Presented by

Dr.Vinutha.M.G
III PG Scholar,
Dept of Roga Nidana
GAMC, Bangalore
 CONTENTS
 INTRODUCTION
 COMPOSITION
 COLLECTION
 PRECAUTION
 PRESERVATION
 MACROSCOPIC EXAMINATION
 CHEMICAL COMPOSITION
 MICROSCOPIC EXAMINATION
 STOOL CULTURE
 MALA/PURISHA
 Human feces - STOOL.

 Faeces / Feces- Plural-latin term- faex- RESIDUE.

 Waste residue of indigestible materials of an animal
digestive tract expelled through the anus during
defecation.

 Meconium

 SCATOLOGY or CAPROLOGY -study of feces.

• ¾ Water, ¼ Solid
• Undigested and Unabsorbed food
• Intestinal secretions, Mucous
• Bile pigments and Salts
• Bacteria and Inorganic material
• Epithelial cells, Leukocytes
• Universal Precautions
• Dry, sterilized, wide mouthed container (50 ml).
• Plastic/waxed cardboard box/match box
• Uncontaminated with Urine or any other body
secretions.
• Properly named
• Always a fresh sample -tested
• Morning specimen-5 to 6 ml
• Labeled specimen
• Contamination
• Specimen should not be left uncovered (Prevent
drying)
• Examined within 1 hr of collection
• Disposed properly after examination
 Various preservatives
 Aq. 10% formalin
 MIF-merthiolate iodine formaldehyde
 LV-PVA-low viscocity polyvinyl alcohol
 SAF-sodium acetate acetic acid formalin
 Schaudinn’s fixative
 Modified PVA Cu and Zn
 One vial fixative-ECOFIX,PARASAFE,UNIFIX
 STOOL EXAMINATION

MACROSCOPIC MICROSCOPIC OTHERS

•Culture
•Consistency •Cellophane tape
•Colour Permanent Temprory •Baeremann tech.
•Composition •Ova quantitaion (Stoll & Kato)

Diect saline smear Iodine smear Concentration techniques

Floatation
Sedimentation

Saline Formol ether Sat saline Zinc sulphate Sheather’s sugar

 Contd..
CONSISTENCY AND FORM
Normal- Well formed-Semisolid
Abnormal: condition
Pale, Bulky, Frothy Steatorrhea

Hard Constipation

Flattened and Ribbon Obstruction in lumen-

Bowel

Watery Bacterial infection

Rice water- Cholera

 COLOUR
Normal- Light to dark brown
Color Condition

• Yellow- Giardiasis, GERD, Gilbert’s syndrome

• Black- Bleeding in the upper GIT, Iron
administration, bismuth subsalicylate,
Beetroot
• Bright red/ Hematochezia- Bleeding in the lower GIT
• Fresh Blood- Amebic dysentry
• Pale/ Gray- Cholecystitis, Gallstones, Hepatitis,
Chronic pancreatitis, Cirrhosis.
• White- After barium meal, Biliary
obstruction.
• Blue- RADIOTHERAPY, cesium & Thallium
poisoning.
• Silver-Aluminium paint Carcinoma of ampulla of vater

• Violet/ Purple- Symptom in porphyria.

Infant stages
• Exclusively breast fed infants-
• Infants fed on cow’s milk
preparations-
• Babies fed on newer modified cow’s
milk-
• Some healthy children
color
loose and green or pasty and yellow
stools.
paler yellow colour and of a much
firmer consistency.
Clay coloured or greenish stools.
pass frequent, loose stools containing
undigested vegetable matter called as
Toddler’s diarrhoea.
 Contd..
ODOUR
 Depends on- PH of stool
 Methyl sulfides
 Benzopyrrole volatiles(indole and sketole) &
Hydrogen sulphide
 substances that produce normal odour- Intestinal
bacterial fermentation and putrefaction.
Odour Condition

• Foul odour- Degradation of undigested protein and

excessive carbohydrate intake.

• Sickly sweet odour- Undigested Lactose.

