DIAGNOSTIC PROCEDURES
RLE 6.2
Mahimer, Ingrid Mahimer
Mamogay, Maria Lourdette
Manalo, Anne Marielle
Maniacop, Almeera Joyce
Mao, Maria Patricia
Manoos, ThomasVeronica Fel
Manuel, Isabelle Kristine
Mapili, Nicole
STOOL EXAM
A stool analysis is a series of tests done on a stool (feces) sample to help diagnose certain
conditions affecting the digestive tract . These conditions can include infection (such as
from parasites, viruses, orbacteria), poor nutrient absorption, or cancer.
Stool sample is collected in a clean container and then sent to the laboratory. Laboratory
analysis includes microscopic examination, chemical tests, and microbiologic tests.
The stool will be checked for color, consistency, amount, shape, odor, and the presence of
mucus.
How to do it?
Urinate before collecting the stool so that you do not get any urine in the stool sample.
Put on gloves before handling your stool. Stool can contain germs that spread
infection. Wash your hands after you remove your gloves.
Pass stool (but no urine) into a dry container. You may be given a plastic basin that can be
placed under the toilet seat to catch the stool.
Either solid or liquid stool can be collected.
In case of diarrhea, a large plastic bag taped to the toilet seat may make the collection
process easier; the bag is then placed in a plastic container.
Do not collect the sample from the toilet bowl.
Do not mix toilet paper, water, or soap with the sample.
Place the lid on the container and label it with your name, your doctor's name, and the
date the stool was collected. Use one container for each day's collection, and collect a
sample only once a day unless your doctor gives you other directions.
Remember
If your stool is being tested for blood, you may need to avoid certain foods for 2 to 3 days
before the test. This depends on what kind of stool test you use. And do not do the test
during your menstrual period or if you have active bleeding from hemorrhoids.
The stool may be examined for hidden (occult) blood, fat, meat fibers, bile, white blood
cells , and sugars called reducing substances. The pH of the stool also may be measured.
A stool culture is done to find out if bacteria may be causing an infection.
NORMAL RESULTS
 The stool appears brown, soft, and well-formed in consistency.
The stool does not contain blood, mucus, pus, undigested meat fibers,
harmful bacteria, viruses, fungi, or parasites.
The pH of the stool is 7.0-7.5,
The stool contains less than 0.25 grams per deciliter (g/dL) of sugars called reducing
factors.
The stool contains 2-7 grams of fat per 24 hours (g/24h).
ABNORMAL RESULTS
The stool is black, red, white, yellow, or green.
The stool is liquid or very hard.
The stool contains blood, mucus, pus, undigested meat fibers, harmful bacteria, viruses,
fungi, or parasites.
The stool contains low levels of enzymes, such as trypsin or elastase.
The pH of the stool is less than 7.0 or greater than 7.5.
The stool contains 0.25 g/dL (13.9 mmol/L) or more of sugars called reducing factors.
The stool contains more than 7 g/24h of fat (if your fat intake is about 100 g a day).

Ova and Parasite Test (O&P)

It is a microscopic examination of stool contents for parasites or their eggs. In an ova and
parasites (O&P) exam, a medical technician views a sample of stool under a microscope to look
for parasites and their ova (eggs) or cysts.

Why It's Done?

A doctor may request an O&P exam if the patient has symptoms of a possible parasitic
infection, such as diarrhea for an extended period of time, blood or mucus in the stool,
abdominal pain, nausea, headaches, or fever, especially if there's been an outbreak of parasitic
illness, or if the patient recently drank untreated water.
Preparation
Unlike most other lab tests, a stool sample is often collected by patients at home, not by
health care professionals at a hospital or clinic.
 If possible, the patient may be asked to avoid certain foods and treatments for 2 weeks
before the test, including:
- antacids, antidiarrheal drugs, and laxatives
- antibiotics and antiparasite drugs
- enemas
- contrast materials (liquids taken before some X-rays, CAT or CT scans, or other imaging
studies)
The stool should be collected into a clean, dry plastic jar with a screw-cap lid. Do not mix
urine, water, or toilet tissue with the sample.For best results, the stool should be brought to the
lab right away. If this isn't possible, the stool should be stored in preservative provided by the lab
and then taken there as soon as possible.
What to Expect
When the sample arrives at the laboratory, a medical technician stains some of the stool
specimen with a special dye and views it under a microscope to identify parasites or ova that are
present.
Getting the Results
In general, the result of the ova and parasites test are reported within 2 days.
Normal Results: Normal results means there was no parasites or parasite eggs found in the stool
sample. In this case, a parasite infection is an unlikely cause of your symptoms.
Abnormal Results: An abnormal result means parasites or eggs have been found in the stool
sample and you have a parasitic infestation. There are over 100 different known parasites in the
world. Some infections include:
giardiasis: an infection contracted by drinking water from lakes and streams where
animals like beavers and muskrats contaminate the water
amebiasis: an infection spread through contaminated food and water, mostly seen in
tropical areas with poor sanitation such as Africa, Mexico, and South America
strongyloidiasis: an infection spread through contact with soil that contains roundworms,
mostly found in warm, moist areas
taeniasis: a type of tapeworm infection that is caused by eating infected meat, such as
beef
Sources:
https://www.nlm.nih.gov/medlineplus/ency/article/003756.htm
http://www.cdc.gov/parasites/references_resources/diagnosis.html
http://kidshealth.org/en/parents/test-oandp.html#
http://www.healthline.com/health/stool-ova-and-parasites-exam#Results5
Bacterial Culture
Also known as:
Micrsocopy, Culture and Sensitivity (MC&S or MCS)
Wound Swab
Bacterial Culture
To detect bacterial pathogens in stool
growing bacteria
A swab can be taken from any area of the body that appears to have an infection.
To culture (grow) a wide range of organisms (especially bacteria) from this sample, to
determine which germ is causing the infection
Bacterial Culture
The process of growing microorganisms in culture by:
Taking bacteria from an infection site by specimen collection - in vivo
Growing bacteria in the artificial environment of the laboratory - in vitro
Why Culture Bacteria?
Obtain definitive identification and characterization

