stool-test(粪便检查-英文)课件

StoolRoutineTestLuWanhongDepartmentofNephrologyFirstaffiliatedhospital,MedicaldivisionXi’anJiaotongUniversityStoolRoutineTestLuWanhong1StoolAnalysisWhatisthestoolorfeces?1.Wasteresidueofindigestiblematerial(celluloseduringtheprevious4days)2.Bilepigmentsandsalts3.Intestinalsecretions,includingmucus4.Leukocytesthatmigratefromthebloodstream5.Epithelialcellsthathavebeenshade6.BacteriaandInorganicmaterial(10-20%)chieflycalciumandphosphates.Undigestedandunabsorbedfood.

StoolAnalysisWhatisthestoo21. Universalprecaution2. Collectstoolinadry,cleancontainer3.uncontaminatedwithurineorotherbodysecretions,suchasmenstrualblood4. Collectthestoolwithacleantonguebladeorsimilarobject.5. DeliverimmediatelyaftercollectionRandomCollection1. UniversalprecautionRandom3Ovaandparasitescollection1.Warmstoolsarebestfordetectingovaorparasites.

Donotrefrigeratespecimenforovaorparasites.2.Ifthestoolshouldbecollectin10%formalinorPVA fixative,storagetemperatureisnotcritical.3.Becauseofthecycliclifecycleofparasites,three separaterandomstoolspecimensarerecommended.Ovaandparasitescollection1.4Entericpathogencollection1.Somecoliformbacilliproduceantibioticsubstancesthatdestroyentericpathogen.

Refrigeratespecimenimmediately.2.Adiarrhealstoolwillusuallygiveaccurateresults.3.Afreshlypassedstoolisthespecimenofchoice.4.Stoolspecimenshouldbecollectedbeforeantibiotictherapy,orasearlyinthecourseofthedisease.5.Ifbloodormucousispresent,itshouldbeincludedinthespecimenEntericpathogencollection1.5Interferingfactors1.Patientsreceivingtetracyclines,anti-diarrhealdrugs,barium,bismuth,oil,iron,ormagnesiummaynotyieldaccurateresults.2. Bismuthfoundintoilettissueinterfereswiththeresults.3. Donotcollectstoolfromthetoiletbowl.Aclean,drybedpanisthebest.4. Lifestyle,personalhabbits,environmentsmayinterferewithpropersampleprocurement.Interferingfactors1.Patients6NormalvaluesinstoolAnalysisMacroscopicexamination

NormalvalueAmount 100-200g/dayColour BrownOdour VarieswithpHofstool anddependonbact- erialfermentationConsistency Plastic,notunusualto seefiber,vegetableskins.Sizeandshape FormedGrossblood,Mucous,Pus,Parasites NoneNormalvaluesinstoolAnalysi7NormalvaluesinstoolanalysisMicroscopicexaminationNormalvaluesFat(Colorless,neutralfat(18%)andfattyacidcrystalsandsoaps)Undigestedfood NonetosmallamountMeatfibers,Starch,Trypsin

None Eggsandsegmentsofparasites

NoneYeasts

NoneLeukocytes

None Normalvaluesinstoolanalysi8NormalvaluesinstoolanalysisChemicalexamination NormalvaluesWater

Upto75%pH

6.5-7.5Occultblood

NegativeUrobilinogen

50-300g/24hrPorphyrins Coporphyrins:400-1200g/24hr

Uroporphyrins:10-40mg/24hrNitrogen

<2.5g/24hrNormalvaluesinstoolanalysi9Chemicalexamination

NormalvaluesBile Negativeinadults:positiveinchildrenTrypsin 20-950units/g

(positiveinsmall

amounts

inadults;

presentingreateramountsinnormalchildren.Osmolarity used200-250mOsmwithserum

osmolaritytocalculateosmoticgapSodium 5.8-9.8mEq/24hrNormalvaluesinstoolAnalysisChemicalexaminationN10Chemicalexamination NormalvaluesChloride 2.5-3.9mEq/24hrPotassium 15.7-20.7mEq/24hrLipids(fattyacid)

0-6g/24hrNormalvaluesinstoolAnalysisChemicalexamination Normalva11ClinicalImplications1.Fecalconsistencymaybealteredinvariousdiseasestatesa.Diarrheamixedwithmucousandredbloodcellsisassociatedwith1.Typhus 2.Typhoid

