S.O.P.

s
‫اﻟطراﺋق اﻷﺳﺎﺳﯾﺔ‬
‫ﻟﻔﺣص اﻟﺑراز‬
Standard Operating
Procedures
Of Stool Analysis

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 ‫ﺍﻟﻔﺤﻮﺻﺎﺕ ﺍﻟﺘﻲ ﲡﺮﻱ ﻋﻠﻲ ﺍﻟﱪﺍﺯ ﰲ ﺍﳌﻌﻤﻞ ‪- :‬‬

‫‪ What to LOOK FOR in STOOL :-‬ـ‬

‫‪ -1‬ﻓﺤﺺ اﻟﻄﻔﯿﻠﯿﺎت ‪-:‬‬

‫اﻟﺑﺣت ﻋن اﻟطﻔﯾﻠﯾﺎت ﻓﻲ اﻟﺑراز ﻣﺛل ‪ :‬ـ )‪( a‬اﻟدﯾدان اﻟﺗﻲ ﯾﻣﻛن رؤﯾﺗﮭﺎ ﺑﺎﻟﻌﯾن‬
‫اﻟﻣﺟردة ل )‪ ( b‬ﺑﯾوض أو ﯾرﻗﺎت ھذه اﻟدﯾدان اﻟﺗﻲ ﺗظﮭر ﺗﺣت اﻟﻣﺟﮭر‬
‫)‪ )protozoa(c‬اﻷوﻟﯾﺎت أو وﺣﯾدات اﻟﻧواة ( اﻟﺗﻲ ﺗوﺟد ﻓﻲ اﻟطور اﻟﺣرﻛﻲ أو‬
‫اﻟﻐﯾر ﺣرﻛﻲ واﻟطور اﻟﻣﻘﺎوم ﻣﺛل اﻟﺣوﺻﻠﺔ ‪.‬‬
‫‪ 2‬ـ اﻟﻔﺤﺺ اﻟﺒﻜﺘﯿﺮي ‪ :‬ـ‬
‫اﻟذي ﯾﺑﺣث ﻋن وﺟود اﻟﺑﻛﺗﯾرﯾﺎ اﻟﻣﺳﺑﺑﺔ ﻟﻠﻣرض وھذا ﻋن طرﯾق ﻋﻣل ﻣزرﻋﺔ‬
‫ﻟﻠﺑراز ‪stool culture‬‬
‫‪ 3‬ـ اﻟﻔﺤﺺ اﻟﻜﯿﻤﯿﺎﺋﻲ ‪ :‬ـ‬
‫وھذا أﺳﺎﺳﺎ ﯾﺟري ﻟﺗﺷﺧﯾص وﺟود اﻟدم اﻟﺧﻔﻲ وﺑﻌض اﻻﺧﺗﺑﺎرات اﻟﻛﯾﻣﯾﺎﺋﯾﺔ‬
‫اﻷﺧرى‪.‬‬

‫‪COLLETION OF STOOl‬‬ ‫ﲡﻤﻴﻊ ﺍﻟﱪﺍﺯ ‪:‬ـ‬

‫ـ ﺗﻧﺑﯾﮫ اﻟﻣرﺿﻲ ﻟﻌدم ﺧﻠط اﻟﻌﯾﻧﺔ ﺑﺎﻟﺑول أو اﻟﻣﺎء أو اﻟﻣطﮭرات ‪.‬‬

‫ـ اﻟﺗﺄﻛد ﻣن أن اﻟﻣرﯾض ﻻﯾﺗﻌﺎطﻲ ﺑﻌض اﻷدوﯾﺔ ﻟﺗﺄﺛﯾرھﺎ ﻋﻠﻲ ﻧﺗﺎﺋﺞ اﻟﻔﺣص ﻣﺛل ‪ :‬ـ‬
‫ﺗﺗراﺳﯾﻛﻠﯾن وأدوﯾﺔ اﻹﺳﮭﺎل ‪ ،‬اﻟﺑﺎرﯾوم ‪ ،‬اﻟﻣﺎﻏﻧﯾﺳﯾوم ‪ ،‬اﻟﺣدﯾد ‪،‬اﻟزﯾت ‪.‬‬
‫ـ ﺗﺳﺟﯾل وﻗت أﺧد اﻟﻌﯾﻧﺔ ﻟﻠﺗﺄﻛد ﻣن ﻋدم اﺳﺗﻘﺑﺎل ﻋﯾﻧﺎت ﺗﺄﺧرت ﻓﻲ اﻟوﺻول ﻟﻠﻣﻌﻣل‬
‫‪ -‬ﻋﯾﻧﺎت اﻟﺑراز ﻟﻼطﻔﺎل ﻻﺗﺟﻣﻊ ﻣن اﻟﺣﻔﺎظ ﻻن اﻟﻌﯾﻧﺔ ﺳوف ﺗﻛون ﺟﺎﻓﺔ ﻧﺗﯾﺟﺔ‬
‫ﺗﺷرب اﻟﺣﻔﺎظ ﻟﻠﺟزء اﻟﺳﺎﺋل ﻣن اﻟﻌﯾﻧﺔ‪.‬‬
‫ـ إذا ﻟم ﺗﺗﻣﻛن ﻣن ﻓﺣص اﻟﻌﯾﻧﺔ ﻣﺑﺎﺷرة اﻷﻓﺿل ﺣﻔظﮭﺎ ﻓﻲ ﺛﻼﺟﮫ ‪ ،‬وﯾﺳﺗﺣب وﺿﻊ‬
‫اﻟﻌﯾﻧﺎت ﻓﻲ اﻟظل ﺑﻌﯾداً ﻋن اﻟﺷﻣس واﻟﺣرارة اﻟﻌﺎﻟﯾﺔ ‪.‬‬
‫‪Safety:-‬‬ ‫اﻟﺳﻼﻣﺔ ‪:‬‬

