Stool Analysis

What is the stool or feces? 1. Waste residue of indigestible material (cellulose during the previous 4 days) 2. Bile pigments and salts 3. Intestinal secretions, including mucus 4. Leukocytes that migrate from the 5. Epithelial cells that have been shade bloodstream 6. Bacteria and Inorganic material(10-20%) chiefly calcium and phosphates. Undigested and unabsorbed food.

Random Collection
1. Universal precaution 2. Collect stool in a dry,clean container 3. uncontaminated with urine or other body secretions, such as menstrual blood 4. Collect the stool with a clean tongue blade or similar object. 5. Deliver immediately after collection

Ova and parasites collection

1. Warm stools are best for detecting ova or parasites. Do not refrigerate specimen for ova or parasites. 2. If the stool should be collect in 10 % formalin or PVA fixative, storage temperature is not critical. 3. Because of the cyclic life cycle of

1.

substances that

Enteric pathogen collection Some coliform bacilli produce antibiotic

destroy enteric pathogen.Refrigerate specimen immediately. 2. A diarrheal stool will usually give accurate results. 3. A freshly passed stool is the specimen of choice. 4. Stool specimen should be collected before antibiotic therapy, or as early in the course of the disease.

Interfering factors

1. Patients receiving tetracyclines, anti-diarrheal drugs, barium, bismuth, oil, iron , or magnesium may not , yield accurate results. Anti-diarrheal drug stool 2. Bismuth found in toilet tissue interferes with the results. 3. Do not collect stool from the toilet bowl.A clean, dry bedpan is the best. 4. Lifestyle, personal habbits, environments may interfere with proper sample procurement.

Normal values in stool Analysis Macroscopic examination

Normal value Amount day Colour Odour pH of stool depend on bacterial fermentation Consistency unusual to fiber, vegetable skins. Size and shape 100-200 g / Brown Varies with and

Plastic, not see Formed

Normal values in stool analysis

Microscopic examination Normal values Fat (Colorless, neutral fat (18%)and fatty acid crystals and soaps) Undigested food amount Meat fibers, Starch, Trypsin Eggs and segments of parasites Yeasts Leukocytes None None None to small None None

Normal values in stool analysis values Chemical examination Normal

Water pH Occult blood Urobilinogen Porphyrins 1200g/24hr mg/24hr Nitrogen Up to 75 % 6.5-7.5 Negative 50-300 g/24hr Coporphyrins:400Uroporphyrins:10-40 <2.5 g/24hr

Normal values in stool analysis Normal values Chemical examination

Bile in children Negative in adults:positive Trypsin 20-950 units/g( positive in small amounts adults; present in greater amounts in normal children.

in

Osmolarity used 200-250 mOsm with serum osmolarity to calculate osmotic gap Sodium 5.8-9.8 mEq / 24hr

Normal values in stool analysis Normal Chemical examination

values Chloride Potassium Lipids ( fatty acid) 2.5-3.9 mEq / 24 hr 15.7-20.7 mEq /24 hr 0-6 g / 24 hr

Clinical Implications
1. Fecal consistency may be altered in various disease states a. Diarrhea mixed with mucous and red blood cells is associated with 1. Typhus Cholera 2. Typhoid 3.

Large bowel 4. Amebiasis 5. cancer

Clinical Implications
b. Diarrhea mixed with mucus and white blood cells is associated with

1. Ulcerative colitis 2. Regional enteritis () 3. Shigellosis 4. Salmonellosis

5. Intestinal tuberculosis /

Clinical Implications
C. Pasty stool is associated with a high fat content in the stool: 1. A significant increase of fat is usually detected on gross examination 2. With common bile duct obstruction, the fat gives the stool a putty- like appearance. 3. In cystic fibrosis,increase the of neutral fat gives a greasy, butter stool appearance.

Stool Odor
Normal value Varies with pH of stool and diet. Indole and sketole are the substances that produce normal odor formed by intestinal bacteria putrefaction and fermentation. Clinical implication. 1. A foul odor is caused by degradation of undigested protein. 2. A foul odor is produced by excessive carbohydrate ingestion. 3. A sickly sweet odor is produced by volatile fatty acids and undigested lactose

Stool pH
Normal value : Neutral to acid or alkaline Clinical implication 1. Increased pH ( alkaline) a. protein break down b. Villous adenoma c.Colitis d.Antibiotic use

2. Decreased pH ( acid)

a. Carbohydrate malabsorption c. Disaccharidase deficiency

b. Fat malabsorption

Normal value : Brown Clinical implication:

Stool color

1. Yellow to yellow-green : severe diarrhea 2. Green : severe diarrhea bile

Black: resulting from bleeding into the upper gastrointestinal tract (>100 ml blood) 3. Tan or Clay colored : blockage of the common bile duct. 4. Pale greasy acholic (no bile secretion) stool

Stool color(con)

4. Maroon-to-red-to-pink : possible result of bleeding from the lower gastrointestinal tract (eg. fissures,inflammatory Tumors, hemorrhoids,, , , process) 5. Blood streak on , surface of usually the outer indicates hemorrhoids or anal abnormalities. 6. Blood in stool can arise from abnormalities higher in the colon. In some case the transit time is rapid blood from stomach or duodenum can appear as bright or dark red or maroon in stool.

Blood in Stool
Normal value : Negative Clinical Implication : 1. Dark red to tarry black indicates a loss of 0.50 to 0.75 ml of blood from the upper GI tract.

2. Positive for occult blood may be caused by a. Carcinoma of colon b. Ulcerative colitis e. Gastric carcinoma g. Ulcers f. Diverticulitis

d. Diaphramatic hernia c. Adenoma

Mucous in Stool
Normal value : Negative for mucous Clinical Implication: 1. Translucent gelatinous mucous clinging to the surface of formed stool occurs in a. Spastic constipation b. Mucous colitis c. Emotionally disturbed patients d. Excessive straining at stool 2. Bloody mucous clinging to the surface suggests a. Neoplasm rectal canal b. Inflammation of the

Mucous in Stool (con)

3. Mucous with pus and blood is associated with a. Ulcerative colitis dysentery c. Ulcerating cancer of colon diverticulitis e. Intestinal tuberculosis

b. Bacilliary d. Acute

Normal value : fat in stool will account for up to 20 % of total solids. Lipids are measured as fatty acids (0-6.0 g/24hr) Clinical Implication :

Fat in Stool

1. Increased fat or fatty acids isassociatedwith the malabsorption syndromes a. Nontropical sprue disease c. Whipples disease fibrosis b. Crohns d. Cystic

e. Enteritis and pancreatic diseases

Normal value :

Urobilinogen in Stool
75-350 Ehrlich units/100 g

125-400 Ehrlich units / 24 hr

Clinical Implication: 1. Increased values are associated with Hemolytic anemias 2. Decreased values are associated with a. Complete biliary obstruction b. Severe liver disease, infectious hepatitis c. Oral antibiotic therapy that alters intestinal bacteria flora d. Infants are negative up to 6 months of age

Bile in Stool
Normal value : Adults negative : Children may be positive Clinical Implication: 1. Bile may be present in diarrheal stools. 2. Increased bile levels occur in Hemolytic anemia

Trypsin in Stool
Normal value : Positive in small amounts in 95 % of normal persons. Clinical Implication : Decreased amounts occur in a. Pancreatic deficiency b. Malabsorption syndromes c. Screen for cystic fibrosis

Leukocytes in Stool
Normal value : Negative Clinical Implication

1. Large amounts of leukocytes a. Chronic ulcerative colitis b. Chronic bacilliary dysentery c. Localized abscess

of sigmoid rectum or anus d. Fistulas 2. Mononuclear leukocytes appear in Typhoid

Leukocytes in Stool (con)

3. Polymorphonuclear leukocytes appear in a. Shigellosis c. Yersinia coli diarrhea e. Ulcerative colitis 4. Absence of leukocytes is associated with a. Cholera diarrhea c. Viral diarrhea b. Non specific d. Amebic colitis b. Salmonellosis d. Invasive Escherichia

e. Noninvasive E.coli diarrhea f. Toxigenic bacteria Staphylococci spp.,

Porphyrins in Stool
Normal value : Coproporphyrin 400-1200 g / 24hr Urophorphyrin 10-40 g / 24 hr. These values vary from Lab to Lab.

Clinical Implication: 1. Increased fecal coproporphyrin is associated with a. Coproporphyria (hereditary) b. Porphyria variegata c. Protoporphyria anemia d. Hemolytic

2. Increased fecal protoporphyrin is associated with

Stool Electrolytes
Normal values : Sodium mEq / 24 hr hr Chloride 2.5-3.9 5.8-9.8 mEq / 24

Potassium 15.7-20.7 mEq /24 hr Clinical Implication : 1. Idiopathic proctocolitis Normal Potassium 2. Cholera Sodium and Chloride

Sodium and Chloride