3.Cholera霍乱4.Amebiasis阿米巴病

5.LargebowelcancerClinicalImplications1.Fecalc12b.Diarrheamixedwithmucusandwhitebloodcellsisassociatedwith1.Ulcerativecolitis 2.Regionalenteritis3.Shigellosis

志贺氏菌（痢疾）4.Salmonellosis

沙门氏菌5.IntestinaltuberculosisClinicalImplicationsb.Diarrheamixedwithmucusa13C.”Pasty”stoolisassociatedwithahighfatcontentinthestool:1.Asignificantincreaseoffatisusuallydetectedongrossexamination2.Withcommonbileductobstruction,thefatgivesthestoolaputty-likeappearance.3.Incysticfibrosis,theincreaseofneutralfatgivesagreasy,“butterstool”appearance.ClinicalImplicationsC.”Pasty”stoolisassociate14StoolOdorNormalvalue:VarieswithpHofstoolanddiet.Indoleandsketolearethesubstancesthatproducenormalodorformedbyintestinalbacteriaputrefactionandfermentation.ClinicalimplicationAfoulodoriscausedbydegradationofundigestedprotein.Afoulodorisproducedbyexcessivecarbohydrateingestion.AsicklysweetodorisproducedbyvolatilefattyacidsandundigestedlactoseStoolOdorNormalvalue:Varies15StoolpHNormalvalue:

NeutraltoacidoralkalineClinicalimplication1.IncreasedpH(alkaline) teinbreakdown b.Villousadenoma c.Colitis d.Antibioticuse2.DecreasedpH(acid)a.Carbohydratemalabsorption b.Fatmalabsorptionc.DisaccharidasedeficiencyStoolpHNormalvalue:Neutral16StoolcolorNormalvalue:BrownClinicalimplication:1.Yellowtoyellow-green:severediarrhea2.Green:severediarrhea

Black:resultingfrombleedingintotheuppergastrointestinaltract(>100mlblood)3.TanorClaycolored:blockageofthecommonbileduct.4.Palegreasyacholic(nobilesecretion)stoolfoundinpancreaticinsufficiency.StoolcolorNormalvalue:Brown174.Maroon-to-red-to-pink:possibleresultofbleedingfromthelowergastrointestinaltract(eg.Tumors,hemorrhoids（痔）,fissures（裂）,inflammatoryprocess)5.Bloodstreak（条纹）

ontheoutersurfaceofusuallyindicateshemorrhoidsoranalabnormalities.6.Bloodinstoolcanarisefromabnormalitieshigherinthecolon.Insomecasethetransittimeisrapidbloodfromstomachorduodenumcanappearasbrightordarkredormarooninstool.Stoolcolor

(cont’d)4.Maroon-to-red-to-pink:pos18BloodinStoolNormalvalue:NegativeClinicalImplication:1.DarkredtotarryblackindicatesalossofbloodfromtheupperGItract.2.Positiveforoccultbloodmaybecausedby a.Carcinomaofcolon b.Ulcerativecolitis c.Adenoma

d.Diaphramatichernia e.Gastriccarcinoma f.Diverticulitis憩室炎

g.UlcersBloodinStoolNormalvalue:Ne19MucousinStoolNormalvalue:NegativeformucousClinicalImplication:1.Translucent（半透明）

gelatinous（凝胶状）

mucousclingingtothesurfaceofformedstooloccursin

a.Spasticconstipation

b.Mucouscolitis

c.Emotionallydisturbedpatients

d.Excessivestrainingatstool2.Bloodymucousclingingtothesurfacesuggests a.Neoplasm

b.InflammationoftherectalcanalMucousinStoolNormalvalue:N20MucousinStool(cont’d)3.Mucouswithpusandbloodisassociatedwitha.Ulcerativecolitis b.Bacilliarydysentery（杆菌痢疾）c.Ulceratingcancerofcolon d.Acutediverticulitis（憩室炎