‫‪-‬ارﺗداء اﻟﻘﻔﺎزات واﻟﻣﻼﺑس اﻟﺧﺎﺻﺔ ﺑﺎﻟﻣﻌﻣل )اﻟﻣراﯾﯾل (ﻋﻧد اﻟدﺧول اﻟﻰ اﻟﻣﻌﻣل ‪.‬‬

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 ‫‪-‬ﻏﺳل اﻟﯾدﯾن ﺟﯾدا ﻗﺑل وﺑﻌد اﻟﻌﻣل ﺑﺎﻟﻣطﮭرات اﻟﻣﻧﺎﺳﺑﺔ ﻟذﻟك ‪،‬وﯾﺟب اﻟﺗﺧﻠص ﻣن‬
‫اﻟﻘﻔﺎزات اﻟﻣﺳﺗﻌﻣﻠﺔ ﺣﺳب اﻟطرق اﻟﻣﺧﺻﺻﺔ ﻟذﻟك ‪.‬‬
‫‪-‬ﻋدم اﻻﻛل واﻟﺷرب واﻟﺗدﺧﯾن واﻟﻣﺿﻎ واﺳﺗﻌﻣﺎل ﻣواد اﻟزﯾﻧﺔ ﻓﻲ اﻟﻣﻌﻣل ‪.‬‬
‫‪-‬اﺳﺗﻌﻣﺎل اﻟﻛﺎﺑﯾﻧﺔ اﻟﺧﺎﺻﺔ ﺑﺗﺣﺿﯾر اﻟﻣﺣﺎﻟﯾل ﻋﻧد اﻟﺣﺎﺟﺔ ﻟذﻟك ‪.‬‬

‫‪ ‬‬

‫ﯾﺟب اﻟﺗﺄﻛد ﻣن ﺻﻼﺣﯾﺔ اﻟﻣﯾﻛروﺳﻛوب وﻣﻌﺎﯾرﺗﮫ ﺟﯾداً ﻗﺑل ﻓﺣص اﻟﺷراﺋﺢ ‪.‬‬

‫‪Macroscopic Examination‬‬ ‫‪ ‬ﻓﺤﺺ ﺍﻟﱪﺍﺯ ﺍﻟﻈﺎﻫﺮﻱ ‪.‬‬

‫‪ ‬‬

‫ﻋﻧدﻣﺎ ﺗﻛون اﻟﻌﯾﻧﺎت ﻛﺛﯾرة ﻣن اﻷﻓﺿل أن ﺗﺑدء ﺑﺎﻟﻌﯾﻧﺎت اﻟﺳﺎﺋﻠﺔ واﻟﺗﻲ ﺗﺣﺗوي ﻋﻠﻲ‬
‫ﻣﺧﺎط أو دم ﻷﻧﮭﺎ ﻗد ﺗﺣﺗوي ﻋﻠﻲ أطوار ﻣﺗﺣرﻛﺔ وھﻲ ﺗﻣوت ﺳرﯾﻌﺎ وﯾﺻﻌب‬
‫اﻛﺗﺷﺎﻓﮭﺎ واﻟﺗﻌرف ﻋﻠﯾﮭﺎ ‪.‬‬
‫ﻣن اھم اﻟﻣﻼﺣظﺎت اﻟﺗﻲ ﯾﺟب ﺗدوﯾﻧﮭﺎ ﺣول ﻋﯾﻧﺔ اﻟﺑراز ظﺎھرﯾﺎ ً ‪ :‬ـ‬
‫‪1-consistency‬‬ ‫ا ـ اﻟﻘوام ‪:‬‬
‫‪-hard and dry‬‬

‫‪-firm and formed‬‬

‫‪-soft and formed‬‬

‫‪-soft and unformed‬‬

‫‪-semi liquid‬‬

‫‪-liquid and watery‬‬

‫‪2- color :-‬‬ ‫‪ 2 .‬ـ اﻟﻠون ‪-:‬‬

‫)‪(a‬اﺳود ‪ black‬ﺑﻌض ﻣﺳﺑﺑﺎﺗﮫ ﻧزﯾف اﻟﺟزء اﻟﻌﻠوي ﻣن اﻻﻣﻌﺎء ‪،‬ﻧزﯾف ﻓﻲ اﻻﺛﻧﺎ‬

‫ﻋﺷر‪.‬‬
‫)‪(b‬اﺣﻣر ‪ Red‬ﺑﻌض ﻣﺳﺑﺑﺎﺗﮫ ﻧزﯾف ﻣن ﻓﺗﺣﺔ اﻟﺷرج ‪،‬ﺑﻠﮭﺎرﺳﯾﺎ ‪)،‬ﺑﻌض اﻻﺣﯾﺎن‬
‫طﻣﺎطم او ﺑﻧﺟر ﻏﯾر ﻣﮭﺿوم(‬

