- Describes hypermotility of the stomach and the shortened

BODY FLUIDS gastric emptying half-time,whichcauses the smallintestine

to fill too quicklywith undigested food from the stomach
Module 2 - Hallmark of early dumping syndrome
FECALYSIS Test to differentiate the mechanisma of diarrhea
 Why examine the stool/feces? o Fecal electrolytes (fecal Na & K ) – used to calculate fecal osmotic gap
Osmotic gap =290 – [2 (fecal sodium + fecal potassium)]
Early detection of gastrointestinal bleeding, liver and biliary duct disorders, maldigestion/malabsorption  SECRETORY -- <50 mOsm / kg & INCREASED ELECTROLYTES
syndroms,inflammation, causes of diarrhea,steatorrhea,identification of pathogenic bacteria and
 OSMOTIC -- >50 mOsm / kg & NEGLIGIBLE ELECTROLYTES
parasites (Micro).
o Fecal osmolality – close to serum osmolality (290 mOsm / kg)
 Normal Fecal Composition:
o Stool pH
¾ water,¼ bacteria,cellulose and other undigested foodstuffs, gastrointestinal secretions, bile  <5.6 = malabsorption of sugars =OSMOTIC
pigments, cells from the intestinal walls, electrolytes. 3. Severity
 Final breakdown of ingested proteins,carbohydrates and fats takes place in the small intestine 4. Stool characteristics
where they are also reabsorbed
o Digestive enzymes (trypsin, chymotrypsin, amino peptidase, and lipase) are secreted by the STEATORRHEA
o Increased in stool fat that exceeds 6 g per day due to absence of bile salts or due to the
pancreas into the small intestine.
o Bile salts that help in fat digestion are provided by the liver decrease in pancreatic enzyme production (as in pancreatic disorders)
o ANY DEFICIENCY OF THESE SUBSTANCES will result to maldigestion or malabsorption and
SPECIMEN COLLECTION AND HANDLING
the excess undigested or unreabsorbed material will appear in the feces.
METHODS
 Bacterial (normal flora) metabolism produces the strong odor associated with feces and
 ROUTINE - collected in a clean container (plastic or glass) with screw- capped tops
intestinal gas ( flatus)
o Carbohydrates , especially oligosaccharides, that are resistant to digestion pass through the  Specimens are also collected on a physician’s glove and samples applied to filter paper ( for
upper intestine unchanged but are metabolized by bacteria in the lower intestine, producing FOBT)
large amount of flatus.  For quantitative testing ( such as in fecal fats ), timed specimens are required wherein the most
o Excessive gas production also occurs in lactose- intolerant individuals when the intestinal representative sample is a 3-day collection
bacteria metabolize the lactose from consumed milk or lactose-containing substances.  CAMMIDGE – scraping of stool from diapers
 The large intestine is capable of absorbing ~3000 mL of water  JALLIFE – insertion of thick walled glass in rectum
o When this amount is exceeded = DIARRHEA
 Specimen must not be contaminated with urine or toilet water which may contain chemical disinfectants
o When the fecal material stays a long time in the large intestine,it provides time for
 PRESERVATION
additional water to be reabsorbed= CONSTIPATION
 DIARRHEA o PHYSICAL –refrigeration
o Defined as an increase in daily stool weight above 200 g with inceased liquidity and frequency o CHEMICAL- formalin, 95 % ethanol, glycerol in NSS, MIF, PVA
of more than three times per day  Containers with preservatives must not be used
o Can be classified based on 4 factors
1. Duration of illness MACROSCOPIC / PHYSICAL EXAMINATION
o Acute - < 4 weeks
o Chronic - > 4 weeks NORMAL VALUES FOR FECAL ANALYSIS
2. Mechanism QUANTITY : 100 – 250 g / day 
o SECRETORY COLOR : LIGHT to DARK BROWN 
o OSMOTIC CONSISTENCY : SOFT TO WELL-FORMED 
o ALTERED MOTILITY ODOR: FOUL TO OFFENSIVE 
 IRRITABLE BOWEL SYNDROME (IBS)= altered motility in which pH : 7.0 - 8.0
there is enhanced motility (HYPERMOTILTY) and SLOW motility
(constipation)
 Rapid (accelerated) gastric emptying (RGE) dumping syndrome 