）e.IntestinaltuberculosisMucousinStool(cont’d)3.Muc21FatinStoolNormalvalue:

fatinstoolwillaccountforupto20%oftotalsolids.Lipidsaremeasuredasfattyacids(0-6.0g/24hr)ClinicalImplication:1.Increasedfatorfattyacidsisassociatedwiththemalabsorptionsyndromes

a.Nontropicalsprue（celiacsprue

）b.Crohn’sdisease

c.Whipple’sdisease d.Cysticfibrosis e.Enteritisandpancreaticdiseases f.SurgicalremovalofasectionoftheintestineFatinStoolNormalvalue:fat22UrobilinogeninStoolNormalvalue:125-400Ehrlichunits/24hr 75-350Ehrlichunits/100gClinicalImplication:IncreasedvaluesareassociatedwithHemolyticanemiasDecreasedvaluesareassociatedwitha.Completebiliaryobstructionb.Severeliverdisease,infectioushepatitisc.Oralantibiotictherapythataltersintestinalbacteriaflorad.Infantsarenegativeupto6monthsofageUrobilinogeninStoolNormalva23BileinStoolNormalvalue:

Adults–negative:ChildrenmaybepositiveClinicalImplication:1.Bilemaybepresentindiarrhealstools.2.IncreasedbilelevelsoccurinHemolyticanemiaBileinStoolNormalvalue:24TrypsininStool（胰蛋白酶）Normalvalue:（胰蛋白酶）Positiveinsmallamountsin95%ofnormalpersons.ClinicalImplication:Decreasedamountsoccurin--PancreaticdeficiencyMalabsorptionsyndromesScreenforcysticfibrosisTrypsininStool（胰蛋白酶）Normalv25LeukocytesinStoolNormalvalue:NegativeClinicalImplication1.Largeamountsofleukocytesa.Chroniculcerativecolitis

b.Chronicbacilliarydysenteryc.Localizedabscess d.Fistulasofsigmoidrectumoranus 2.MononuclearleukocytesappearinTyphoidLeukocytesinStoolNormalvalu26LeukocytesinStool(cont’d)3.Polymorphonuclearleukocytesappearin a.Shigellosis b.Salmonellosis c.Yersinia d.InvasiveEscherichiacolidiarrhea e.Ulcerativecolitis4.Absenceofleukocytesisassociatedwith a.Cholera b.Nonspecificdiarrhea c.Viraldiarrhea d.Amebiccolitis e.NoninvasiveE.colidiarrhea f.ToxigenicbacteriaStaphylococcispp.,ClostidiumCholera g.Parasites-Giardia,LeukocytesinStool(cont’d)3.27PorphyrinsinStool（卟啉类化合物

）Normalvalue:Coproporphyrin400-1200g/24hr Uroporphyrin10-40g/24hr. ThesevaluesvaryfromLabtoLab.ClinicalImplication:1.IncreasedfecalcoproporphyrinisassociatedwithCoproporphyria(hereditary)遗传性粪卟啉病Porphyriavariegatac.

Protoporphyria d.Hemolyticanemia2.Increasedfecalprotoporphyrinisassociatedwitha.Porphyriaveriegata变异性卟啉病

b.Protoporphyriac.Acquiredliverdisease PorphyrinsinStool（卟啉类化合物）No28

roundworm

;

ascarid

tapeworm

;

cestode

roundworm

;

ascaridtapeworm

2930写在最后成功的基础在于好的学习习惯Thefoundationofsuccessliesingoodhabits30写在最后成功的基础在于好的学习习惯谢谢聆听·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LearningIsToAchieveACertainGoalAndWorkHard,IsAProcessToOvercomeVariousDifficultiesForAGoal谢谢聆听LearningIsToAchieveAC31StoolRoutineTestLuWanhongDepartmentofNephrologyFirstaffiliatedhospital,MedicaldivisionXi’anJiaotongUniversityStoolRoutineTestLuWanhong32StoolAnalysisWhatisthestoolorfeces?1.Wasteresidueofindigestiblematerial(celluloseduringtheprevious4days)2.Bilepigmentsandsalts3.Intestinalsecretions,includingmucus4.Leukocytesthatmigratefromthebloodstream5.Epithelialcellsthathavebeenshade6.BacteriaandInorganicmaterial(10-20%)chieflycalciumandphosphates.Undigestedandunabsorbedfood.

