AUBF Lab Stool&Urine MicroMacro Flashcards
Human feces is called as
STOOL
Feces: latin term ______ meaning RESIDUE.
faex
It is the waste residue of indigestible materials of an animal’s digestive tract expelled through the anus during defecation.
Stool
______ is newborn’s first feces.
Meconium
______ or ________ is the study of feces.
SCATOLOGY or CAPROLOGY
COMPOSITION of stool
o 3/4 Water, 1/4 Solid
Undigested and Unabsorbed food
Intestinal secretions, Mucous Bile
pigments and Salts
Bacteria and Inorganic material
Epithelial cells, Leukocytes
Stool collection: Stool should be collected in a (3) container.
dry, sterilized, wide mouthed
Stool collection: It should be _______ with Urine or any other body secretions.
uncontaminated
Stool collection: Properly _____ and always a ______ sample should be tested.
named; fresh
MACROSCOPIC EXAMINATION of stool includes: (6)
o Volume
o Color
o Consistency
o Odor
o Blood, Mucous
o Parts of parasite and Adult parasite
Human fecal matter is normally ______ in color which result from a combination of ____ and _____
yellowish brown; bile and bilirubin
Variation of stool colors (8)
o Bright Red/Maroon o Blood streak
o Yellow
o Green
o Black Blue o Tan/Clay
o White
o Pale greasy
Exclusively breast fed infants pass ____ and ____ or _____ and _____ stool.
loose and green or pasty and yellow
Infants fed on cows’ milk preparations pass stools of a _____ color and of a much
______ consistency
paler yellow; firmer
Babies fed on newer modified cows’ milk
preparations have ____ colored or ______
stools.
clay; greenish
Some healthy children may pass frequent,
______ stools containing undigested vegetable matter called as ______ diarrhea.
loose; Toddler’s
Separate hard lumps, like nuts. Hard to pass
Type 1
Sausage-shaped but lumpy
Type 2
Like sausage but with cracks on the surface
Type 3
Like sausage or snake, smooth and soft
Type 4
Soft blobs with clear-cut edges.
Passed easily
Type 5
Fluffy pieces with ragged edges, a mushy stool
Type 6
Watery, no solid pieces. Entirely Liquid.
Type 7
Stool odor: Basically depends on the ____ of the stool and _______ and ______ are the substances that produce normal odor formed by Intestinal bacterial fermentation and putrefaction.
pH; INDOLE and SKETOLE
Stool odor: A foul odor is caused by degradation of _______ and excessive ______ intake.
undigested protein; carbohydrate
Stool odor: Sickly sweet odor is produced by?
undigested Lactose.
Diarrhea mixed with mucous and Blood is suggestive of:
Typhoid, Amoebiasis, Typhus, Large bowel Carcinoma.
Diarrhea mixed with mucous and Pus is suggestive of:
Ulcerative Colitis, Regional Enteritis, Shigellosis, Salmonellosis, Acute diverticulitis, Intestinal TB.
Pasty stool with high fat content is suggestive of:
CBD Obstruction, Cystic fibrosis-butter stool.
Translucent gelatinous mucous clinging to the surface of the formed stool is found in:
Spastic Constipation, Excessive straining,
Mucous colitis.
Rice water stools which is colorless and almost devoid of odor is suggestive of?
Cholera
Stools may look like Redcurrant jelly in?
Intussusception
PARASITE that may be present in the stool (5)
Round worm
Hook worm
Tape worm
Pin worm
Whip worm
MICROSCOPIC EXAMINATION: SLIDE PREPARATION
- A drop of warm Saline or Lugol’s lodine
is placed over a clean microscopic slide. - About 2mg of stool sample should be taken and mixed with solution placed
over the slide. - Coverslip is placed avoiding air bubbles.
- Examined under Microscope
______ METHOD to detect Ova.
CONCENTRATION
____ stools are best for detecting Ova or
parasites. Do not_______ the specimen.
Warm; refrigerate
Because of cyclic life cycle of parasites, _______ random stool specimens
are recommended for examination
three separate
Eggs of Pin worm - _________ rarely appear in stools. These are usually collected in the folds of skin in ______
region.
Enterobius vermicularis; perianal
o COLLECTION
_____ swab/______ patch - Anus especially in _______ - Dipped in _____ – Observed
Cotton; Plaster; early morning; Saline
NORMAL VALUES of Undigested food materials in stool
None to small amount
NORMAL VALUES of in Starch stool
None
NORMAL VALUES of in Eggs, Cysts, Parasitic fragments stool
None
NORMAL VALUES of in Yeasts stool
None
NORMAL VALUES of Leukocytes in stool
None
Large amounts of leukocytes is suggestive of :
Chronic Ulcerative Colitis, Chronic Bacillary Dysentery, Localized Abscess, Fistulas.
Mononuclear Leukocytes appear in:
Typhoid
Polymorphonuclear Leukocytes appear in :
Shigellosis, Salmonellosis, Invasive E. coli PINWORM diarrhea, Ulcerative Colitis.
Absent Leukocytes in:
Cholera, Viral diarrhea, Non-specific diarrhea, Amoebic Colitis, Giardiasis.
HOOKWORM
Ancylostoma duodenale
ROUNDWROM
Ascaris lumbricoides
WHIPWORM
Trichuris trichura
PINWORM
Enterobius vermicularis
TAPEWORM
Taenia solium- pork
Taenia saginata- beef
ENTAMOEBA
Entamoeba histolytica
GIARDIASIS
Giardia lamblia
Normal Microbial flora of GI tract contains following organisms. Gram-ve:
E. coli, Enterobacter, Proteus, Pseudomonas aeruginosa, Bacteroides.
Normal Microbial flora of GI tract contains following organisms. Gram +ve:
Clostridia, Lactobacilli, Enterococci, Anaerobic streptococci.