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 COLOR Why do we examine cerebrospinal fluid?
 PALE – blockage of bile duct - Indicated in suspicions of encephalitis, meningitis, multiple sclerosis, neurosyphilis, and
 BLOODY subarachnoid hemorrhage.
o Upper GI ( BLACK , TARRY STOOL, from esophagus, stomach or
duodenum, takes 3 days to appear in stool  First recognized by Cotugno (1764 )
o Lower GI bleeding ( from colon, rectum,takes lesser time to appear,  Considered as the THIRD MAJOR FLUID in the body
medicatios such as Rifampicin, and foods including beets – red )  Not an ultrafiltrate of a plasma
 GREEN ( seen in patients with oral antibiotics, ingestion of increased amounts of green  Does not contain proteins, lipids and substances bound to protein
vegetables or food coloring  BLOOD BRAIN BARRIER – representsthe control and filtration of blood components to the CSF
 YELLOW ( milk diet, corn meal , rhubarb,and fats) and then to the brain

MICROSCOPIC EXAMINATION FUNCTIONS:
1. PRODUCES A MECHANICAL BARRIER TO CUSHION THE BRAIN AND SPINAL CORD
- FECAL LEUCOCYTES (presence of neutrophils – if the diarrhea is caused by invasive bacteria AGAINST TRAUMA
such as Salmonella, Shigella, Campylobacter , Yersinia and eneteroinvasive E.coli 2. SUPPLY NUTRIENTS TO THE NERVOUS TISSUES
- MUSCLE FIBERS ( can be helpful in diagnosis and monitoring of patients with PANCREATIC 3. REMOVES METABOLIC WASTES
INSUFFICIENCY
- QUALITATIVE FECAL FATS ( SUDAN III, SUDAN IV, OIL RED O) The brain and spinal cord is lined by meninges which has 3 layers :
 DURA MATER ( latin word for “ hard mother”)
CHEMICAL EXAMINATION o Outermost layer
- OCCULT ( HIDDEN ) BLOOD or FECAL OCCULT BLOOD TESTING (FOBT) o Lines the skull and vertebral canal
o Used as a MASS SCREENING PROCEDURE FOR THE EARLY DETECTION OF  ARACHNOID MATER ( “SPIDERWEB-LIKE”)
COLORECTAL CANCER  PIA MATER (latin for “ gentle mother”)
o Principle : PSEUDOPEROXIDASE ACTIVITY OF HEMOGLOBIN o Innermost layer which adheres to the cerebrum brain tissue)
 INDICATOR CHROMOGENS:
 BENZIDINE
 ORTHO-TOLUIDINE  Produced by the CHOROID PLEXUSES of each of the 4 ventricles of the brain
 GUM GUAIAC  Flows through the SUBARACHNOID SPACE around the brain and spinal cord
o Food and medications to be avoided:  Reabsorbed by the ARACHNOID VILLI /GRANULATIONS into the superior sagittal sinus
- Red meats,horseradish,raw broccoli,cauliflower,radishes and  VOLUME :
turnips 20 mL of CSF produced every hour
- Aspirins and NSAIDs ADULTS : 140 -170 mL
- Vitamin C and iron supplements containing vit.C NEONATES : 10 – 60 Ml
- HEMOQUANT
- HEMOCCULT ICT – IMMUNOCHEMICAL FECAL OCCULT BLOOD TEST (iFOBT) SPECIMEN COLLECTION AND HANDLING:
- TRYPSIN (GELATIN TEST) 1. Collected by lumbar puncture between 3rd , 4th and 5th lumbar vertebrae
- CHYMOTRYPSIN 2. Measurement of intracranial pressure should be done
- ELASTASE I 3. CSF tests are STAT, but if not possible, must be kept:
i. Tube 1 = Chemical and serological test –Frozen
 CARBOHYDRATES (CELIAC DISEASE) ii. Tube 2 = Microbiology – room temperature
 COPPER REDUCTION TEST = CLINITEST iii. Tube 3 = Hematology – refrigerated
 SERUM CARBOHYDRATE TEST iv. Tube 4 may also be collected for microbiology to provide better exclusion of skin
 USED FOLLOWING A POSITIVE FECAL CLINITEST contamination
 D-xylose test for malabsorption  Low volume specimens collected on one tube , order of testing should be
 Lactose tolerance test MICROBIOLOGY first,then HEMATOLOGY and CHEMISTRY/ SEROLOGY.
 STOOL CHROMATOGRAPHY
 SMALL BOWEL BIOPSY AND DISACCHARIDE ENZYME ASSAY DIFFERENTIATION TRAUMATIC TAP CEREBRAL HEMORRHAGE
Blood distribution Uneven (from TT1-TT3) Even