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 ‫)‪(c‬اﺣﻣر ﻧﺎﺻﻊ ‪ Bright red‬ﻧزﯾف ﻓﻲ اﻟﺟزء اﻟﺳﻔﻠﻲ ﻣن اﻻﻣﻌﺎء اﻟدﻗﯾﻘﺔ او ﺑﺳﺑب‬
‫ﺗﻠوث ﻣﻌوي ‪.‬‬
‫)‪(d‬ﻣﺧﺎطﻲ او وﺣﻠﻲ ‪ Mucous or Clay colored‬ﺑﺳﺑب اﻟدﺳﻧﺗﺎرﯾﺎ اﻻﻣﯾﺑﯾﺔ او‬
‫اﻟﯾرﻗﺎن او ﺑﺳﺑب اﻋﺎﻗﺔ ﺗدﻓق اﻟﺻﻔراء اﻟﻰ اﻻﻣﻌﺎء ‪.‬‬
‫)‪(e‬اﺑﯾض ‪White‬ﺑﻌد ﺗﻧﺎول وﺟﺑﺔ اﻟﺑﺎرﯾوم ﻋﻧد ﻋﻣل اﻻﺷﻌﺔ ‪.‬‬

‫)‪(f‬ﺑﺎھت ‪Pale‬اﻧﺳداد ﻓﻲ اﻟﻘﻧﺎة اﻟﻣرارﯾﺔ ‪.‬‬

‫)‪(g‬اﺧﺿر ‪Green‬ﺑﺳﺑب ﺑﻌض اﻻدوﯾﺔ ﻣﺛل ‪. Diathiazine , Mercurous‬‬

‫‪-3 odor‬‬ ‫‪ 3‬ـ اﻟراﺋﺣﺔ ‪.‬‬

‫‪4- mucus .‬‬ ‫‪ 4‬ـ اﻟﻣﺧﺎط ‪.‬‬

‫‪5 -Blood .‬‬ ‫‪ 5‬ـ اﻟدم‬

‫‪Microscopic examination‬‬ ‫‪ ‬ﺍﻟﻔﺤﺺ ﺍﳌﻴﻜﺮﻭﺳﻜﻮﺑﻲ ‪ :‬ـ‬

‫‪ -‬ﺗﺣظﯾر اﻟﺷرﯾﺣﺔ ‪ :‬اﻟﻣواد ‪ :‬ـ‬

‫‪-Microscopic Slides‬‬ ‫ـ ﺷراﺋﺢ زﺟﺎﺟﯾﺔ‬

‫‪–Cover Slides‬‬ ‫ـ آﻏطﯾﺔ ﺷراﺋﺢ‬

‫‪–Waxes pen or Markers for Labelling‬‬ ‫ـ ﻗﻠم ﺷﻣﻊ ﻟﻠﺗرﻗﯾم أو اﻟﺗﻌﻠﯾم ‪.‬‬

‫‪ Saline solutions‬ـ‬ ‫ـ ﻣﺣﻠول ﻣﻠﺣﻲ ‪.‬‬

‫‪–Iodide solution‬‬ ‫ـ ﻣﺣﻠول ﯾود‬

‫‪-Loop or applicator sticks‬‬

‫اﻟﻌﻣل ‪ :‬ـ‬
‫‪ 1‬ـ ﻧﺄﺧد ﺷرﯾﺣﺔ وﺑﺎﻟﻘﻠم اﻟﺷﻣﻌﻲ ﻧﺿﻊ رﻗم اﻟﻌﯾﻧﺔ ﻋﻠﻲ طرف اﻟﺷرﯾﺣﺔ ‪.‬‬

‫‪ 2‬ـ ﺗم ﻧﺿﻊ ﻗطرة ﻣن اﻟﻣﺣﻠول اﻟﻣﻠﺣﻲ ﻓﻲ ﻣﻧﺗﺻف ﻧﺻف اﻟﺷرﯾﺣﺔ ﺗم ﻧﺿﻊ ﻗطرة‬
‫ﯾود ﻓﻲ ﻣﻧﺗﺻف اﻟﻧﺻف اﻻﺧر ‪.‬‬

