stooltest糞便檢查英文

1、Stool Routine Test,Lu WanhongDepartment of NephrologyFirst affiliated hospital , Medical divisionXi’an Jiaotong University,Stool Analysis,What is the stool or feces?1. Waste residue of indigestible material (cellulo

2、se during the previous 4 days)2. Bile pigments and salts3. Intestinal secretions, including mucus4. Leukocytes that migrate from the bloodstream5. Epithelial cells that have been shade6. Bacteria and Inorganic

3、material(10-20%) chiefly calcium and phosphates. Undigested and unabsorbed food.,,1.Universal precaution2.Collect stool in a dry,clean container3. uncontaminated with urine or other body secretions, such as menst

4、rual blood4.Collect the stool with a clean tongue blade or similar object.5.Deliver immediately after collection,Random Collection,Ova and parasites collection,1. Warm stools are best for detecting ova or parasites.

5、Do not refrigerate specimen for ova or parasites.2. If the stool should be collect in 10 % formalin or PVA fixative, storage temperature is not critical.3. Because of the cyclic life cycle of parasites, three sep

6、arate random stool specimens are recommended.,Enteric pathogen collection,1. Some coliform bacilli produce antibiotic substances that destroy enteric pathogen. Refrigerate specimen immediately.2.A diarrheal stool will u

7、sually give accurate results.3.A freshly passed stool is the specimen of choice.4. Stool specimen should be collected before antibiotic therapy, or as early in the course of the disease.5. If blood or mucous is presen

8、t, it should be included in the specimen,Interfering factors,1. Patients receiving tetracyclines, anti-diarrheal drugs, barium, bismuth, oil, iron , or magnesium may not yield accurate results.2.Bismuth found in toilet

9、 tissue interferes with the results.3.Do not collect stool from the toilet bowl.A clean, dry bedpan is the best.4. Lifestyle, personal habbits, environments may interfere with proper sample procurement.,,,Normal valu

10、es in stool Analysis,Macroscopic examination Normal valueAmount100-200 g / dayColourBrownOdourVaries with pH of stool and depend on bact-erial fermentationConsi

11、stencyPlastic, not unusual to see fiber, vegetable skins.Size and shape FormedGross blood,Mucous,Pus, Parasites None,Normal values in stool analysis,Microscopic examination

12、 Normal valuesFat (Colorless, neutral fat (18%)and fatty acid crystals and soaps)Undigested food None to small amountMeat fibers, Starch, Trypsin NoneEggs and segments of parasites NoneYeasts N

13、oneLeukocytes None,Normal values in stool analysis,Chemical examinationNormal valuesWater Up to 75 %pH 6.5-7.5Occult blood NegativeUrobilinogen 50-300 ?g/24hrPorphyrins

14、Coporphyrins:400-1200?g/24hr Uroporphyrins:10-40 mg/24hrNitrogen <2.5 g/24hr,Chemical examination Normal valuesBileNegative in adults:positive in childrenTrypsin20-950 u

15、nits/g ( positive in small amounts in adults; present in greater amounts in normal children.Osmolarityused 200-250 mOsm with seru

16、m osmolarity to calculate osmotic gapSodium5.8-9.8 mEq / 24hr,Normal values in stool Analysis,Chemical examinationNormal valuesChloride2.5-3.9 mEq / 24 hrPotassiu

17、m15.7-20.7 mEq /24 hrLipids ( fatty acid) 0-6 g / 24 hr,Normal values in stool Analysis,Clinical Implications,1.Fecal consistency may be altered in various disease statesa. Diarrhea mixed with mucous an

18、d red blood cells is associated with1. Typhus2. Typhoid 3. Cholera 霍亂4. Amebiasis阿米巴病5. Large bowel cancer,,,,b. Diarrhea mixed with mucus and white blood cells is associated with1. Ulcerative colitis2. Reg

19、ional enteritis3. Shigellosis 志賀氏菌（痢疾）4. Salmonellosis 沙門氏菌5. Intestinal tuberculosis,Clinical Implications,,C. ”Pasty” stool is associated with a high fat content in the stool:1. A significant increase of fat is

20、 usually detected on gross examination2. With common bile duct obstruction, the fat gives the stool a putty- like appearance.3. In cystic fibrosis, the increase of neutral fat gives a greasy, “butter stool” appearance.

21、,Clinical Implications,Stool Odor,Normal value: Varies with pH of stool and diet. Indole and sketole are the substances that produce normal odor formed by intestinal bacteria putrefaction and fermentation.Clinical impl

22、icationA foul odor is caused by degradation of undigested protein.A foul odor is produced by excessive carbohydrate ingestion.A sickly sweet odor is produced by volatile fatty acids and undigested lactose,Stool pH,Nor

23、mal value: Neutral to acid or alkalineClinical implication1. Increased pH ( alkaline)a. protein break downb. Villous adenomac.Colitisd.Antibiotic use2. Decreased pH ( acid)a. Carbohydrate malabsorptionb.