Cerebrospinal fluid Clot formation YES due to fibrinogen No

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 GENERAL CONSIDERATION:
Xanthochromic supernatant Clear,hemolysis appears after Xanthochromic 1. WBC count is routinely done, RBC count is determined only when traumatic tap has occured
2hrs in CSF and a correction for WBC and protein is needed.
D-dimer test Negative Positive RBC count = Total cell count – WBC count

ADULT = 0-5 wbc /uL

Erythrophagocytosis Absent Present Children = VALUES ARE HIGHER
NEONATES = 0-30 mononuclear cells / uL
Hemosiderin granules Absent Present 2. WBC and rbc’s disintegrate within 1hour
3. 40 % of leukocytes after 2hours

PHYSICAL EXAMINATION /APPEARANCE OF CSF o TOTAL CELL COUNT

NORMAL VALUES FOR CSF o CELLS ARE COUNTED IN 4 CORNER SQUARES AND CENTER SQUARE OF THE
COLOR : COLORLESS HEMATOCYTOMETER
VISCOSITY: SAME WITH WATER o PASTEUR PIPET IS USED TO LOAD HEMATOCYTOMETER
CLARITY: CRYSTAL CLEAR
SP.GRAV 1.006-1.008 DESCRIPTION POSSIBLE CAUSE/S
pH 7.30 to 7.45
PRESSURE : 50 to 200 mm H2O
Sl. Hazy 200 to 500 wbc/µL

VARIATIONS
Cloudy Above 500 wbc/µL

CHEMICAL EXAMINATION
Turbid/ milky Wbc, rbc, proteins, ↑ lipid conc, microrganisms, aspirated epidural fats, radiographic
 PROTEIN contrast media
 NV : 15 to 45 mg/dL
 Albumin (major csf protein), Prealbumin (2nd most prevalent), Haptoglobin and
Ceruloplasmin (alpha-globulins), tranferrin (major beta –globulin), IgG and small amounts of Clotted FROIN’S disease (increased proteins and clotting factors)
IgA ( gamma globulin )
 IgM ,Fibrinogen, Beta-Lipoproteins ( not normally found in CSF) Bloody Non-PATHOLOGIC: TRAUMATIC TAP
 GLUCOSE PATHOLOGIC: INTRACRANIAL HEMORRAGE OR SUBARACHNOID HEMORRAGE
 NV : 60 to 70 % of plasma glucose
 Increased in: DM, encephalitis, conditions associated with intracranial pressure Viscous CRYPTOCOCCAL MENINGITIS
 Decreased in: aids in determining the causative agent of meningitis
 LACTATE
<25 mg/dL = VIRAL meningitis Oily Radiographic contrast media
>25 mg/dL= TUBERCULAR & FUNGAL MENINGITIS
>35 mg/dL = BACTERIAL MENINGITIS
Pellicle formation TUBERCLAR MENINGITIS
 GLUTAMINE : NV = 8-18 mg/Dl
 LD ISOENZYME
 CK –BB ISOENZYME Xanthochromia Presence of RBC degradation product
PINK : very small amount of oxyhemoglobin
CSF CELL COUNT ORANGE – heavy hemolysis
YELLOW – conversion of oxyhemoglobin to unconjugated biirubin

