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STOOL EXAMINATION

STOOL EXAMINATION. DR RONALDA DE LACY. WHY IS IT DONE?. Colour Consistency Frequency Blood Bacteria Viruses Parasites Fungal Pancreatic function Intestinal malabsorption Inflammatory markers. STOOL COLOUR. STOOL CONSISTENCY. STOOL FREQUENCY.

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STOOL EXAMINATION

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  1. STOOL EXAMINATION DR RONALDA DE LACY

  2. WHY IS IT DONE? • Colour • Consistency • Frequency • Blood • Bacteria • Viruses • Parasites • Fungal • Pancreatic function • Intestinal malabsorption • Inflammatory markers

  3. STOOL COLOUR

  4. STOOL CONSISTENCY

  5. STOOL FREQUENCY • Breastfed infants – stool after every breastfeed - once to twice a week • Children on average 1 to 2 stools per day • Some children might have a stool every 2nd day

  6. BLOOD FRESH BLOOD • Lower GIT bleed - anal fissure - rectal haemorrhoids - polyps - inflammatory bowel disease - infections i.e. Shigella, salmonella - meckel’sdiverticulum - intussception - NEC

  7. BLOOD ALTERED BLOOD (MALAENA) • Upper GIT bleed - oesophagitis - mallory-weiss tear - gastritis - ulcers–gastric, duodenal, small bowel - vascular malformations - anastomotic sites

  8. BACTERIA SHIGELLA • Gram-negative rod • Nonspore forming, non-motile • Four serogroups - S. Dysenteriae (12 serotypes) - S. Flexeneri (6 serotypes) - S. Boydii (18 serotypes) - S. Sonnei (1 serotype) • S. Flexeneri most frequently isolated in developing world – 60% of cases • S. Sonneimost frequently isolated in developed world – 77% of cases

  9. SHIGELLA

  10. BACTERIA SALMONELLA • Gram-negative rod • Nonspore forming, motile • Many serotypes

  11. SALMONELLA

  12. BACTERIA CHOLERA • Only infects humans • Transmission by faecal contamination of water and food • Organism secretes an enterotoxin • Results in watery diarrhoea

  13. CHOLERA

  14. BACTERIA CAMPYLOBACTER • Gram-negative rod- comma or S-shaped • Transmission is faecal-oral • Cattle, chickens and dogs are sources

  15. CAMPYLOBACTER LIFECYCLE

  16. BACTERIA YERSINIA ENTEROLITICA • Gram-negative oval rod • Contaminated food • Enterocolitis

  17. BACTERIA CLOSTRIDIUM DIFFICILE • Antibiotic use • Fresh stool sample

  18. BACTERIA MYCOBACTERIA Tuberculosis • Transmission by respiratory droplets • Mainly respiratory disease • Dissemination can result in intestinal involvement Bovis • Transmission by unpasteurised cow’s milk • Intestinal involvement • Difficult to culture from stool-need tissue

  19. VIRUS ROTAVIRUS • RNA virus • Most common cause for diarrhoea • Vaccine available • Diagnosis antigen testing on the stool

  20. ROTAVIRUS

  21. VIRUS ADENOVIRUS • DNA virus • 31 antigenic types • High swinging fevers • Pneumonia • Conjunctivitis • Diarrhoea • Diagnosis – antigen testing on the stool

  22. ADENOVIRUS

  23. PARASITES ENTEROBIUS VERMICULARIS • Pinworm infection • Lifecycle confined to humans • Eggs recovered from peri-anal area with tape • Adult worms may be found in the stool

  24. ENTEROBIUS VERMICULARIS

  25. ENTEROBIUS VERMICULARIS(PINWORM)

  26. PARASITES ASCARIS LUMBRICOIDES • Transmission-eating eggs in contaminated soil • Diagnosis- oval eggs in the stool or adult worms seen

  27. ASCARIS LUMBRICOIDES EGG

  28. ASCARIS LUMBRICOIDES LIFECYCLE

  29. PARASITES TRICHURIS TRICHURIUM • Whipworm infection • Transmission-eating eggs in contaminated soil • Diagnosis- barrel-shaped eggs in the stool

  30. TRICHURIS TRICHIURA EGGS

  31. TRICHURIS TRICHURIUM LIFECYCLE

  32. PARASITES TAENIA SOLIUM • Ingestion of larvae in undercooked pork • Diagnosis- proglottids in stool gravid proglottids have 5-10 primary uterine branches TAENIA SAGINATA • Ingestion of larvae in undercooked beef • Diagnosis- gravid proglottids have 15-20 primary uterine branches

  33. TAENIA EGG

  34. TAENIA SAGINATA FOUR SUCKERS NO HOOKS

  35. TAENIA SOLIUM FOUR SUCKERS DOUBLE ROW OF HOOKS

  36. TAENIA LIFECYCLE

  37. PARASITES-PROTOZOA GIARDIA LAMBLIA • Flagellated protozoan • Waterborne transmission • Faecal-oral route • Infects the small intestine • Difficult to isolate, need minimum of 3 stool specimens • Diagnosis - trophozoites or cysts in diarrhoeal stools - trophozoites- pear-shaped, 2 nuclei, 4 pairs of flagella, suction disk

  38. GIARDIA LAMBLIATROPHOZOITE

  39. PARASITES-PROTOZOA CRYPTOSPORIDIUM • Coccidian protozoa • Waterborne transmission • Direct person to person contact • Immunocompromised patients • Diagnosis- oocysts in faecal smears

  40. CRYPTOSPORIDIUM OOCYSTS

  41. CRYPTOSPORIDIUM OOCYSTS-EM

  42. PARASITES-PROTOZOA ENTAMOEBA HISTOLYTICA • Transmission-faecal-oral route, contaminated food and water • Diagnosis - trophozoites in diarrhoeal stools - cysts in formed stools – 4 nuclei

  43. ENTAMOEBA HISTOLYTICACYST

  44. PARASITES-PROTOZOA ISOSPORA BELLI • Faecal-oral transmission • Immunocompromised patients • Diagnosis-oocysts in faecal specimen

  45. ISOSPORA BELLI OOCYSTS

  46. FUNGAL CANDIDA ALBICANS • Part of normal gut flora • Overgrowth in diabetes, immunocompromised patients and prolonged antibiotic use. • Diagnosis- oval yeast with a single bud in the stool

  47. CANDIDA ALBICANS

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