stool-test(粪便检查-英文)PPT课件.pptx

1、Stool Routine TestLu WanhongDepartment of NephrologyFirst affiliated hospital , Medical divisionXian Jiaotong UniversityStool AnalysisWhat is the stool or feces?1. Waste residue of indigestible material (cellulose during the previous 4 days)2. Bile pigments and salts3. Intestinal secretions, includi

2、ng mucus4. Leukocytes that migrate from the bloodstream5. Epithelial cells that have been shade6. Bacteria and Inorganic 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 othe

3、r body secretions, such as menstrual blood4.Collect the stool with a clean tongue blade or similar object.5.Deliver immediately after collectionRandom CollectionOva and parasites collection1. Warm stools are best for detecting ova or parasites. Do not refrigerate specimen for ova or parasites.2. If

4、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 separate random stool specimens are recommended.Enteric pathogen collection1. Some coliform bacilli produce antibiotic substances that destroy ent

5、eric pathogen. Refrigerate specimen immediately.2.A diarrheal stool will usually 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 present, it sho

6、uld be included in the specimenInterfering factors1. Patients receiving tetracyclines, anti-diarrheal drugs, barium, bismuth, oil, iron , or magnesium may not yield accurate results.2.Bismuth found in toilet tissue interferes with the results.3.Do not collect stool from the toilet bowl.A clean, dry

7、bedpan is the best.4. Lifestyle, personal habbits, environments may interfere with proper sample procurement.Normal values in stool AnalysisAmount100-200 g / dayColourBrownOdourVaries with pH of stool and depend on bact-erial fermentationConsistencyPlastic, not unusual to see fiber, vegetable skins.

8、Size and shape FormedGross blood,Mucous,Pus, Parasites NoneNormal values in stool analysisFat (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 NoneLeukocytes NoneWater Up to 7

9、5 %pH 6.5-7.5Occult blood NegativeUrobilinogen 50-300 g/24hrPorphyrinsCoporphyrins:400-1200g/24hr Uroporphyrins:10-40 mg/24hrNitrogen 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-t

10、o-red-to-pink : possible result of bleeding from the lower gastrointestinal tract (eg. Tumors, hemorrhoids（痔）（痔）, fissures（裂）（裂）,inflammatory process)5. Blood streak（条纹）（条纹） on the outer surface of usually indicates hemorrhoids or anal abnormalities.6. Blood in stool can arise from abnormalities hig

11、her 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.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 ca

12、used bya. Carcinoma of colonb. Ulcerative colitisc. Adenoma d. Diaphramatic herniae. Gastric carcinomaf. Diverticulitis憩室炎憩室炎 g. UlcersNormal value: Negative for mucousClinical Implication:1. Translucent （半透明）（半透明） gelatinous （凝胶状）（凝胶状） mucous clinging to the surface of formed stool occurs in a. Spa

13、stic constipation b. Mucous colitis c. Emotionally disturbed patients d. Excessive straining at stool2. Bloody mucous clinging to the surface suggests a. Neoplasm b. Inflammation of the rectal canal3. Mucous with pus and blood is associated witha. Ulcerative colitisb. Bacilliary dysentery（杆菌痢疾 ）c. U

14、lcerating cancer of colond. Acute diverticulitis（憩室炎（憩室炎 ）e. Intestinal tuberculosisNormal value: fat in stool will account for up to 20 % of total solids. Lipids are measured as fatty acids (0-6.0 g/24hr) Clinical Implication:1. Increased fat or fatty acids is associated with the malabsorption synd

15、romes a. Nontropical sprue（celiac sprue ）b. Crohns disease c. Whipples diseased. Cystic fibrosise. Enteritis and pancreatic diseasesf. Surgical removal of a section of the intestineNormal value:125-400 Ehrlich units / 24 hr 75-350 Ehrlich units/100 g Clinical Implication:Increased values are associa

16、ted with Hemolytic anemiasDecreased values are associated with a. Complete biliary obstructionb. Severe liver disease, infectious hepatitisc. Oral antibiotic therapy that alters intestinal bacteria florad. Infants are negative up to 6 months of ageNormal value: Adults negative: Children may be posit

17、iveClinical Implication:1. Bile may be present in diarrheal stools.2. Increased bile levels occur in Hemolytic anemia（胰蛋白酶）（胰蛋白酶）Normal value: （胰蛋白酶）（胰蛋白酶）Positive in small amounts in 95 % of normal persons.Clinical Implication: Decreased amounts occur in- Pancreatic deficiencyMalabsorption syndrome

18、sScreen for cystic fibrosisNormal value: Negative Clinical Implication1. Large amounts of leukocytesa. Chronic ulcerative colitis b. Chronic bacilliary dysenteryc. Localized abscessd. Fistulas of sigmoid rectum or anus2. Mononuclear leukocytes appear in TyphoidLeukocytes in Stool (contd)3. Polymorph

19、onuclear leukocytes appear ina. Shigellosisb. Salmonellosisc. Yersiniad. Invasive Escherichia coli diarrheae. Ulcerative colitis4. Absence of leukocytes is associated witha. Cholerab. Non specific diarrhea c. Viral diarrhead. Amebic colitise. Noninvasive E.coli diarrhea f. Toxigenic bacteria Staphyl

20、ococci spp., Clostidium Cholera g. Parasites-Giardia, Normal value: Coproporphyrin 400-1200 g / 24hr Uroporphyrin 10-40 g / 24 hr. These values vary from Lab to Lab.Clinical Implication:1. Increased fecal coproporphyrin is associated with a.Coproporphyria (hereditary)遗传性粪卟啉病b. Porphyria variegata c.

21、 Protoporphyria d. Hemolytic anemia2. Increased fecal protoporphyrin is associated with a. Porphyria veriegata变异性卟啉病 b. Protoporphyriac. Acquired liver disease roundworm ; ascarid ntapeworm ; cestode 30写在最后写在最后成功的基础在于好的学习习惯成功的基础在于好的学习习惯The foundation of success lies in good habits谢谢聆听 学习就是为了达到一定目的而努力去干, 是为一个目标去战胜各种困难的过程,这个过程会充满压力、痛苦和挫折Learning Is To Achieve A Certain Goal And Work Hard, Is A Process To Overcome Various Difficulties For A Goal