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Brown Methemoglobin, hematoma, melanin
 o DILUENT : NSS  KEEP SPECIMEN AT ROOM TEMPERATURE if needed to be transported
 Specimen must be at body temperature while awaiting analysis
NUMBER OF CELLS COUNTED X DILUTION________________ = CELLS / uL  Specimen for fructose levels should be tested within 2 hours or frozen to prevent fructolysis
NUMBER OF SQUARES COUNTED X VOLUME OF 1 SQUARES
SEMINAL FLUID
Normal values for seminal fluid:
WHY EXAMINE SEMINAL FLUID ?
o To investigate the causes of infertility in marriages MACROSCOPIC
o To check the effectiveness of previous vasectomy
o In medico legal cases,where paternity is being disclaimed on the basis COLOR : GRAYISH WHITE AND TRANSLUCENT
of sterility VISCOSITY: HIGHLY VISCOUS
VOLUME : 2- 5 mL / ejaculation
COMPOSITION: pH 7.20 to 8.0
o Sperm cells – 5 % of the semen ODOR : FISHY , DISTINCT,CHLOROX LIKE, MUSTY
o Testes - 5 % LIQUEFACTION TIME: 30 mins to 1 hour
o Seminal vesicles - 5 %
MICROSCOPIC
o Prostate glands – 20 %
SPERM MOTILITY : > 50% with grade of 2.0 (a,b,c) within 1 hour
o Epididymis, vas deferens, bulbourethral glands, urethral glands – 10 to 15 % SPERM CONCENTRATION: 20- 160 million /mL or 20 million/mL
o Chemical constituents: SPERM count: > 40 million /ejaculate
- Acid phosphatase
- Zinc MORPHOLOGY
- Fructose
- Potassium,citric acid, ascorbic acid >14% normal forms –KRUGER’S strict criteria
- Proteolytic enzymes >30% normal forms -routine criteria
- Spermine and choline

SPECIMEN COLLECTION, HANDLING & PRSERVATION

 ABSTINENCE PERIOD = 3 to 5 days not more than 7 days SPERM MOTILITY

-prolonged abstinence will result to hgher volume and decrease sperm motilit and
increased flavin fiving the semen a yellowish color
 COMPLETE COLLECTION IS ESSENTIAL CRITERIA
GRADE
METHODS OF COLLECTION 4.0 a Rapid ,straight line motility
 SELF-PRODUCTION O MASTURBATION
 COITUS INTERRPTUS
3.0 b Slower speed,some lateral movement
 VAGINAL VAULT ASPIRATION
 CONDOM METHOD
2.0 c Slow forward progression,noticeable lateral movement
1.0 d No forward progression
SPECIMEN HANDLING
0.0 e No movement
 ALL SEMEN ARE POTENTIAL RESERVOIRS FOR HIV AND HEPATITIS VIRUSES
 STANDARD PRECAUTIONS must be observed at all times
 Specimens are discarded as biohazardous waste
 Sterile materials and techniques must be used when semen culture is to be processed for
bioassay, intra-uterine insemination, or in-vitro fertilization Sperm count and CONCENTRATION
o 2 types of counting chambers
PRESERVATION - Makler
- Neubauer hemocytometer