24、Fat malabsorptionc. Disaccharidase deficiency,,Stool color,Normal value: BrownClinical implication:1. Yellow to yellow-green : severe diarrhea2. Green : severe diarrhea Black: resulting from bleeding into the up

25、per gastrointestinal tract (>100 ml blood) 3. Tan or Clay colored : blockage of the common bile duct.4. Pale greasy acholic (no bile secretion) stool found in pancreatic insufficiency.,,4. Maroon-to-red-to-pink : po

26、ssible result of bleeding from the lower gastrointestinal tract (eg. Tumors, hemorrhoids（痔）, fissures（裂）,inflammatory process)5. Blood streak（條紋） on the outer surface of usually indicates hemorrhoids or anal abnormaliti

27、es.6. Blood in stool can arise from abnormalities higher in the colon. In some case the transit time is rapid blood from stomach or duodenum can appear as bright or dark red or maroon in stool.,,Stool color (cont’d),Bl

28、ood in Stool,Normal value: NegativeClinical Implication :1. Dark red to tarry black indicates a loss of blood from the upper GI tract. 2. Positive for occult blood may be caused bya. Carcinoma of colonb. Ulcerativ

29、e colitisc. Adenoma d. Diaphramatic herniae. Gastric carcinomaf. Diverticulitis憩室炎 g. Ulcers,Mucous in Stool,Normal value: Negative for mucousClinical Implication:1. Translucent （半透明） gelatin

30、ous （凝膠狀） mucous clinging to the surface of formed stool occurs in a. Spastic constipation b. Mucous colitis c. Emotionally disturbed patients d. Excessive straining at stool2. Bloody mucous clinging to

31、the surface suggests a. Neoplasm b. Inflammation of the rectal canal,Mucous in Stool (cont’d),3. Mucous with pus and blood is associated witha. Ulcerative colitisb. Bacilliary dysentery（桿菌痢疾 ）c. Ulcerating

32、 cancer of colond. Acute diverticulitis（憩室炎 ）e. Intestinal tuberculosis,,Fat in Stool,Normal value: fat in stool will account for up to 20 % of total solids. Lipids are measured as fatty acids (0-6.0 g/24hr)

33、Clinical Implication:1. Increased fat or fatty acids is associated with the malabsorption syndromes a. Nontropical sprue（celiac sprue ）b. Crohn’s disease c. Whipple’s diseased. Cystic fibrosise. Enteritis a

34、nd pancreatic diseasesf. Surgical removal of a section of the intestine,,Urobilinogen in Stool,Normal value:125-400 Ehrlich units / 24 hr 75-350 Ehrlich units/100 g Clinical Implication:Increased values are asso

35、ciated with Hemolytic anemiasDecreased values are associated with a. Complete biliary obstructionb. Severe liver disease, infectious hepatitisc. Oral antibiotic therapy that alters intestinal bacteria florad. Infant

36、s are negative up to 6 months of age,,Bile in Stool,Normal value: Adults –negative: Children may be positiveClinical Implication:1. Bile may be present in diarrheal stools.2. Increased bile levels occur in Hemolytic

37、anemia,Trypsin in Stool（胰蛋白酶）,Normal value: （胰蛋白酶）Positive in small amounts in 95 % of normal persons.Clinical Implication: Decreased amounts occur in-- Pancreatic deficiencyMalabsorption syndromesScreen for cystic

38、 fibrosis,,Leukocytes in Stool,Normal value: Negative Clinical Implication1. Large amounts of leukocytesa. Chronic ulcerative colitis b. Chronic bacilliary dysenteryc. Localized abscessd. Fistulas of sigmoid rect

39、um or anus2. Mononuclear leukocytes appear in Typhoid,Leukocytes in Stool (cont’d),3. Polymorphonuclear leukocytes appear ina. Shigellosisb. Salmonellosisc. Yersiniad. Invasive Escherichia coli diarrheae.

40、Ulcerative colitis4. Absence of leukocytes is associated witha. Cholerab. Non specific diarrhea c. Viral diarrhead. Amebic colitise. Noninvasive E.coli diarrhea f. Toxigenic bacteria Staphylococci spp., C

41、lostidium Cholera g. Parasites-Giardia,,Porphyrins in Stool（卟啉類化合物 ）,Normal value: Coproporphyrin 400-1200 ?g / 24hr Uroporphyrin 10-40 ?g / 24 hr. These values vary from Lab to Lab.Clinical Implication:1. In

42、creased fecal coproporphyrin is associated with Coproporphyria (hereditary)遺傳性糞卟啉病 Porphyria variegata c. Protoporphyria d. Hemolytic anemia2. Increased fecal protoporphyrin is associated with a. Porphyr

43、ia veriegata變異性卟啉病 b. Protoporphyriac. Acquired liver disease,roundworm ; ascarid,tapeworm ; cestode,Stool Electrolytes,Normal values : Sodium 5.8-9.8 mEq / 24 hr Chl