eggs that do not float • A. Lumbricoids • T. solium • T. Saginata • Trematodes • F. Buski • F. Hepatica • C. Sinensis Stool examination by Dr. Priyanka Buragohain 127
  128. 128. Stool examination by Dr. Priyanka Buragohain 128
  129. 129. Stool examination by Dr. Priyanka Buragohain 129
  130. 130. Stool examination by Dr. Priyanka Buragohain 130
  131. 131. Stool examination by Dr. Priyanka Buragohain 131 Plant hairs can be confused for larvae oh hookworm or Strongyloides stercoralisPlant hair resembling S. strongiloids
  132. 132. Stool examination by Dr. Priyanka Buragohain 132 Parasite of earth worm Pollen grain resemblening to fertile egg of A. lumbricoids Bee pollen resembling t. Trichuria egg
  133. 133. Stool examination by Dr. Priyanka Buragohain 133
  134. 134. STOOL CULTURE • Used to detect the presence of disease causing(pathogenic )bacteria • Help to diagnose an infection of digestive system • Used in conjunction with stool test • Reference range for stool culture is negative Stool examination by Dr. Priyanka Buragohain 134
  135. 135. Most common bacteria for culture of stool • Campylobacter species • Salmonella species • Shigella species • Yersinia species • Vibrio species(travel history) • Some bacteria cause illness by producing toxins(PCR, Antigen test are to be done with stool test) • Escherichia coli • Clostridium difficile Stool examination by Dr. Priyanka Buragohain 135
  136. 136. Collection • Specimen collected via rectal swab(in infants) • Sterile collection container not required • No detergent or preservative should be present in the container • Specimen should be immediately transported to the laboratory • If transport is delayed by longer than 2 hours, transport media(eg Cary- Blair) is recommended • Samples must be sent in a sealed, leak-proof container marked with a biohazard sticker Stool examination by Dr. Priyanka Buragohain 136
  137. 137. Medias used commonly • MacConkey agar- Salmonella species, shigella species • Eosin methylene blue agar • Triple sugar iron(TSI)- differentiate salmonella and shigella • Sabouraud agar • Hekteon enteric agar • Selenite broth Stool examination by Dr. Priyanka Buragohain 137
  138. 138. Summary • Definition of stool • Composition of stool • Precaution and collection of sample • Physical examination • Chemical examination • Microscopic examination • Artifacts • Stool culture Stool examination by Dr. Priyanka Buragohain 138
  139. 139. THANK YOU !!!Stool examination by Dr. Priyanka Buragohain 139
  • ChandruN5

    Nov. 11, 2021
  • ZahraaFaris1

    Nov. 9, 2021
  • GoodLuckSozyFaiz

    Oct. 27, 2021
  • RohitPotphode2

    Oct. 25, 2021
  • LincyJohny

    Oct. 20, 2021
  • BismahTariq

    Oct. 18, 2021
  • TahreemShahzadi1

    Sep. 29, 2021
  • RaniUpadhyay1

    Sep. 28, 2021
  • henshreejoshi

    Sep. 23, 2021
  • Ravneet12345678

    Sep. 18, 2021
  • DheryaPatel

    Sep. 13, 2021
  • DineshDini21

    Sep. 12, 2021
  • RosemaryAnsah

    Aug. 31, 2021
  • Devika33

    Aug. 26, 2021
  • ThasleemaChungath

    Aug. 16, 2021
  • RishiTripathi22

    Aug. 14, 2021
  • SivaA41

    Aug. 11, 2021
  • AbdulHakimIddris

    Aug. 1, 2021
  • DharshiniKrish

    Jul. 23, 2021
  • Saals007

    Jul. 18, 2021

Routine examination of stool

Views

Total views

84,101

On Slideshare

0

From embeds

0

Number of embeds

25

Actions

Downloads

1,359

Shares

0

Comments

0

Likes

245

×