Investigation Seminar

Sputum ExamiNAtionBy

Dr.Ajay Chavan

104/12/09

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OBJECTIVE

Production of Sputum . Collection of sample. Examination – Macroscopic . Microscopic . Conclusion .

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PRODUCTION OF SPUTUM Sputum is produced by a spontaneous

deep cough bringing up material from

small airways and alveoli.

Sputum is basically a product of secretions

of mucous glands & goblet cells in the

bronchial wall. It's the cellular material

from the respiratory tree.

95% water,5%solids

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COLLECTION OF SPECIMEN1. Before collecting or expectorating sputum

the mouth should be prerinsed and this

removes contaminants from oral cavity.

2. For best results early morning freshly

expectorated sputum specimen should be

collected in dry sterile bottle.

A cough plate is held before the child’s

mouth & the child’s urged to cough.

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CONT ….

Cough swab method gives the most

representative, non contaminated sputum

sample. Child’s mouth is held open by using

tongue depressor. Material expelled from

Trachea is deposited on the swab, which can

then plated on the appropriate culture media.

In pts who are uncooperative or cannot

produce adequate sputum, induction should

be tried.

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7SPUTUM IN THE CONTAINER

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EXAMINATION

Specimen should be collected in a sterile,

disposable , impermeable container.

Transfer specimen in sterile petridish placed

against dark background.

Wooden applicator sticks can be used to

spread it thinly & can be seen by naked eye

or by using lens.

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CONT ….

A. MACROSCOPIC OR BEDSIGHT

B. MICROSCOPIC OR IN LABORATERY

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MACROSCOPIC

VOLUME-

A 24 hr volume of sputum is measured in

pt with chronic bronchitis, lung abscess or

bronchial asthma. A rising volume indicates

worsening & decreasing volume indicates

improvement.

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CONT …. COLOUR-

Watery or Frothy = pulmonary oedema

Green= Early stage of T.B.

Yellow= Brochiectasis

Blood in sputum= T.B., Ca of lung

Pink= lung oedema

White= mucoid

Black= excess ‘C’in respiratory track

Rusty= lobar pneumonia (Streptococcal)

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CONT….

ODOUR-

Normal sputum is odorless

Suppurative smell= pulmonary

disorders

Fecal odour= liver abscess

Intolerable smell= gangrene of lungs

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CONT ….

VISOSITY-

Mucoid sputum has high viscosity

Purulent sputum has low viscosity

Mucopurulent has intermediate viscosity

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CONT ….

APPEARANCE-

Serous frothy= bronchioalvolar CA

Nummular sputum= pulmonary TB

Thick viscid sputum= asthma

Thin watery sputum= pulmonary

oedema

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MICROSCOPIC

After macroscopic examination

transfer material to a clear slides.

Smears made on clear slides should be

air dried, fixed over flame and stained.

Then examine under the microscope.

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16SPUTUM SLIDE

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CONT ….

Diff stains used:-

Gram’s stain/ Ziehl-Neelsen stain = for

AFB

Wright’s stain= for blood cells

Buffered crystal violet= for epithelial

cells

Pap’s stain= cytology of sputum

Usual peripheral smear stain= for

blood cell

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Gram’s Stain

Smear the sputumStained by

Gentian violet stain Keep for 3 min.

Bacteria get violet colourPour

Gram’s IodineFor 1 min.

Wash with Alcohol

Wash with water and dry

Mount under oil immersion

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Ziehl Nielsen's Stain

Smear the sputumFixed by Heating

Pour carbol fuchin and heat it from belowKeep for 5 min.

Wash with water

Decolorize with 20%H2SO4Wash with

Loffler's methyene blue for 1 min.Wash &dry

Mount under oil immersion

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SPUTUM CULTURE

Each specimen received for culture should be plated on agar.

Diff agars:-

Blood agar

Chocolate agar

MacConkey’s agar

Thioglycollate broth

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CLASSICAL REFERENCES

Pitavarna ,Kaphasthibana – Pittaj Kasa.(Ch.chi. 18\14)

Madhur Snigdha Ghana – Kaphaj Kasa.(Ch.Chi. 18\17)

Pita Shava Sashonita – Kshataja Kasa.(Ch.Chi 18\19)

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CONT ….

Duraghanda Harita – Kshayaja Kasa Rakta Puyamapi (Ch.Chi.

18\25) Shonita Drashana (Raktasthibana) –

Rajayakshama.

(Ma.Ni.Rajayakshama \2,6,7) Shonita Shleshamana Chardi – Ekadasha

rupa of Rajayakshama.

(Ch.Chi.8\43)

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CONCLUSION

Sputum sample are easily obtained is the

advantage.

Sputum have cellular contain which

represented the entire Respiratory tract.

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REFERENCES

Chamberlain’s symptoms & signs in clinical medicine

Medical laboratory technology-Dr. Sood Index of differential diagnosis Harrison’s Internal Medicine Text book of pathology- Harsha Mohan Hutchison’s Charka Sahita Chikastastana Madava Nidana www.Scribed.com

Thank

You27

04/12/09