• Increased odor- Celiac disease, Crohn’s disease,

Ulcerative colitis, Chronic Pancreatitis,
Cystic fibrosis,.
PARTS OF PARASITE AND ADULT PARASITE
 Worms and their parts
• Round worm
• Hook worm
• Tape worm
• Pin worm
• Whipworm
CHEMICAL NORMAL
EXAMINATION

• Water – Upto 75%

• pH – 5.8 to 7.5

• Occult blood- Negative

• RS – Negative

• Bile – Negative in Adults

• 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
 PH
Procedure Increased pH- Decreased pH-ACIDIC
ALKALINE

• Atleast ½ ml of faeces • Colitis • Carbohydrate

-collected. Malabsorption-
• Antibiotic use Lactose intolerance
• Patient shouldn’t
receive any • Villous adenoma • Fat Malabsorption
antibiotics.
• Excess Protein in diet. • Disaccharidase
• Strip of nitrazine defficiency
paper – dipped in
sample. • Contagoin- E.Coli,
rotavirus.
 OCCULT BLOOD:
Principle Method Intpretation

Benzidine test- Benzidine – Glacial acetic Ulcers,Diverticullitis,Ulcer

Perioxidase +hemoglobin acid – Hydrogen peroxide – ative
in blood converts Over stool in slide – Colour Collitis,Diaphragmatic
hydrogen peroxide change. Hernia,Adenoma,CA
Colon, Gastrium
water and nascent oxygen

oxygen oxidises

benzidine in acidmedium

green to blue coloured

complex.
 FAT
Microscopic Quantitative fecal fat Interpretation
examination: test:

•Random faeces stained •Done over a period of 3 • Malabsorption

with Sudan staining ( days Syndrome
Sudan III or IV) •In a container all faeces • Obstructive Jaundice
•Visible amounts of fat collected • Non tropical
•Thoroughly mixed to sprue/Coeliac Sprue
homogenize • Crohn’s disease
•Small sample is obtained • Cystic Fibrosis
•Fat content extracted • Whipple’s disease
with solvents • Enteritis and
•Measured by Pancreatic diseases
saponification
 Contd..
REDUCING SUBSTANCES
 Screening test -carbohydrate malabsorbtion
disorders -lactose intolerance or disaccharidase
deficiency,
 Stool - positive for RS -Rota viral Infection in
Infants.
Materials: Reagents: Procedure:

•Wooden applicator •Clinitest tablets •1 volume of stool

sticks •Type I water (approximately “pea”
•Plastic transfer pipette, 6 •MAS Urinalysis size) to a 16 x 125 mm test
inches Abnormal Level 1 control tube.
16 x 125 mm test tubes •Normal Urinalysis •Add 2 volumes of type I
•Clinitest color reaction Control water.
chart •Mix thoroughly using a
•Vortex mixer vortex mixer
• centrifuge for 5 minutes
at 2000 rpm (full speed).
•Using a plastic (uniform
drop) pipette, transfer 15
drops of this suspension
to a clear test tube (16 x
125).
•Add one Clinitest tablet.
•end of this 15 second
waiting period
•Compare the color of the
liquid
Contd..
 Warning: This is an exothermic reaction and the
test tube will become very hot. Keep hands and
face away from the test tube opening.
 Note: Ignore sediment that may form in the
bottom of the test tube and changes after the 15
second waiting period.
 Results
CLINITEST % REPORTING COLOUR
SYSTEM
0.0 N -Normal BLUE

0.25 T-Nomal Blue to green

0.5 1+ Suspicious Shades of green

0.75 2+ To Brown

1.0 3+ to

2.0 4+ Orange

>2 >4+ greenish-brown

 STOOL EXAMINATION

MACROSCOPIC MICROSCOPIC OTHERS

•Culture
•Consistency •Cellophane tape
•Colour Permanent Temprory •Baeremann tech.
•Ova quantitaion
•Composition •(Stoll & Kato)