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 o ARTHROCENTESIS – needle aspiration of joints
o Dilution : 1:20 o A sterile heparinized tube or sodium polyethelenetetraacetic acid (EDTA ) tube for cell
o Diluting fluids counts
 5 % NaHCO3 or 1 %Formalin o A non anticoagulated tube for other test
 Distilled water or tap water o A sodium fluoride tube for glucose analysis
o Azoospermia – complete or total abscence of spermatozoa
o Necrospermia- presence of sperm cells whether completely dead or immobile Collection tube order and tests done
o Oligospermia –deficiency in the number of sperm cells or presence of few motile cells o #1 – chemical examination- 1-3 mL
o #2 – microscopic examination – 2-5 mL
Sperm concentration o #3 – microbiological studies – 3-10 mL

NUMBER OF sperms COUNTED X DILUTION________________ = sperms / uL o Synovial fluid specimens should be handled like stat specimens and delivered
NORMAL VALUES : immediately to the laboratory for testing to avoid alteration of chemical constituents,
VOLUME : <3.5 mL cell lysis, and problems in microorganism detection and identification.
COLOR : COLORLESS TO PALE YELLOW
CLARITY: CLEAR o If a glucose is to be performed, the patient should be fasting for at leat 6hours prior to
VISCOSITY: ABLE TO FORM A STRING 4 TO 6 cm LONG collection of joint fluid. A 6 hour fast is necessary to establish an equilibrium between
LEUCOCYTE COUNT: <200 % cells/uL plasma and joint glucose levels.
NEUTROPHILS : <25% OF THE DIFFERENTIAL
Crystals : NONE o Synovial diluents
GLUCOSE : PLASMA DIFFERENCE : <10 mg/dL lower than the blood
TOTAL PROTEIN: < 3g/dL  NSS.1% saponin in saline, 0.1 N HCL

Inclusions:
 Reiter cells –vacuolated macropahges with ingested neutrophils
NUMBER OF SQUARES COUNTED X VOLUME OF 1 SQUARES
 Ra cells or ragocytes- neutrophils with small, dark, cytoplasmic granules tha consist of
precipitated rheumatoid factor
 To convert sperms/uL to sperms/mL multiply it by 1000
 LE cells- neutrophils containing characteristic ingested “round body”
Sperm count  Tart cells- monocytes that have engulfed nuclear material
 Multiply sperm/mL by volume of semen  Synovial lining cell – similar to macrophage, but may be multinucleated, resembling
MESOTHELIAL CELLS
 Cartilage cells –large , multinucleated cells
SYNOVIAL FLUID  Rice bodies- macroscopically resemble polished rice
- microscopically show collagen and fibrin
WHY EXAMINE SYNOVIAL FLUID ?  Fat droplets- refractile intracellular and extracellular globules
-stained with Sudan dyes
 DIAGNOSIS OF JOINT DISORDERS  Hemosiderin – inclusionds within clusters of Synovial fluid
 Ochronotic shards- dbris from metal and plastic joint prosthesis
ORIGIN AND FUNCTION - Look like ground pepper
 Often referred to as joint fluid
 Present within the synovial cavity in free-moving joints (diarthroses) to provide lubricatio and Rope’s Test/ Mucin Clot test
sole nutrient for the joint tissue  Estimation of the integrity of the hyaluronic acid-protein complex (mucin)
 ULTRAFILTRATE OF PLASMA with a very mucoidal substance –HYALURONIC ACID  Forms a tight rpoy clot upon addition of acetic acid
 Largest amount in the knee cavity  Reagent: 2-5 % Acetic acid
SPECIMEN COLLECTION, HANDLING Chemical Examination:
 Protein: contains all proteins except fibrinogen,beta 2 macroglobulin and alpha 2
 Method of Collection macroglobulin

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 Detection of effusions associated with conditions affecting the abdomen(peritoneal fluid),
 Glucose: NV: <10 mg/dL Heart( pericardial fluid), and lung( pleural).