StoolAnalysisWhatisthestoo331. Universalprecaution2. Collectstoolinadry,cleancontainer3.uncontaminatedwithurineorotherbodysecretions,suchasmenstrualblood4. Collectthestoolwithacleantonguebladeorsimilarobject.5. DeliverimmediatelyaftercollectionRandomCollection1. UniversalprecautionRandom34Ovaandparasitescollection1.Warmstoolsarebestfordetectingovaorparasites.

Donotrefrigeratespecimenforovaorparasites.2.Ifthestoolshouldbecollectin10%formalinorPVA fixative,storagetemperatureisnotcritical.3.Becauseofthecycliclifecycleofparasites,three separaterandomstoolspecimensarerecommended.Ovaandparasitescollection1.35Entericpathogencollection1.Somecoliformbacilliproduceantibioticsubstancesthatdestroyentericpathogen.

Refrigeratespecimenimmediately.2.Adiarrhealstoolwillusuallygiveaccurateresults.3.Afreshlypassedstoolisthespecimenofchoice.4.Stoolspecimenshouldbecollectedbeforeantibiotictherapy,orasearlyinthecourseofthedisease.5.Ifbloodormucousispresent,itshouldbeincludedinthespecimenEntericpathogencollection1.36Interferingfactors1.Patientsreceivingtetracyclines,anti-diarrhealdrugs,barium,bismuth,oil,iron,ormagnesiummaynotyieldaccurateresults.2. Bismuthfoundintoilettissueinterfereswiththeresults.3. Donotcollectstoolfromthetoiletbowl.Aclean,drybedpanisthebest.4. Lifestyle,personalhabbits,environmentsmayinterferewithpropersampleprocurement.Interferingfactors1.Patients37NormalvaluesinstoolAnalysisMacroscopicexamination

NormalvalueAmount 100-200g/dayColour BrownOdour VarieswithpHofstool anddependonbact- erialfermentationConsistency Plastic,notunusualto seefiber,vegetableskins.Sizeandshape FormedGrossblood,Mucous,Pus,Parasites NoneNormalvaluesinstoolAnalysi38NormalvaluesinstoolanalysisMicroscopicexaminationNormalvaluesFat(Colorless,neutralfat(18%)andfattyacidcrystalsandsoaps)Undigestedfood NonetosmallamountMeatfibers,Starch,Trypsin

None Eggsandsegmentsofparasites

NoneYeasts

NoneLeukocytes

None Normalvaluesinstoolanalysi39NormalvaluesinstoolanalysisChemicalexamination NormalvaluesWater

Upto75%pH

6.5-7.5Occultblood

NegativeUrobilinogen

50-300g/24hrPorphyrins Coporphyrins:400-1200g/24hr

Uroporphyrins:10-40mg/24hrNitrogen

<2.5g/24hrNormalvaluesinstoolanalysi40Chemicalexamination

NormalvaluesBile Negativeinadults:positiveinchildrenTrypsin 20-950units/g

(positiveinsmall

amounts

inadults;

presentingreateramountsinnormalchildren.Osmolarity used200-250mOsmwithserum

osmolaritytocalculateosmoticgapSodium 5.8-9.8mEq/24hrNormalvaluesinstoolAnalysisChemicalexaminationN41Chemicalexamination NormalvaluesChloride 2.5-3.9mEq/24hrPotassium 15.7-20.7mEq/24hrLipids(fattyacid)

0-6g/24hrNormalvaluesinstoolAnalysisChemicalexamination Normalva42ClinicalImplications1.Fecalconsistencymaybealteredinvariousdiseasestatesa.Diarrheamixedwithmucousandredbloodcellsisassociatedwith1.Typhus 2.Typhoid

3.Cholera霍乱4.Amebiasis阿米巴病

5.LargebowelcancerClinicalImplications1.Fecalc43b.Diarrheamixedwithmucusandwhitebloodcellsisassociatedwith1.Ulcerativecolitis 2.Regionalenteritis3.Shigellosis

