糞便檢查-課件

STOOLROUTINETEST

1ppt課件fecesarecomposedof:WasteresidueofindigestedmaterialinfoodIntestinalsecretions,includingmucusLargenumbersofbacteria(1/3)BilepigmentsandsaltsEpithelialcellsfromintestinaltractwater2ppt課件DestinationHelptodiagnosedigestivetractinflammation,bleeding,parasitesinfection,tumorJudgethedigestivetractfunctionsHelptodiagnoseentericinfectiondiseases:bacillarydysentery,cholera

3ppt課件Collectionofstoolspecimen

Fecesshouldbecollectedinadry,cleancontainerForovaorparasites,stoolshouldnotberefrigerated.ShouldbecollectedbeforeantibiotictherapyorasearlyinthecourseofthediseaseShouldnotbecontaminatedbyotherbodysecretions,suchas

urine,menstrualblood.Adiarrhealstoolwillusuallygiveaccurateresults.4ppt課件StoolroutinetestPhysicalexaminationChemicalexaminationMicroscopicexamination5ppt課件PhysicalExamination:

AppearanceNormalstoolisyelloworbrownandtendstobesoft,howeverinfant’sstoolisapproximatelylightyellow.6ppt課件PhysiologicalExaminationQuantity:Anadultexcretes100-300gramsoffecalmatteraday------about65%ofitiswater.

7ppt課件

Colorisinfluencedbydiet,fooddyes,cerealfoodsanddrugs

Yelloworyellow-green:thestoolofbreast-fedinfants,sterilisationofbowelbyantibioticGreen:dietshighinchlorophyll-richvegetables,useofthedrugcalomelBlackorverydarkbrown:drugs(iron,charcoal,bismuth),foods(cherries)Light-colouredstoolwithlittleodor:dietshighinmilkandlowinmeat8ppt課件ClinicalsignificanceThecolorchangesindiseasestatesYelloworyellowgreen------inseverediarrhoeaGreen-----inseverediarrhoeaBlack------theresultsofbleedingfromtheuppergastro-intestinaltract(gastriculcers,esophagealvarices

)Red------theresultsofbleedingfromthelowergastro-intestinaltract(hemorrhoids)Claycolor----blockageofthecommonbileduct9ppt課件Grosslyvisiblebloodalwaysindicatesan

abnormalstateBloodclingtothesurfaceofstool-----hemorrhoidsoranalabnormalitiesBloodpresentinstool-----abnormalitieshigherinthecolon.10ppt課件Appearanceandconsistency

PathologicalChanges

1.Mucousstool:Paste(mush):SeeninacuteintestineAIDSinwhichfeceslikemucousandwaterstool,dyspepsiaWhitecolor(likewashricewater):seenincholera,paracholera.

11ppt課件2.Pusorpusmixingbloodstool:bacillarydysentery,amoebicdysentery,ulcerativecolitis,ulceratingcarcinomaofthecolon,intestinaltuberculosis,carcinomaofrectum.Inamoebicdysentery,fecesmainlyhaveblood(bloodmixingpus)justlikedarkapplejam,somustgiveattentiontosomepatientswhodrinkalotofcoffee&chocolates,becausethecoloroffecesislikeamoebicdysenteryfeces.Inbacillarydysentery,mainlyismucusorpuswithlittleblood.12ppt課件

3.Reddishstool(redcolor):

Bleedingfromlowergastro-intestinaltract:rectumcancer,rectumpolyps,hemorrhoids4.Black-tarrystool:Bleedingintheuppergastro-intestinaltract5.Claycolorstool:obstructivejaundice,presenceofbariumsulfate.6.Narrowribbon-likestool:stricturerectum:rectumcancer.13ppt課件ChemicalexaminationOccultbloodtest--------

Bloodthatisinthefecesorvomitusthatisnotobviousbygeneralinspection.goldcolloid

methodNormal-------------negative14ppt課件controltestnegativepositive

invalid15ppt課件

Bloodinstoolshouldneverbeignoredevenifslightthequantitymaybe

>50-70ml/day-------adarkredtoblackandatarryconsistencytothestool>1000ml/day------persistanceoftarryappearancefor2or3days<5ml/day-------occultblood16ppt課件clinicalsignificance

todiagnoseslightbleedinginGIT:GITbleeding,intestinalTB,ulcerativecolitis,colon&rectumcancer,colonpolyps,gastriccarcinoma,GITtumor,damagedgastricmucosa17ppt課件IfapatientsufferinggastriculcerhasintermittentOBpositiveandafterthetreatmentturnstonegative,itshowsthatthepatientisnormalnow.ButiftheOBispositivecontinuouslyfor5to7daysbeforeandafterthetreatment,thenadoctormustthinkaboutgastrictumor/cancer.Moreoverapatientsufferinganemiahavingnoobviouscause,somustundergoOBtestbecauselittlebleedingoftenhasnoclearclinicalsymptoms.Agoodindextoscreendigestivetracttumor18ppt課件MicroscopicExaminationTakethestoolwithmucus,pus,bloodMixingwithnormalsodiumonacleanslideObserveusingmicroscope19ppt課件MicroscopicExamination

1.Cells:1)WBC:Normal-------absent(negative).ClinicalsignificanceChroniculcerativecolitisAcuteorchronicbacillarydysenteryLocalizedabscessFistulainsigmoidcolon,rectumoranus

WBC<15/HP--------intestinalinflammationWBC>15/HP----------dysentery20ppt課件2)RBC:Normal------noRBCClinicalsignificance:NoorlittleRBCbutOBpositive-----upperGITbleedingAbundantRBC------lowerGITinflammationorhemorrhage:dysentery,ulcerativecolitis,colonandrectumcancerorrectumpolyps.WBCaswellasRBCundermicroscopeRBC>WBC------indicatesamoebicinfection.WBC>RBC------indicatesbacteriainfection.21ppt課件3)macrophage:commonlyfoundinbacillarydysenteryorrectuminflammation.4)epithelialcells:coloninflammation.5)tumorcell:coloncancer,rectumcancer22ppt課件2FoodResidue

1)fat:accountfor20%oftotalsolidssteatorrhea:pancreaticdiseases,surgicalremovalofasectionoftheintestine,malabsorptionsyndromes,cysticfibrosis2)starchgranule:maldigestion,diarrhea,chronicpancreatitis,pancreaticinsuffficiency3)musclefibers4)vegetablecell/plantfibers

23ppt課件24ppt課件parasiteeggsandprotozoon

Entamoebacoli25ppt課件Ascarislumbricoides26ppt課件Enteroblusvermicularis27ppt課件hookworm28ppt課件Schistosomajaponicum29ppt課件Case1Female,42,bellyach,diarrheaandfeverwithpusmixingbloodstoolfor4daysPhysicalexamination:T38.9℃,

P95/min，R21/min，Bp125/80mmHg,nojaundice,heartandlungareno