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 ‫‪ 3‬ـ ﺗم ﻧﺄﺧد ﺟزء ﺻﻐﯾر ﻣن اﻟﻌﯾﻧﺔ ‪ ،‬إذا ﻛﺎﻧت اﻟﻌﯾﻧﺔ ﺟﺎﻓﺔ ﻧﺄﺧد ﻣن داﺧل وﺧﺎرج‬
‫اﻟﻌﯾﻧﺔ ‪ ،‬وإذا ﻛﺎن ﺑﮭﺎ ﻣﺧﺎط أو دم ﻧﺄﺧد ﻣن ذﻟك اﻟﺟزء ﺗم ﻧﺧﻠط اﻟﻌﯾﻧﺔ ﺟﯾداً ﻣﻊ‬
‫اﻟﻣﺣﻠول ‪ ،‬ﻋﻠﻲ أن ﻻﺗﻛون اﻟﻠطﺎﺧﺔ ﺳﻣﯾﻛﺔ او رﻗﯾﻘﺔ ﺟداً ) ﺑﺣﯾت إذا وﺿﻌت ﻋﻠﻲ‬

‫ﻋﻧوان ﻓﻲ ﺟرﯾدة ﯾﻣﻛن ﻗراءﺗﮫ (‬

‫ﺛم ﻧﻐطﻲ ﻛل ﻗطرة ﺑﻐطﺎء ﺷراﺋﺢ ﻣﻊ ﻣراﻋﺎة ﻋدم دﺧول اﻟﮭواء وﺗﻛون ﻓﻘﺎﻋﺎت ‪.‬‬
‫ـ ﻓﻲ ﺣﺎﻟﺔ وﺟود ‪amoebic trophozoites‬‬

‫ﻧﺿﻊ ﻋﻠﻲ اﻟﺷرﯾﺣﺔ ﻗطرة ﻛﺑﯾرة ﻣن ‪)(Buffered Methylene Blue ) BMB‬‬

‫وﻧﺧﻠط اﻟﻌﯾﻧﺔ ﺟﯾداً وﻧﻐطﯾﮭﺎ ﺑﻐطﺎء اﻟﺷراﺋﺢ وﺗﺗرﻛﮭﺎ ﻣن ‪ 5‬ـ ‪ 10‬دﻗﺎﺋق ﻗﺑل ﻓﺣﺻﮭﺎ‬
‫ﻟﻛﻲ ﯾﺗم دﺧول اﻟﺻﺑﻐﺔ ﻋﻠﻲ أن ﺗﻔﺣص اﻟﺷرﯾﺣﺔ ﻓﻲ ﺧﻼل ‪ 30‬دﻗﯾﻘﺔ ‪.‬‬
‫اﻟﻔﺣص ‪-:‬‬
‫ﺗﻔﺣص اﻟﻌﯾﻧﺔ ﺗﺣت اﻟﻣﻛروﺳﻛوب ﻟﻌﯾﻧﺔ اﻟﻣﺣﻠول اﻟﻣﻠﺣﻲ ﺗﺣت ﻗوة ‪ 10 X‬و ‪، 40 X‬‬
‫وﻟﻌﯾﻧﺔ اﻟﯾود ﺗﺣت ﻗوة ‪ ، 40 X‬وﻗﻠل اﻟﺿوء ﻟﻠﻔﺣص ﺟﯾدا ‪ ،‬وﺗﻔﺣص اﻟﺳﺎﺣﺔ ﻣن‬
‫ﺟﺎﻧب إﻟﻲ ﺟﺎﻧب وﻣن اﻷﻣﺎم إﻟﻲ اﻟوراء ‪.‬‬

‫ـ اﻟﺑﯾوض ﻗد ﺗري ﺑﺳﮭوﻟﺔ ﻓﻲ ﻋﯾﻧﺔ اﻟﻣﺣﻠول اﻟﻣﻠﺣﻲ وﻻﺗﺻﺑﻎ ﻷن اﻟﺻﺑﻎ ﻗد‬

‫ﻻﯾﺳﺎﻋد ﻓﻲ اﻟﺗﺷﺧﯾص اﻟﺻﺣﯾﺢ‪ ,‬واﻟﺑﯾوض ﯾﻣﻛن رؤﯾﺗﮭﺎ ﻓﻲ ﻗوة ‪ 10 X‬وﻟﻛن ﺑﻌض‬
‫اﻟﺑﯾوض ﻻﺗرى إﻻﻓﻲ اﻟﻘوة اﻟﻌﻠﯾﺎ ﻟﻠﻌدﺳﺔ اﻟﺟﺎﻓﺔ ‪.‬‬
‫ـ ﯾرﻗﺎت ﺑﻌض اﻟدﯾدان أﯾﺿﺎ ً ﻗد ﺗري ﻓﻲ ﻋﯾﻧﺔ اﻟﻣﺣﻠول اﻟﻣﻠﺣﻲ ‪.‬‬

