Diarrhea stool examination

A thorough history and examination is important to determine the cause of phlyctenulosis. Inspect the lid margins for signs of staphylococcal blepharitis and question the patient regarding recent infections or tuberculosis exposure. If there is reason to suspect tuberculosis or if no other cause can be found, a tuberculin skin test may be indicated. If diarrhea or gastrointestinal distress is present, consider a stool examination for nematodes. 

A 63-year-old hjrpertensive woman, who had a carcinoma of the distal esophagus resected 19 months earlier, developed chronic diarrhea. Clostridium difficile toxin was identified in her stools and the diarrhea resolved after treatment with metronidazole. Enalapril was added to her antihypertensive treatment, and 3 months later the diarrhea recurred. Stool examination was negative and there was no Clostridium difficile toxin. Her condition worsened and she lost 5 kg in weight She had marked eosinophiha (2.4 x 10 /1), and a small bowel biopsy showed mild chronic inflammation and edema, partial villous atrophy, and large clusters of eosinophils in the lamina propria with some focal infiltration of the epithelium. She stopped taking enalapril and her diarrhea promptly abated and the eosinophil count fell to 0.5 X 10 /1 at 3 weeks and 0.1 x 10 /1 at 2 months. 

Unless ordered otherwise, the nurse should save all stools that are passed after the drug is given. It is important to visually inspect each stool for passage of the helminth. If stool specimens are to be saved for laboratory examination, the nurse follows hospital procedure for saving the stool and transporting it to the laboratory. If the patient is acutely ill or has a massive infection, it is important to monitor vital signs every 4 hours and measure and record fluid intake and output. The nurse observes the patient for adverse drug reactions, as well as severe episodes of diarrhea. It is important to notify the primary health care provider if these occur. 

DIARRHEA AND DEFICIENT FLUID VOLUME The nurse records the number, character, and color of stools passed. Daily stool specimens may be ordered to be sent to die laboratory for examination. The nurse immediately delivers all stool specimens saved for examination to die laboratory because the organisms die (and therefore cannot be seen microscopically) when die specimen cools. The nurse should inform laboratory personnel diat the patient has amebiasis because die specimen must be kept at or near body temperature until examined under a microscope... 

Because patients often present with nonspecific GI symptoms, initial diagnostic evaluation includes methods to characterize the disease and rule out other potential etiologies. This may include stool cultures to examine for infectious causes of diarrhea. 

A 7-year-old girl has a 1-month history of foul-smelling diarrhea. Upon further inquiry, the frequency seems to be 4-6 stools per day. She has also had trouble seeing at night in the past 2 weeks. Her WBC count is normal. Physical examination is entirely normal. Examination of a stool sample reveals that it is bulky and greasy. Analysis does not reveal any pathogenic microorganisms or parasites but confirms the presence of fats. 

A 52-year-old real estate salesperson has a 2-week history of watery diarrhea without blood. The patient states that 4 to 5 weeks ago she and her husband visited Aspen, Colorado, on a backpacking vacation and on occasion drank water from mountain streams. They were sure the water was potable, as the unspoiled, pristine area abounded with fish, beaver, and plant life. She states she has enjoyed perfect health except that she takes antacids for what she describes as gastroesophageal reflux disease. Her physical examination produced unremarkable findings. Examination of liquid stool revealed trophozoites and cysts of G. lamblia. Which of the following is the correct treatment for this disease ... 

A 42-year-old woman with a renal transplant taking triple immunosuppression (azathioprine, ciclosporin, and glucocorticoids) was converted after 7 years from azathioprine plus ciclosporin to mycophenolate (2 g/ day) because of ciclosporin nephrotoxicity (15). Within 2 months she had developed severe persistent watery diarrhea (5-10 stools/day) and lost 7 kg over 2 months. Investigations ruled out an infectious cause and there were features of duodenal villous atrophy on histological examination. Diarrhea disappeared after mycophenolate withdrawal and two subsequent duodenal biopsies showed improvement 2 months later and further complete recovery 6 months later. 

The average incubation period for V. cholerae infection is 1 to 3 days. The clinical presentation can vary from asymptomatic to life-threatening dehydration owing to watery diarrhea. The onset of diarrhea is abrupt and is followed rapidly or sometimes preceded by vomiting. Initial stools generally do not have the rice water appearance that is classically noted with cholera. Fever occurs in less than 5% of patients, and the physical examination correlates weU with the severity of dehydration. In the most severe state, this disease can progress to death in 2 to 4 hours if not treated. In some cases, fluid accumulates within the intestinal lumen causing abdominal distension and ileus and may cause intravascular depletion without diarrhea. Patients may lose up to 1 liter of isotonic fluid every hour. 

The reported incidence of diarrhea associated with the administration of clindamycin ranges from 2 to 20%. A number of patients (variously reported as 0.01 to 10%) have developed pseudomembranous colitis caused by the toxin from the organism C. difficile. This colitis is characterized by abdominal pain, diarrhea, fever, and mucus and blood in the stools. Proctoscopic examination reveals white-to-yellow... 

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