志贺氏菌（痢疾）4.Salmonellosis

沙门氏菌5.IntestinaltuberculosisClinicalImplicationsb.Diarrheamixedwithmucusa44C.”Pasty”stoolisassociatedwithahighfatcontentinthestool:1.Asignificantincreaseoffatisusuallydetectedongrossexamination2.Withcommonbileductobstruction,thefatgivesthestoolaputty-likeappearance.3.Incysticfibrosis,theincreaseofneutralfatgivesagreasy,“butterstool”appearance.ClinicalImplicationsC.”Pasty”stoolisassociate45StoolOdorNormalvalue:VarieswithpHofstoolanddiet.Indoleandsketolearethesubstancesthatproducenormalodorformedbyintestinalbacteriaputrefactionandfermentation.ClinicalimplicationAfoulodoriscausedbydegradationofundigestedprotein.Afoulodorisproducedbyexcessivecarbohydrateingestion.AsicklysweetodorisproducedbyvolatilefattyacidsandundigestedlactoseStoolOdorNormalvalue:Varies46StoolpHNormalvalue:

NeutraltoacidoralkalineClinicalimplication1.IncreasedpH(alkaline) teinbreakdown b.Villousadenoma c.Colitis d.Antibioticuse2.DecreasedpH(acid)a.Carbohydratemalabsorption b.Fatmalabsorptionc.DisaccharidasedeficiencyStoolpHNormalvalue:Neutral47StoolcolorNormalvalue:BrownClinicalimplication:1.Yellowtoyellow-green:severediarrhea2.Green:severediarrhea

Black:resultingfrombleedingintotheuppergastrointestinaltract(>100mlblood)3.TanorClaycolored:blockageofthecommonbileduct.4.Palegreasyacholic(nobilesecretion)stoolfoundinpancreaticinsufficiency.StoolcolorNormalvalue:Brown484.Maroon-to-red-to-pink:possibleresultofbleedingfromthelowergastrointestinaltract(eg.Tumors,hemorrhoids（痔）,fissures（裂）,inflammatoryprocess)5.Bloodstreak（条纹）

ontheoutersurfaceofusuallyindicateshemorrhoidsoranalabnormalities.6.Bloodinstoolcanarisefromabnormalitieshigherinthecolon.Insomecasethetransittimeisrapidbloodfromstomachorduodenumcanappearasbrightordarkredormarooninstool.Stoolcolor

(cont’d)4.Maroon-to-red-to-pink:pos49BloodinStoolNormalvalue:NegativeClinicalImplication:1.DarkredtotarryblackindicatesalossofbloodfromtheupperGItract.2.Positiveforoccultbloodmaybecausedby a.Carcinomaofcolon b.Ulcerativecolitis c.Adenoma

d.Diaphramatichernia e.Gastriccarcinoma f.Diverticulitis憩室炎

g.UlcersBloodinStoolNormalvalue:Ne50MucousinStoolNormalvalue:NegativeformucousClinicalImplication:1.Translucent（半透明）

gelatinous（凝胶状）

mucousclingingtothesurfaceofformedstooloccursin

a.Spasticconstipation

b.Mucouscolitis

c.Emotionallydisturbedpatients

d.Excessivestrainingatstool2.Bloodymucousclingingtothesurfacesuggests a.Neoplasm

b.InflammationoftherectalcanalMucousinStoolNormalvalue:N51MucousinStool(cont’d)3.Mucouswithpusandbloodisassociatedwitha.Ulcerativecolitis b.Bacilliarydysentery（杆菌痢疾）c.Ulceratingcancerofcolon d.Acutediverticulitis（憩室炎

）e.IntestinaltuberculosisMucousinStool(cont’d)3.Muc52FatinStoolNormalvalue:

fatinstoolwillaccountforupto20%oftotalsolids.Lipidsaremeasuredasfattyacids(0-6.0g/24hr)ClinicalImplication:1.Increasedfatorfattyacidsisassociatedwiththemalabsorptionsyndromes

a.Nontropicalsprue（celiacsprue

）b.Crohn’sdisease

c.Whipple’sdisease d.Cysticfibrosis e.Enteritisandpancreaticdiseases f.SurgicalremovalofasectionoftheintestineFatinStoolNormalvalue:fat53UrobilinogeninStoolNormalvalue:125-400Ehrlichunits/24hr 75-350Ehrlichunits/100gClinicalImplication:IncreasedvaluesareassociatedwithHemolyticanemiasDecreasedvaluesareassociatedwitha.Completebiliaryobstructionb.Severeliverdisease,infectioushepatitisc.Oralantibiotictherapythataltersintestinalbacteriaflorad.Infantsarenegativeupto6monthsofageUrobilinogeninStool