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 ‫ﻣﻼﺣظﺔ ﻋﻣﻠﯾﺔ ‪-:‬‬
‫ﻋﻧد اﻟﺷك ﻓﻲ اﺣﺗﻣﺎل وﺟود ﺑوﯾﺿﺔ ﻣﺎ ﻻﺗﻌرﻓﮭﺎ اﺗرك اﻟﻌﯾﻧﺔ ﻟﻐﯾرك ﯾﻔﺣﺻﮭﺎ او‬
‫اﺳﺗﻌن ﺑﺎﻟﺻور ﻣن اﻻطﻠس واذا ﻟم ﯾﺗوﻓر ذﻟك ﻓﻣن اﻻﻓﺿل ﻋدم ﻛﺗﺎﺑﺔ اﻟﺑوﯾﺿﺔ‬
‫اﻟﻣﺷﻛوك ﻓﯾﮭﺎ واطﻠب ﻣن اﻟﻣرﯾض ﻋﯾﻧﺔ اﺧرى ﻓﻲ اﻟﺻﺑﺎح ﻻﻋﺎدة اﻟﻔﺣص ‪.‬‬
‫ـ ﻣن اﻻﻓﺿل ﻓﺣص اﻟﺑراز ﻗﺑل ﻣرور ﺳﺎﻋﺔ واﺣدة ﻋﻠﻲ اﻟﺗﺟﻣﯾﻊ ﻷن ﺑﻌض‬
‫ﺣوﺻﻼت اﻟوﺣﯾدات ) ‪ (Protozoa cysts‬ﻗد ﺗﻣوت وﻣن اﻟﻣﻣﻛن رؤﯾﺗﮭﺎ ﺗﺗﺣرك‬
‫ﻓﻲ اﻟﻌﯾﻧﺎت اﻟطﺎزﺟﺔ ‪ ,‬ﻋﻧد وﺟود اﻟدم او اﻟﺻدﯾد ﻓﻲ اﻟﻌﯾﻧﺔ ﻣن اﻟﻣﺳﺗﺣﺳن ﻓﺣص‬
‫ﺷرﯾﺣﺗﯾن ﻟﻧﻔس اﻟﻌﯾﻧﺔ ‪.‬‬

‫‪ ‬‬

‫اﻟدم ﻓﻲ اﻟﺑراز ﻣرﺿﻲ وأي ﻣﻼﺣظﺔ ﻟﮫ ﯾﺟب ان ﺗﺳﺟل ﻓﻲ اﻟﻧﺗﯾﺟﺔ ‪.‬‬

‫ﲢﻀﲑ ﺍﻟﻴﻮﺩ ﻟﻔﺤﺺ ﺍﻟﱪﺍﺯ ‪ :‬ـ‬

‫‪1 – 1gm Iodine‬‬

‫‪2- 2gm Potasium Iodide‬‬

‫‪3-100 ml Dise l ed W‬‬

‫‪a t er‬‬

‫ﻧﺿﻊ ﺑوﺗﺎﺳﯾوم اﯾوداﯾد ‪ 30 +‬ﻣل ﻣن اﻟﻣﺎء ﺗم ﻧﺿﯾف اﻟﯾود وﺑﺎﻗﻲ اﻟﻣﺎء ﺛم ﯾﺧﻔف‬
‫ﻟﺧﻣس ﻟﺗرات )‪ ( L5‬ﻋﻠﻲ أن ﯾﺣﻔظ ﻓﻲ ﻣﻛﺎن ﺑﺎرد ﺑﻌﯾدأ ﻋن اﻹﺿﺎءة ‪.‬‬

‫‪Occult Blood‬‬ ‫‪ ‬ﺍﻟﺪﻡ ﺍﳋﻔﻲ ﰲ ﺍﻟﱪﺍﺯ ‪.‬‬

‫‪ -‬ﻗﺑل ﻓﺣص اﻟدم اﻟﺧﻔﻲ ﻓﻲ اﻟﺑراز ‪ Occult Blood test‬ﯾﺟب أن ﯾﻌد‬
‫اﻟﻣرﯾض ﻗﺑل أﺧد اﻟﻌﯾﻧﺔ ﻓﯾﺟب أن ﻻﯾﺗﻌﺎطﻰ ﺑﻌض اﻻدوﯾﺔ ﻣﺗل اﻻﺳﺑرﯾن‬
‫اﻻﺑﯾوﺑروﻓﯾن‬
‫‪,anticoagulants,antimetabolites,colchicines,indomthacine,(N‬‬
‫)‪ SAIDs‬ﻟﻣدة ﻻﺗﻘل ﻋن ﺛﻼﺗﺔ أﯾﺎم اﻟﻰ ﺳﺑﻌﺔ اﯾﺎم وﺧﻼل أﺧد اﻟﻌﯾﻧﺎت ﻟﻣدة ﺳﺑﻌﺔ‬
‫اﯾﺎم وان ﯾﻣﺗﻧﻊ ﻋن أﻛل ﺑﻌض اﻟﺧﺿﺎر ﻣﺗل اﻟﻠﻔت ‪Turnip‬واﻟﻔﺟل ‪Radishes‬و‬
‫اﻟﺑطﯾﺦ ‪ Melons‬واﻟﻠﺣم اﻻﺣﻣر واﻟﻛﺑد ﻟﻣدة ‪ 3‬أﯾﺎم وﺧﻼل اﺧد اﻟﻌﯾﻧﺎت ‪.‬‬
‫ﻧزﯾف اﻟدم ﻣن اﻟﻠﺛﺔ ﻧﺗﯾﺟﺔ اﺳﺗﺧدام ﻓرﺷﺎة اﻻﺳﻧﺎن ﺑﻘوة ﯾؤدي اﻟﻰ ﻧﺗﺎﺋﺞ اﯾﺟﺎﺑﯾﺔ ﻛﺎذﺑﺔ‬
‫ﻓﻲ اﺧﺗﺑﺎر اﻟدم اﻟﺧﻔﻲ ‪.‬‬

