PRACTICUM IV MACROSCOPIC EXAMINATION OF FEATS Practice : Stool examination Objective : Obtain stool/stool specimens that meet the requirements for routine stool examination. Feces are the remaining products of digestion and absorption of the food we eat and are excreted through the anus from the digestive tract. The normal amount of production is 100 – 200 grams/day. Feces consist of water, food waste, epithelial cells, debris, cellulose, bacteria and pathological materials. The type of food and peristalsis influence its shape, quantity and consistency with a normal defecation frequency of 3x per day to 3x per week. Indications for a stool examination: diarrhea, constipation, blood in the stool,mucus in the stool, jaundice, indigestion, and suspicion of gastrointestinal disease. Sampling : Feces for examination should come from spontaneous defecation. If an examination is absolutely necessary, a stool sample may also be taken with a gloved finger from the rectum. For regular examinations using feces at any time, 24 hour feces are rarely needed for certain examinations. Feces should be examined fresh, if left untreated it is possible that the elements in the feces will become damaged. Macroscopic examination of feces includes examination of quantity, color, pus, blood, mucus and parasites Method : macroscopic feces Principle : to examine the phases completely and determine the shape or morphology (normal or abnormal) in the phase. Time : collection is carried out at any time, especially at the first symptoms and preferablybefore administering antibiotics Tools : - sterile cotton swab - stool pot How it works: 1. The patient is required to urinate first because there is no stool may be contaminated with urine. 2. Instruct the patient to defecate directly into a stool pot (approximately 5 grams) 3. Close the pot tightly 4. Provide a label containing the examination date, patient name and specimen type A. Quantity Check Normally, the amount of stool ranges from 100-250 grams per day. The amount of stool is influenced by the type of food. If you eat lots of vegetables, the amount of stool increases. B. Smell Check Indole, skatol and butyric acid cause a normal odor in the stool. A foul odor occurs when protein decay occurs in the intestines which are not digested and broken down by germs. The reaction of feces becomes leachate by such decomposition. Stool that smells rancid or sour is caused by the fermentation of undigested sugar as in diarrhea. The stool reaction in that situation becomes acidic. Consuming foods with spices can result in the ingested spices adding to the smell of stool. C. Color Check - In normal feces it is yellow brown and this color can change to darker with the formation of more urobilin. Apart from urobilin, color is influenced by various types of food, abnormalities in the digestive tract and medications taken. - Green stools can be caused by vegetables containing chlorophyll or in newborn babies caused by biliverdin and porphyrin in meconium. - The gray color can be caused by the absence of urobilinogen in the digestive tract which is obtained in obstructive jaundice, the stool is called acholic. This condition may occur in pancreatic enzyme deficiencies such as: steatorrhoewhich causes food to contain a lot of fat that cannot be digested and also after giving barium salts after a radiological examination White, putty-like stools may be found in the conditionobstructive jaundice, for example due to blockagecholedohus ductor due to impaired fat absorption - Pink stools can be caused by fresh distal bleeding, perhaps also by foods such as beets or tomatoes. - The brown color may be caused by bleeding in the proximal part of the digestive tract or due to foods such as chocolate, coffee and others. The dark brown color is caused by excessive urobilin as inhemolytic anemia. Meanwhile, the black color can be caused by drugs containing iron, charcoal or bismuth and possibly also by melena. D. Consistency Check Normal stool has a slightly soft and shaped consistency. In diarrhea the consistency becomes very soft or liquid, whereas on the contrary hard or loose stools are found in constipation, fermentation. Carbohydrates in the intestines produce stools that are soft and mixed with gas. A ribbon-shaped stool consistency is found in hisprung disease. Very large, oily stools indicate intestinal malabsorption E. Mucus Examination Under normal circumstances, there is very little mucus in the stool. The presence of a lot of mucus means there is stimulation or inflammation of the intestinal wall. - Mucus is found on the outside of the stool, the localization of the irritation may be in the large intestine. Meanwhile, if mucus is mixed with feces, irritation is likely to occur in the small intestine. - In dysentery,intussusceptionAndileocolitisyou can get mucus alone without stool. - Transparent mucus that sticks to the outside of the feces is causedspastic colitis,mucous colitis in anxiety. - Stools with mucus and mixed with blood occur in anal rectal malignancy and inflammation - Stools with mucus mixed with pus and blood are due to thisulcerative colitis, bacillary dysentery,ulcerative diverticulitis - Stools with a lot of mucus are due tocolon vilousadenoma F. Blood Examination The presence of blood in the stool can be pink, brown or black. The blood may be found on the outside of the stool or mixed with the stool. - In bleeding proximal to the digestive tract, the blood will mix with the stool and the color will turn black, this is called melena as in stomach ulcers or internal varicose veins.esophagus - In bleeding in the distal part of the digestive tract, blood is found on the outside of the pink stool which is found in hemorrhoids or carcinoma of the rectum. The more proximal the source of bleeding, the blacker the color G. Pus/Pus examination On examination of the stool, pus can be found. This occurs in chronic ulcerative colon disease,sigmoid colon fistula, local abscess. Meanwhile, in bacillary dysentery, large amounts of pus are not found. H. Parasite Examination Also checked for the presence of Ascaris worms, Anylostoma and other worm species that may be found in the feces. I. Check for food residue Almost always undigested food remains can be found, it is not their presence that indicates an abnormality but rather the amount which in certain circumstances is associated with something abnormal. Some of the remaining food comes from leafy foods and some comes from animal food, such as muscles, elastic fibers and other substances. For further identification, the fecal emulsion is mixed with Lugol's solution, so the incompletely digested starch (amylum) appears as blue or red grains. Addition of a saturated solution of Sudan III or Sudan IV in 70% alcohol makes the neutral fat visible as red or orange droplets.