INVESTIGATION SEMINAR

STOOL EXAMINATION
Dr. Prabhavati . C. Kichadi. 2nd P G Schlolar , Dept of Bhaishajya Kalpana, KLEUS Shri BMKAM, Belgaum.
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Contents
Introduction Objectives History Investigation Types Application Precautions Possible errors Own research view Research article Summary Conclusion References
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INTRODUCTION
Stool is the waste matter discharged from the bowels fallowing the digestion and absorption of essential food ingredients in the stomach and Intestine.

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Clinical significance
Fecal material is an important specimen for the diagnosis of diseases of GI tract- Diarrhea, Dysentery, Parasitic infection, GI bleeding, Peptic ulcer, Carcinoma and Mal absorption syndromes including Steatorrhea

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Composition of feaces
Waste residue of indigestible material in food Bile Intestinal secretions Leucocytes that migrate from the blood streams Shed epithelial cells Large number of Bacteria's Inorganic material chiefly Calcium and Phosphates

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OBJECTIVES
Instruments and methods used in stool test Application of the observations with respect to medical conditions. To understand the analysis performed from stool in various ailments.
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Normal values in stool analysis

Microscopic examination Colour Odour Consistency Size and shape Gross Blood Pus Parasites Fat Values Brown Varies with pH of stool and depends on bacterial fermentation and putrefaction Bulky Small and dry Formed Absent Absent Absent Colourless, Neutral fat 18% and fatty acid crystals and soaps

Undigested
Eggs and segments of parasites Yeasts
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None to small amount food, Meat fibers, starch, trypsin

Absent Absent
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Leucocytes

Absent

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History

Acc Su Ut 40 Atisara Cikitsa. Acc to Charaka Ama and Pakwa mala. Jala nimajjana Pareeksha. Acc Yogaratnakara: Vata Prakoapa-Blakish, Dry, thick. Pitta Prakopa-Yellowish, bit thin. Kapha Prakopa-Whitish, frothy.
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Instruments
Microscope Glass rod Slide Coverslip Test tube

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INVESTIGATION

A stool test involves the collection and analysis of fecal matter to diagnose the presence or absence of a medical condition.

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Microscopic

Types
Chemical
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Physical
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Inspection of faeces
Type of stool
Watery stool Large amount of mushy, foul smelling, gray stool that floats on water Little firm, spherical masses Narrow ribbon

Likely reason
Diarrhoea Steatorrhoea Constipation Spastic bowel or rectal narrowing or stricture

Clay coloured
Reddish Black, tarry Green

Obstructive Jaundice or presence of Barium sulfate

Blood from lower gastro intestinal tract, beets consumption or BSP use Bleeding from upper GIT, Iron, Bismuth or Charcoal consumption Ingestion of spinach etc, presence of biliverdin seen in patients taking antibiotics orally
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Parasites

Parasitic infestation

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Chemical test
The routine chemical test performed with the stool specimen are detection of Occult blood Steatorrhea

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Occult blood
Bleeding in the GI tract may be due ton Amoebiasis, bacillary dysentery, ulcerative or neoplastic diseases Gum guaiac test Principle- The peroxidase activity of the hemoglobin results in the liberation of O2 from H2O2 and the released O2 oxidizes Gum guaiac to a coloured oxidation product which is blue in colour Aminophenazone test
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Procedure
Gum guaiac test Spread small amount feaces on filter paper Add 2 drops of Glacial acetic acid Add 4 drops of working guaiac peroxides reagent Observe, grade and report the result

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Aminophenazone test Aminophenozone solution: Dissolve 0.25 grm of Aminophenozone in 5ml of 90% alcohol Procedure Mix 4ml of fecal specimen in 7ml of distilled water, centrifuge and decant the supernatant in to a test tube Add 10 drops of acetic acid solution and 5ml of Aminophenozone solution, finally add 10 drops of H2O2 Observe and report the result

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Steatorrhea
Reagent: Thin strips of X-ray film. Procedure: Take 4 ml of distilled water in a 10 ml graduated centrifuge tube. Add faeces abt 1 ml, mix thoroughly with glass rod. Place a large drop of the suspension on the X-ray film and clip it to clip board. Incubate the film at room temperature for 2 hrs Take out the X-ray film and wash it with cold water with rubbing Cleaning at the site of drop indicates enzyme activity which is normal. Absence of clearing indicates malfunction of pancreas.
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Chemical Examination
1) Examination of Stool Smear: It is the easiest way to examine formed stool under microscope, helpful in screening of crude objects. 2) Examination of Wet mount: It is convenieniently under high power microscope. Place faeces sample in a small porcelain or glass dish, again dilute it with sufficient quantity of saline.
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Conti..
Place a drop of suspension on slide, cover with cover slip, keep it on microscope stage Observe a variety of structures like parasite eggs, abnormal cysts. Parasites: Faecal Fat:

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Precautions
1) Should be collected in clean sterile container 2) Labelling should be done properly.

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Possible Errors
1) During specimen collection. 2)During observing under microscope. 3) During occult blood examination, examinors hand should be free from any cuts or wounds.

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Own Research view

Standardization should be done on Ayurvedic stool examination.

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Research article
1)Clinical and Community Studies Parasitology: diagnostic yield of stool examination
Helene Sinai, MD, FRCPC Douglas Macpherson, MD, FRCPC

2) BRITISH MEDICAL JOURNAL volume 286 25 June 1983 Value of stool examination in patients with diarrhea
BARBARA J STOLL, ROGER I GLASS, HASINA BANU, M IMDADUL HUQ M U KHAN,MAFIZUDDIN AHMED

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Summary
Collection of specimen. Different investigations. Different methods adopted.

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Conclusion
Stool examination is very much helpful in diagnosing different ailments.

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References
1) Text book of Medical Laboratory Technology by Kanai L Mukherjee. 2) Text book of Medical Laboratory Technology by Ramnik sood. 3) Charaka Samhita. 4) Sushruta Samhita. 5) Yogaratnakara. 6) Text book of Medical Laboratory Technology by Thalib.
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