Grow and isolate all bacteria present in an infection

Determine which bacteria is most likely causing infection

Determine which bacteria is likely a contaminant or colonizer

Why Culture Bacteria?

Obtain sufficient growth of clinically relevant bacteria to:
Test antimicrobial susceptibility

Measure response to treatment

Characterize the agent

Bank strain for future use including vaccine development

Methods of Obtaining Pure Culture

1) The Streak Plate Method sterile wire loop and streaked in different patterns on agar
2) Pour Plate Method- serial dilutions using melted agar
How to do it?
Body fluids may be collected into a suitable sterile container. Alternatively a cotton-wool swab,
which is like an ear-bud, is used to collect a small amount of fluid from a wound or surface.
Some of this sample may then be transferred onto a glass slide at the bedside, for microscopy.
How to do it?
The swab is transported in a special medium that encourages growth of bacteria.
It may take 2 to 3 days to actually culture (grow) the relevant bacterium in the laboratory. Small
amounts of antibiotics are then applied to determine which antibiotics are most likely to be
effective in treating the infection: the antibiotic sensitivity.
Results: A negative culture or no growth does not necessarily exclude infection, but is
relatively reassuring.
An organism may initially be identified by its general group, for example gram-negative
bacillus and then subsequently identified more accurately: E coli.
Results: One or two days later the report will often contain the antibiotic sensitivities as a list of
antibiotics with R (resistant) or S (sensitive) next to each drug. This reflects the sensitivity of
the organism to the antibiotic in the laboratory dish, in vitro. This may not always be exactly
the same as the clinically observed sensitivity in the human body, in vivo, in real life.
Remember:
Fresh specimen is important to improve probability of detection of organism.

Serologic tests will determine presence of bacterial toxins.

Liver Biopsy Procedure in Pediatrics

Quick, painless procedure designed to remove a small piece of liver tissue for
microscopic examination by a hollow-tube needle
Helps to estimate degree of liver damage or to identify cause of persistent abnormal liver
blood tests (liver enzymes), jaundice, hepatitis, metabolic disease, biliary obstruction,
liver abnormality found during ultrasound, CT scan, or nuclear scan procedures, and
hepatomegaly
Uses general sedation or local anesthesia
Preliminary laboratory studies must be obtained before the procedure

Contraindications
 1. Prolonged bleeding or clotting times
2. Anemia
3. Infection
4. Obstructive jaundice

Procedure
1. Let the client lie supine.
2. Palpate the liver to find the best area where to insert the needle.
3. Mark that area by encircling it with a marker.
4. Sterilize the area around the biopsy mark with Betadine solution.
5. Place a sterile paper sheet over the area to frame the location where to insert the needle.
6. Administer a local anesthetic (e.g. Lidocaine) by injection.
7. Make a very small, deep incision at the biopsy mark using a small, sharp blade.
8. Insert a hollow biopsy needle through the incision and into the liver.
9. Quickly remove the needle.
10. Deposit the sample into a jar of formalin.
11. Put a bandage over the wound.
12. Place client in right side-lying position to put pressure on the liver and help stop any
bleeding that may occur.

Post-procedure

1. Let the client lie in bed for a few hours.

2. Outpatients should remain at the healthcare institution at least 4 hours after the procedure for
monitoring of any signs of internal bleeding or other complications.
3. Warn the client that she/he may feel tired for the rest of the day.
4. Advise client not to take any aspirin or any other medications that may predispose client to
bleeding (e.g. NSAIDs) and to report any difficulty of breathing.

Risks after the procedure

Internal bleeding
Leakage of bile from gall bladder
Pneumothorax if the needle makes a hole in the chest wall

Other methods of liver biopsy

a. Laparoscopic biopsy A laparoscope is inserted through an incision in the abdomen, and it sends
images to a monitor while other instruments are used to remove tissue samples from the liver.
This type of biopsy is used when tissue samples are needed from specific parts of the liver.
 b. Transvenous biopsy A catheter is inserted into a vein in the neck and it is guided to the liver. A
biopsy needle is inserted into the catheter and then into the liver to obtain a sample. This may be
done when client has blood-clotting problems or fluid in the abdomen.

Results

Ready in 2-4 days

NORMAL: Liver tissue looks normal under the microscope. No signs of infection, inflammation,
cancer, or cirrhosis.
ABNORMAL: Abnormal cells or liver tissue are present. Causes may be any of the following:
a. Infection such as hepatitis
b. Disease such as cirrhosis, or cancer

Reference: Childrens Hospital of Pittsburgh & WebMD

http://www.chp.edu/our-services/transplant/liver/education/patient-procedures/liver-biopsy

http://www.webmd.com/digestive-disorders/digestive-diseases-liver-biopsy