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 ‫ﻣن اﻻﻓﺿل إﻋﺎدة ﺗﺣﻠﯾل اﻟدم اﻟﺧﻔﻲ ﻋﻧدﻣﺎ ﯾﻛون ﻣوﺟﺑﺎ ً ﺑﻌﯾﻧﺔ اﺧرى ﻣن اﻟﻣرﯾض‬
‫ﺑﻌد ‪ 3‬أﯾﺎم أظﺎﻓﯾﺔ ﺑﻧﻔس ﺑرﻧﺎﻣﺞ اﻻﻣﻧﺗﻧﺎع ﻋن اﻻدوﯾﺔ واﻟﻣﺄﻛوﻻت اﻟﺗﻲ ﺗﺳﺑب ﺑﻌض‬
‫اﻻﺧﺗﻼطﺎت ﻓﻲ اﻟﻧﺗﺎﺋﺞ ‪،‬ﯾﺟب اﻟﺗﻘﯾد ﺑﻛﺎﻓﺔ اﻟﺗﻌﻠﯾﻣﺎت اﻟﻣرﻓﻘﺔ ﻟﻛل ﻋدة ‪Kit‬ﺣﺳب ﻧوع‬
‫اﻟﺷرﻛﺔ اﻟﻣﺻﻧﻌﺔ ﻟظﻣﺎن ﺻﺣﺔ اﻟﻧﺗﺎﺋﺞ ‪.‬‬

‫ﺑﻌض اﻟﺟداول اﻟﺗوﺿﯾﺣﯾﺔ ‪:‬‬

‫ﺟدول رﻗم ‪ 1‬ﻟﻠﻣﻘﺎرﻧﺔ ﺑﯾن اﻻﻣﯾﺑﺎ اﻟﻣﻌوﯾﺔ ﻓﻲ ﻋدد ﻣن اﻟﺗﺣﺿﯾرات ﻟﻔﺣص اﻟﺑراز ‪.‬‬ ‫‪-‬‬
‫ﺟدول رﻗم ‪ 2‬ﻟﻠﻣﻘﺎرﻧﺔ ﺑﯾن اﻟﻔروﻗﺎت اﻟﺷﻛﻠﯾﺔ ﻟﻠوﺣﯾدات اﻟﻣوﺟودة ﻓﻲ اﻟﺑراز ‪Amebae‬‬ ‫‪-‬‬
‫‪Trophozoites‬‬
‫ﺟدول رﻗم ‪ 3‬ﻟﻠﻣﻘﺎرﻧﺔ ﺑﯾن اﻟﻔروﻗﺎت اﻟﺷﻛﻠﯾﺔ ﻟﻠوﺣﯾدات اﻟﻣوﺟودة اﻟﺑراز ﻓﻲ‪Amebae -cysts‬‬ ‫‪-‬‬

‫‪Table 1‬‬
‫‪Characteristics of Intestinal Amebae Visible in Different Types of Fecal‬‬
‫‪Preparations‬‬

‫‪UNSTAINED‬‬ ‫‪TEMPORARY‬‬ ‫‪PERMANENT‬‬

‫‪STAINS‬‬ ‫‪STAINS‬‬
‫‪Buffered‬‬
‫‪Characteristic‬‬ ‫‪Iodine‬‬ ‫‪Methylene‬‬
‫‪Saline‬‬ ‫‪Formalin‬‬
‫)‪(Cysts‬‬ ‫‪Blue‬‬
‫‪(Trophs)1‬‬

‫‪Trophozoites‬‬

‫‪Motility‬‬ ‫‪+‬‬

‫‪Cytoplasm‬‬

‫‪Appearance‬‬ ‫‪+‬‬ ‫‪+‬‬ ‫‪+‬‬ ‫‪+‬‬

‫)‪Inclusions (rbc., bacteria‬‬ ‫‪+‬‬ ‫‪+‬‬ ‫‪+‬‬ ‫‪+‬‬

‫‪Nucleus‬‬ ‫‪+2‬‬ ‫‪+‬‬ ‫‪+‬‬

‫‪Cysts‬‬

‫‪Nuclei‬‬ ‫‪+‬‬ ‫‪+‬‬ ‫‪+‬‬

‫‪Chromatoid bodies‬‬ ‫‪+‬‬ ‫‪+‬‬ ‫‪+3‬‬ ‫‪+‬‬

‫‪Glycogen‬‬ ‫‪+‬‬
‫)‪(vacuole present‬‬

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 Table 2

Differential Morphology of Protozoa Found in Stool Specimens

of Humans: Amebae-Trophozoites

NUCLEUS CYTOPLASM

Periph
Size
Specie Motilit Numb eral Karyosomal Appeara Inclusio
(Leng
s y er Chrom Chromatin nce ns
th)
atin
Entamo 10-60 Progres 1 Fine Small, Finely Red blood
eba m. U sive Not granule discrete. Usually qranular. cells
histolyti sual with visible s. Usua centrally located, occasionall
ca range, hyaline, in lly but occasionally y. Noninv
15-20 finger- unstai evenly is eccentric. asive
m like ned distribu organisms
comme pseudo prepar ted and may
nsal pods. ations. uniform contain
form.1 in size. bacteria.
Over
20 m
invasiv
e
form.2

Entamo 5- Usually 1 Similar Small, discrete, Finely Bacteria.

eba 12m. nonpro Not to often eccentric. granular.
hartman Usual gressiv visible E.
ni range, e but in histolyti
8-10 may be unstai ca.
m. progres ned
sive prepar
occasio ations.
nally.