Diect saline smear Iodine smear Concentration techniques

Sedimentation Floatation

Saline Formol ether Sat saline Zinc sulphate Sheather’s sugar

M I C R O S C O P I C E X A M I N AT I O N
OF TEMPORARY METHOD
Requirements
 Microscope slides
 Cover slips
 Sodium chloride solution
 Lugol’s Iodine Solution
 Wooden applicator
 Fresh stool
 Gloves
Method:
 A drop of warm Saline or Lugol’s Iodine is placed over a
clean microscopic slide.
• About 2mg of stool sample should be taken and mixed
with soln placed over the slide.
• Coverslip is placed avoiding air bubbles.
• Examined under Microscope.
STOOL EXAMINATION
Temporary
 Scanty infection
Concentration techniques
Saline sedimentation
Formol Ether Sed. Conc.
Baermann’s technique
 Permanent Stained smears
 Iron haematoxylin stain
 Trichrome stain
 Modified Ziehl Neelsen stain (Crypto.)
Iron haematoxylin stain
 Fecal smear- fixed in Schaudinn’s solution-15min
 Immersed 2-5 min 70%alcohol
 70%alcohol having trace of iodine
 50% alcohol for 2-5min
 Washed in H2o-5-10min
 Immersed in 2%aqeous ferric ammonium sulphate
 Washed in H2o 3-5 min & stained by 0.5% aqueous
hematoxylin 5-15min
 Washed 2-5 min & differentiated in saturated aq. Picric acid
10-15min
 Washed 10-15min & dehydrated by passing through increasing
of alcohol
 Cleared in toulene /xylol and mounted
 Trichrome stain

 Quicker & simpler

 Smear is fixed in Schaudinn’s solution
 Taken up by alcohol
 Trichrome stain- applied-5-10min
 Differentiated in acid-alcohol
 Dehydrated
 Cleared
 Mounted
 Normal
• Undigested food materials – None to small
amount
• Starch – None
• Eggs, Cysts, Parasitic fragments – None
• Yeasts – None
• Leukocytes – None
 ABNORMAL
ABNORMAL IMPLICATION
Large amounts of leukocytes Chronic Ulceratice Collitis, Chronic
Bacillary Dysentry, Localised Abscess,
Fistulas.

Mononuclear Leukocytes Typhoid

Polymorphonuclear Leukocytes Shigellosis, Salmonellosis, Invasice E. coli
diarrhoea, Ulceratice Collitis.
 EGG COUNTING METHODS
Semi quantitative assessment
 Standard Wet mount
 Modified Kato thick smear technique
 Mc. Master’s method
 Stoll’s dilution tech
 Scotch tape method- Enterobius vermicularis
 Bell’s dilution-filtration count- schistosome eggs
 No. of
eggs

STANDARD
Rough 1-2mg of
indication WET feces
MOUNT

No. of
eggs/ gram
Thick smear-Kato technique
MC. MASTER’S METHOD
Chamber

Square grid on
the roof of Eggs in 20mg
chamber

Concentration Salt floatation

Stoll’s technique
Scotch tape method
App. 4inch
cellophane tape

Sticky side of
3 consecutive
tape pressed
days @ early
against the skin
morning
across the anus

Drop of
Sticky side of
toulene/xylol
tape placed on
betW. Tape &
glass slide
slide
STOOL CULTURE
Gram –ve - E. coli,
Enterobacter, Proteus,
Pseudomonas
aeruginosa,
Bacteroides.

Gram +ve - Clostridia,

Lactobacilli,
Enterococci,
Anaerobic
streptococci.
Contd..
Culture media -
AGAR and is
done aerobically.
XLD Agar
media –
Salmonella,
Shigella.