Human feces contain approximately ______ organisms per gram wet weight as normal flora. Whereas gut bacterial pathogens rarely exceed _____ organisms per gram.
10^11; 10^5
CHEMICAL EXAMINATION
- Water-
- pH-
- Occult tblood-
- Bile - _______ in Adults
______ in Children
- Sodium -
- Chlorides -
- Potassium -
- Lipids/Fatty acids -
- Nitrogen-
CHEMICAL EXAMINATION
Water-Up to 75%
pH-5.8 to7.5
Occul tblood, RS-Negative
Bile - Negative in Adults
Positive in Children
Sodium -5.8 to 9.8 mEq/24hrs
Chlorides -2.5 to 3.9 mEq/24hrs
Potassium - 15.7 to 20.7 mEq/24hrs
Lipids/Fatty acids - 0 to 6 gms/24hrs
Nitrogen-<2.5g/24hrs
Stool: Increased pH-
ALKALINE Colitis
Stool: Increased pH-ALKALINE Colitis is found in
o Antibiotic use
o Villous adenoma
o Excess Protein in diet.
Stool: Decreased pH-
ACIDIC
Stool: Decreased pH-ACIDIC is found in
o Carbohydrate Malabsorption
o Fat Malabsorption
o Disaccharidase deficiency
Occult blood PRINCIPLE-
BENZIDINE TEST
Peroxidase action of hemoglobin in blood converts hydrogen peroxide to _____ and ______. This oxygen oxidizes benzidine in acid medium to form _____ to _____ colored complex.
water and nascent oxygen; green to blue
Occult blood in stool is found in:
o Ulcers,
o Diverticulitis
o Ulcerative Colitis
o Diaphragmatic Hernia
o Adenoma,
o CA Colon, Gastrium
Increased Fats in stool is associated with Malabsorption Syndromes and conditions such as:
o Obstructive Jaundice
o Non tropical sprue/Coeliac Sprue
o Crohn’s disease
o Cystic Fibrosis
o Whipple’s disease
o Enteritis and Pancreatic diseases
o Surgical removal of section of
Intestine
Stool is tested for RS especially in infants with Chronic diarrhea to rule out ______
Lactose Intolerance.
Stool will be positive for RS in variety of conditions especially in ______Infection in Infants.
Rota viral
Urine is A/K as
‘liquid biopsy of the urinary tract’
_____ consists of various microscopic, insoluble, solid elements in suspension.
Urine
Urine consists of various microscopic, insoluble, solid elements in suspension. These elements divided into (2)
organized and unorganized substances.
Organized substances in urine includes (6)
RBCs, WBCs, epithelial cells, cast, bacteria & parasites
Unorganized substances in the urine includes (2)
crystalline and amorphous material
Main aim of microscopic examination of urine is to identify different (2)
cellular elements and casts.
Urine Micro Exam: Cellular elements are best preserved in
hypertonic acidic urine.
(3) concentrated sample is preferred.
First morning, mid-stream, freshly voided
Should be examined within _______. of voiding because cells and casts begin to ______ within 2 hrs of collection.
1-2 hrs; lyse
If delay is suspected: ______ or ______ can be used as preservative; or urine can be refrigerated at _______.
Formalin (40%) or thymol; 2-8°C (not >1 hr)
Urine Micro Exam: ________ is separated & used for chemical analysis.
Supernatant
Unstained normal erythrocytes appear as pale biconcave disks about?
7 μm in D
If the urine specimen is not fresh RBCs may appear as ______, ________, or _______ because the ______ may dissolves out.
faint, colorless circles or shadow cells;
In hypertonic urine, RBCs become _______ and appear as small rough cells with crinkled edges.
crenated
In dilute urine the cells will ______ and _____, releasing Hb and leaving only cell membranes (______).
swell and rapidly lyse; ghost cells
______ RBCs in GN
Dysmorphic
RBCs may be confused with_______ and _____
oil droplets and yeast cells.
______ exhibit a greater variation in size and are highly refractile.
Oil droplets
______ are more oval, show budding.
Yeast cells
If identification is difficult, 2 preparation may be made and a few drops of _______ added to the one. RBCs are _____ in the acidified preparation.
acetic acid; lysed
RBCs: 0-2 /HPF
Normals
_______ in two of the three properly collected urine sample: Microscopic hematuria.
Greater than or equal to 3 per HPF
Greater than or equal to 3/HPF in two of the three properly collected urine sample:
Microscopic hematuria.
Increased no. of RBCs are seen in
GN, LN, Berger’s disease, HSP etc
_______ is the most predominant lymphocyte that appear in urine.
Neutrophil
When cellular degeneration has begun, nuclear details may be lost, and neutrophils may then become difficult to distinguish from?
renal tubular epithelial cells.
Urine Micro exam: ________ may enhance nuclear detail so that differentiation may still be possible.
Dilute acetic acid/ supravital stain
_________ is also useful in distinguishing neutrophils from tubular cells.
Peroxidase cytochemical reaction
Ultimately with continued degeneration, __________ segments fuse, making difficult/impossible to distinguish from mononuclear cells.
neutrophilic nuclear
In dilute or hypotonic urine the neutrophils are called?
glitter cells.