Entamo 15- Sluggis 1 Coarse Large, discrete, Coarse, Bacteria,

eba coli 50m. h, Often granule usually eccentric. often yeasts,
Usual nonpro visible s, vacuolate other
range, gressiv in irregula d. materials.
20-25 e, with unstai r in size
m. blunt ned and
pseudo prepar distribu
pods. ations. tion.

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Entamo 10- Usually 1 Usually Small, discrete, Coarsely, Bacteria,
eba 25m. sluggis May be fine eccentric. Occasi granular, yeasts.
polecki Usual h, slightly granule onally large, may
range, similar visible s diffuse or resemble
15-20 to E. in evenly irregular. E.
m. coli. Oc unstai distribu coli. Cont
casional ned ted. Oc ains
ly, in prepar casional numerous
diarrhei ations. ly vacuoles.
c Occas granule
specim ionally s may
ens, may be
motility be irregula
may be irregul rly
progres arly arrange
sive. distort d. Chro
ed by matin
pressu someti
re mes in
from plaques
vacuol or
es in crescen
cytopla ts.
sm.

Endolim 6-12 Sluggis 1 None. Large, irregularly Granular, Bacteria.

ax nana m. U h, Visible shaped, blot-like. vacuolate
sual usually occasio d.
range, nonpro nally in
8-10 gressiv unstai
m. e with ned
blunt prepar
pseudo ations.
pods.

Iodamo 8-20 Sluggis 1 None. Large, usually Coarsely Bacteria,

eba m. U h, Not central. Surroun granular, yeasts, or
buetschl sual usually usually ded by refractile, vacuolate other
ii range, nonpro visible achromatic d. material.
12-15 gressiv in granules. These
m. e. unstai granules are
ned often not distinct
prepar even in stained
ations. slides.

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Dientam 5-15 Pseudo 2 None. Large cluster of Finely, Bacteria:
oeba m. U pods (In 4-8 granules. qranular. occasionall
3
fragilis sual are approx y red
range, angular imatel blood cells.
9-12 , y 20%
m. serrate of
d, or organi
broad sms
lobed, only 1
and nucleu
hyaline, s is
almost presen
transpa t.) Nu
rent. clei
invisibl
e in
unstai
ned
prepar
ations.

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 Table3

Differential Morphology of Protozoa Found in Stool Specimens of Humans:

Amebae-cyst

NUCLEUS CYTOPLASM
Speci Size Shape Number Periphe Karyosom Chromat Glycogen
es (Diamet ral al oid
er or Chrom Chromatin Bodies
length)
atin
Enta 10-20 Usually 4 in Peripher Small, Present. Usually
moeb m spherical mature al discrete, Elongated diffuse. Co
a Usual . cyst. chromat usually bars with ncentrated
histol range, Immatur in centrally bluntly mass often
ytica 12-15 e cysts present. located rounded present in
m with 1 or Fine, ends. young
2 uniform cysts. Stai
occasion granules ns reddish
ally seen , evenly brown with
distribut iodine.
ed
Enta 5-10 Usually 4 in Similar Similar to Present. Similar to
moeb m spherical mature to E. E. Elongated E.
a Usual . cyst. histolyti histolytica. bars with histolytica.
hart range, Immatur ca. bluntly
mann 6-8 m. e cysts rounded
i with 1 or ends.
2 often
seen
Enta 10-35 Usually 8 in ripheral Large, Present, Usually
moeb m spherical mature chromat discrete, but less diffuse,
a coli Usual . Occasi cyst. Oc in usually frequently but,
range, onally casionall present. eccentric seen than occasionall
15-25 oval, y super- Coarse but in E. y well
m triangula nucleate granules occasionall histolytica defined
r, or d cysts irregular y centrally . Usually mass in
other with 16 in size located. splinter- immature
shapes. or more and like with cysts. Stai
are seen. distribut pointed n reddish
Immatur ion, but ends. brown with
e cysts often iodine.
with 2 or appear
more more
occasion uniform
ally seen. than in
trophoz
oites.
Enta -18 m Spherica 1. Rarely Usually Usually Present. Usually
moeb Usual l or oval. 2. fine small and Many small,
a range, Occasion granules eccentric. small diffuse
polec 11-15 ally evenly bodies masses
ki m. visible in distribut with stain
unstaine ed angular reddish
d or brown with
preparati pointed iodine. A
ons ends, or dark area
few large called an
ones. Ma "inclusion
y be oval, mass"
rod-like, (possibly