 Uric Acid: NV: 6-8 mg/dL  Serous fluids are serum-like fluids formed as ultrafiltrate of plasma which provides lubrication
in the caities where they are found
 Lactic Acid: NV: <25 mg/dL o pericardial fluid= is contained in the pericardium which encloses the heart
o pleural fluid = is contained in the pleural cavity which encloses the lungs
Joint disorders o peritoneal fluid= is contained in the peritoneum which encloses the abdominal organs
o serous fluid is produced and reabsorbed at a constant rate.
Group classification Lab Findings o If an alteration in the hydrostatic and oncotic pressure i the capillaries of the cavities
Non-infalmmatory Clear,yellow fluid happens there will be an increase in volume between the two embranes called
Good viscosity EFFUSION.
Wbc <100/uL o There are two types of effusion: transudate and exudates
Neutrophils <30% o Transudate = serous effusions that result from disturbance of the fluid production and
Normal glucose regulation between serous membranes.
o EXUDATES –purulent effusions that result from disturbance of the fluid production
Inflammatory Cloudy, yellow fluid and regulation between serous membranes
Immunologic origin Poor viscosity
Wbc 2000-75,000 /uL Differentiation of Transudates and Exudates
Neutrophils >50%
Decreased glucose level Parameters Transudates Exudates
Possible autoantibodies present
Appearance Clear Cloudy
Crystal-induced origin Cloudy, milky fluid
Low viscosity
Wbc up to 100000/uL Fluid: serum protein Ratio <0.5 >0.5
Neutrophils <70% Fluid: serum LD Ratio <0.6 >0.6
Decreased glucose level Wbc count <1000/Ul >1000/uL
Crystals present Sponteous Clotting No Possible
Pleural fluid cholesterol <45 to 60 mg/dL >45 to 60 mg/dL
Pleural fluid : serum cholesterol <0.3 >0.3
Ratio
Septic Cloudy, yellow green fluid
Pleural fluid : bilirubin Ratio <0.6 >0.6
Variable viscosity
Serum-Ascites Albumin Gradient >1.1 <1.1
Wbc equal to blood
Neutrophils equal to blood
Decreased glucose level
Positive culture and gram stain
AMNIOTIC FLUID
 WHY EXAMINE SEROUS FLUIDS?
hemorrhagic Cloudy, red fluid
Low viscosity Detection of fetal lung maturity, hemolytic disease of the newborn,neural tube defects
Wbc equal to blood Determination of featal age
Neutrophils equal to blood  PHYSIOLOGY : found in the amnion, a sac surrounding the fetus and is forme from the
Normal glucose level metabolism of fetal cells and fetal urine
 1st trimester , 35 mL of amniotic fluid is derived primarily from maternal circulation
(maternal plasma)
 After the 1st trimester, fetal urine is the major contributor to the amniotic fluid
SEROUS FLUID volume
 WHY EXAMINE SEROUS FLUIDS?  Functions:
o Protective cushion for the fetus

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 o Allows movement  Creatinine concentration
o Stabilize the temperature to protect the fetus from extreme temperature changes
o Permit proper lung development NORMAL AMNIOTIC FLUID
o Exchanges of water and chemicals BILIRUBIN : ∆ A 450 > 0.025
 AMNIOCENTESIS AFP: <2.0 Mom
o NEEDLE ASPIRATION OF AMNIOTIC FLUID L/S ratio : ≥ 2.0
o MAYBE SAFELY DONE AFTER 14TH WEEK OF GESTATION AMNIOSTAT –FLM : POSITIVE
o DONE INTHE 2ND TRIMESTER FOAM STABILITY INDEX : ≥ 47
 16th week of gestation- for assessment of genetic defects/chromosome MICROVISCOSITY: ≥ 55 mg/g
analysis OPTICL DENSITY : ≥ 0.150
 Near the end of 2nd trimester-for assessment of intrauterine growth LAMELLAR BODY COUNT : ≥ 32000/ mL
restriction Creatinine(for Age): > 2.0 mg/dL
o Done in the 3rd trimester for assessment of pulmonary maturity or fetal hemolytic
disease GASTRIC FLUID AND DUODENAL CONTENT