Campylobacter
TCBS Agar
culture media -
media–
Campylobacter
Cholera.
species.
MacConkey
media – Yersinia
enterocolitica
Hanging drop test:
 Cultures
Harada mori filter
paper strip culture Agar plate culture
S.Stercoralis S.Stercoralis
Charcoal culture
Trichostrongylus sensitive
 Contd..
HARADA MORI FILTER PAPER STRIP CULTURE:
 AGAR PLATE CULTURE

App. 2g
• Inoculated • Sealed • 2 days
• Agar plates • Room • Larva crawl
temperature over agar
CHARCOAL CULTURE
Contd..
 Wet film- microscopy
 Culture on selective media- salmonella, shigella &
Camphylo bacter spp.,etc
 Molecular genetics-PCR probes- detect Shiga toxin- E.coli
 EIA- detection of rotavirus & adeno virus- children
 Diarrhoel outbreaks- Norovirus-PCR/electron
microscopy
 Outbreaks of viral meningitis/encephalitis-viral
culture
INTESTINAL PARASITES
 Entamoeba histolytica- Pathogenic
Entameoba coli-Non pathogenic
Endolimax nana- Non pathogenic
Iodamoeba buetschlii –Non pathogenic
Balantidium coli-Pathogenic
Giardia lamblia-Pathogenic
Trichomonas vaginalis- Pathogenic
Cryptosporidium parvum-Pathogenic
Ascaris lumbricoides- Large round worm
Contd..
Enterobius vermicularis-pin worm
Contd..
Trichuris trichura- Whipworm
Necator americanus and Ancylostoma
duodenale- Hookworm
Necator americanus and Ancylostoma
duodenale
Strongyloides stercoralis-Threadworm
Taenia solium- Tape worm
Taenia solium- Tape worm
MALA / PURISHA

 Dosha dhathu mala moolam hi ….

 Synonyms:- Shakrit, Upveshana, Vit, Gutha,
Varcha
Formation of purisha
 “Pakwashya Tu Prapatasya Shoshyemanasye
Vahinna Paripinditpakavasye Vayu
Syat Katubhavata” [Charak Chikitsa Sthana
15/11]
 “Kittam Annasye Vinmutram”. [Charak
Chikitsa Sthana 15/18]
 Panchbhautika constitution of
purisha
 Purisha predominantly consists of agni and
vayu mahabhuta.
 “Purisham parthivam” (Bhanumati on
Sushruta sutrasthan15/8)
 Site of formation
 “Purishvahanam srotsam pakvashyo mulam
sthulgudam” (Charak vimansthana5/8)
 “Tatra vatvaschonirasnam
sthulantrapratibaddam
gudam naam marmamch”(Sushruta sharirsthana
6/25)
 Purishadhara kala
 “Panchmi purishdharanam,ya Ante kosthe
malam Abhivibhajyte pakvashyastha” [Sushruta
Shareer Sthana 4/16]
 “Yakrit samantat koshte ch tathaantrani
Samashrita Undukastham vibhajte Malam
Maladharakala” [Sushruta shareer Sthana 4/17]
Quantity- Functions of purisha
 “Sapta Anjali purishasye” [Charak shareer
Sthana 7/15]
 “Avshtambh purishasye” [Ashtang Hridya
Sutrasthana Sthana 11/5]
ASHTA STHANA PARIKSHA
Arishta • Mala swaroopa

Mruthyu • Ati krishna, atishubra

karaka • Atipeeta, Aruna

Avashya
mruthyu • Excess ushna
karaka
Mala pareeksha Contd..
Condition Lakshana

Saama mala Guru, Durgandhi, Apsu nimajjathi

Nirama mala Laghu, Na Apsu nimajjathi

Kamala Tila pista Nibha

Atisara Bahu drava

Pravahika Kapha yukta mala

Grahani Muhur baddam, muhur dravam

 PURISHAJA KRIMI

Sthana Akruty Varna

• Pakvashaya • Sookshma • Shweta(white),
(minute),Vritha Shyava (pale), Neela
(round), Deergha (blue),
(long) • Harita (green), Peeta
• Sthoola(big), (yellow).
Prithavapucksa (flat
tail) and Tanu(thin)
 Kakeruka –highly motile
 Makeruka – shape of Mudrika
 Sausrada- shelters on fermented materials
 Leliha- continuously licks/feeds and consume Dhatus
(seven tissue elements of the body)
 Sashoolika -causing pain in the host.21