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 or concentrat
irregular. ed
cytoplasm)
is often
also
present. M
ass does
not stain
with
iodine.
Endol 5-10 Spherica 4 in None Large Occasiona Usually
imax m. l, immatur (blot-like), lly diffuse. Co
nana Usual ovoidal, e cysts. usually granules ncentrated
range, or Immatur central. or small mass seen
6-8 m. ellipsoid e cysts oval occasionall
al. with less masses y in young
than 4 seen, but cysts. Stai
rarely bodies as ns reddish
seen. seen in brown with
Entamoeb iodine
a spp. are
not
present.
Ioda 5-20 Ovoidal, 1 in None Large, Occasiona Compact,
moeb m. ellipsoid mature usually lly well-
a Usual al, cyst. eccentric. granules defined
buets range, triangula Refractile, present, mass. Stai
chlii 10-12 r, or achromatic but ns dark
m other granules chromatoi brown with
shapes on one side d bodies iodine.
of as seen in
karyosome. Entamoeb
Indistinct a spp. are
in iodine not
preparation present.
s

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Normal Values in Stool Analysis ‫ا ﻟﻘﯾم اﻟطﺑﯾﻌﯾﺔ ﻟﺗﺣﻠﯾل اﻟﺑراز‬

Macroscopic Examination Normal Values

Amount 100-200g/24h
Color Brown
Odor Offensive- varies with PH of stool and
depends on bacterial fermentation and
putrefaction
Consistency Plastihc ,not unusual to see
fiber,vegetableskins,and seeds,soft and
bulky in high – vegetable diet ,small and
dry in high – meat diet
Size and shape Formed
Gross blood None

Mucus None
Pus None
Parasites None
Microscopic Examination Normal Values
Fat Colorless ,neutral fat(18%)and fay aci d
crystals and soaps

Undigested food ,meat fibers ,trypsin None to small amount

,starch
Eggs and segments of parasites None
Bacteria and viruses None
Yaests None
Leukocytes None

Clinical Examination Normal Values

Water Up to 75%
PH Neutral to weakly alkaline (PH 7.0 – 7.5)
Occult blood Negative
Uorobilinogen 50 – 300gm/24h
Porphyrins Corpoporphyrins 400-1200ug/24h
Uroporphyrins10-40ug/24h
Nitrogen ˂2.5g/24h
Trypsin 20 -95U/g
Sodium 5.8- 9.8mmol/d
Chloride 2.5 – 3.9 mmol/d
Potassium 15.7 – 20.7 mmol/d
Lipids (fatty acids ) 0 - -6gm /24h
Carbohydrates (as reducing substances) ˂2.5 g/L

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 -:‫ﺑﻌض اﻧواع اﻷوﻟﯾﺎت اﻟﻣوﺟودة ﻓﻲ اﻟﺑراز‬

Protozoa Found in Stool Specimens of Humans: AmebaeAmebae

Entamoeba Entamoeba Entamoeba Entamoeba Endolimax Iodamoeba
histolytica/dispar hartmanni coli polecki nana beutschlii

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Protozoa Found in Stool Specimens of Humans:
Ciliate and Flagellates

Ciliate Flagellates

Balantidium Chilomastix Giardia Dientamoeba

coli mesnili intestinalis fragilis

no
cyst stage

_______ ______
40 µm 10 µm

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Protozoa Found in Stool Specimens of Humans:
Coccidia and Blastocystis

Coccidia Blastocystis

Cystoisospora Sarcocystis Cryptosporidium Cyclospora Blastocystis

belli spp. spp. cayetanensis hominis

wet mount oocyst wet mount wet mount wet mount

safranin sporocyst acid-fast acid-fast trichrome

_____
10 µm

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 Eggs Found in Stool Specimens of Humans Trematode E
‫ﺑﻌض اﻧواع‬
‫اﻟﺑﯾوض‬
‫اﻟﻣوﺟودة‬
‫ﻓﻲ اﻟﺑراز‬

Clonorchis Opisthorchis Paragonimus Nanophyetus

sinensis viverrini westermani1 salmincola

Schistosoma Schistosoma
Schistosoma japonicum Schistosoma mekongi
mansoni intercalatum

Schistosoma Fasciola Fasciolopsis Echinostoma

haematobium2 hepatica buski spp.

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Adult Visceral Trematodes of Humans
Heterophyes heterophyes Metagonimus yokogawai

Opisthorchis felineus Opisthorchis viverrini

Clonorchis sinensis Dicrocoelium dendriticum

Fasciola hepatica Paragonimus westermani

Echinostoma revolutum

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Key

 AC=acetabulum (ventral sucker)  IN=intestine

 CE=cecum  OS=oral sucker

 CL=collar  OV=ovary

 CS=cirrus sac  PH=pharynx

 EB=excretory bladder  SR=seminal receptacle

 EG=eggs (within uterus)  TE=testes

 ES=esophagus  UT=uterus

 GA=genitoacetabulum  VT=vitellaria

Hookworm and Strongyloides Larvae

Rhabditiform (L1) Stage Filariform (L3) Stage

______
Scale
100 µm

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