SPECIMEN COLLECTION, HANDLING  WHY EXAMINE GASTRIC FLUID AND DUODENAL CONTENT?
o A maximum of 30 mL of amniotic fluid is collected in sterile syringes. Diagnosis of zollinger-Ellison syndrome *, pernicious anemia, duodenal ulcer
 The first 2 or 3 mL collected can be contaminated by maternal blood, tissue Determination of proper surgical procedure for peptic ulcer treatment
Assess completeness of surgical vagotomy
fluid and cells and are discarded.
 Physiology
o Specimens should be transferred to sterile plastic containers and taken immediately
o Presence of food and fluid in the stomach and stimulation by the vagus nerve
to the lab
promotes the g cells of the stomach to produce Gastrin
o Fluid for bilirubin analysis in cases of hemolytic disease of the new born must be
o Gastrin stimulates the parietal cells to produce HCL
protected fro light at all times
o Intrinsic factor –necessary for intestinal absorption Vit B12
o Fetal lung maturiy tests- placed on ice for delivery to lab and ref prior to testing, low
o HCL converts Pepsinogen to Pepsin
speed centrifuge for no longer than 5 minutes to prevent loss of phospholipids
o Pepsin catalyzes protein digestion
o Cytogenetic studies- maintatined at room temperature orbody temperature to prolong
the life of cells needed for analysis
 Gastric Juice composition
o Chemical testing- separate from cellualr elements and debris asap
o HCL ACID- secreted by parietal cells of the stomach and activates pepsinogen
Tests for Fetal lung Maturity o Electrolytes
 L/S(lecithin /sphingomyelin )ratio o Mucus
 Phosphatidylglycerol/Phosphatidylinositol o Digestive and non-digestive enzyme
 Amniostat –FLM  Pepsin pH 1.6 to 3.6
 Foam /shake test  Gastrin
 Foam stability index  Gastric lipase
 Rennin
 Microviscosity
 LDH, AST, ALT and ribonuclease
 Lamellar bodies and optical Density

Collection
Test for Fetal Distress
o Should fast for 12 hours or 15 hours with no medication during the 24 hours ;done by
 Infection of mother and fetus (>50 /uL =infection)
physician
 Bilirubin analysis
o Should swallow excessive amount of saliva during collection
 Alpha feto protein
 Acetylcholinesterase level Methods:
o Tube or Intubation method
Tests for Fetal age
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 o Ewald’s or Boa’s  FORENSIC TESTING IN SEXUAL ASSAULT PATIENTS
o Rehfuss
o Sawyer
NORMAL VAGINAL SECRETION FINDINGS
o Levine APPEARANCE : WHITE ,FLOCCULENT DISCHARGE
o Kaslow pH 3.8- 4.2
o Miller abbott AMINE TEST : NEGATIVE
WBCs 2+
LACTOBACILLI : PREDOMINANT
Typical Reference Intervals OTHER ORGANISMS : OTHER LACTOBACILLI SUBGROUPS, OCCASSIONAL YEAST
CLUE CLEELS: ABSENT
Fasting residual volume 20 to 100 Ml OTHER CELLS : ABSENT (EXCEPT RBCs DURING MENS
pH <2
Basal acid output 0-6 mEq/hr ( mmol/hr)
maximum acid output 5-40 mEq/hr ( mmol/hr)
BAO/MAO ratio <0.4

NORMAL GASTRIC FLUID

APPEARANCE: TRANSLUCENT,PALE GRAY, SL.VISCOUS,NO FOOD ,BLOOD,DRUGS OR BILE
PRESENT
VOLUME: 50 TO 75mL
ODOR: FAINTLY PUNGENT
Ph 1.6-1.9 (1.5-3.5)
Mucus: separates into 3 layrs on standing( top-mucus, Middle- opalescent, bottom- sediments

VAGINAL SECRETIONS

WHY EXAMINE VAGINAL SECRETIONS ?

 DIAGNOSIS OF INFECTION AND COMPLICATIONS OF PREGNANCY

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