Chapter-19

Clinical Investigation

Complete stool Examination

Macroscopic Examination
1- Volume :
Normally less than 200 gm/day unless excessive dietary fibers are
ingested
Large volumes indicate diarrhea
2- Consistency :
Normal stools are found but soft
Watery diarrhea is characteristic of bowel infection ( viral or bacterial )
Soft stools are seen in mal-absorption
3- Colour :
The normal colour varies from light to dark brown depending on diet
Black stools may be due to :
- Bleeding from upper gastrointestinal tract melena
- Iron intake
Red blood is usually due to bleeding from the lower alimentary tract and
anal
e.g. hemorrhoids , ulcerative colitis
Dark green stools are seen in diarrhea due to intestinal hurry . In cholera ,
the stools are almost watery and conatin epithelial cells and shreds of mucus
( rice water ) .
Greyish white stools in obstructive jaundice ( lack of bile pigments )
Clay stools are produced by excessive amounts of fat ( Steatorrhea )
4- colour :
+ The normal odour is mainly due to products of protein putrefaction (
Indole , skatol )
+ Offensive stool are seen in :
- Excessive protein intake
- Melena stools
- Infective diarrheas , but cholera stools are odourless
- Mal-absorption ( stools smell rancid )
- Obstructive jaundice ( absence of bile leads to putrefaction )
5- Other changes :
- Mucus :
o Normally , stools contain very little mucus
o Excessive mucus is seen in :

Chapter-19

Clinical Investigation

Irritable colon ( mucus may be in casts )

Inflammatory conditions
Intake of purgatives and antibiotics
Neoplasms ( often with pus and blood )
- Pus is seen commonly in :
Dysentry
Ulcerative colitis
Malignancy

Microscopic Examination
1- Examination for red blood cells : excess RBCs is seen in the presence of
hemorrhage , inflammation or ulceration .
2- Examination for pus cells : a large number is seen in dysentery and
ulcerative colitis .
3- Examination for muscle fibers : undigested muscle fibers indicate deficient
digestion usually due to diarrhea
4- Examination for fats :
Normally , present in minimal amounts as neutral fats , ( as oily
globules ) fatty acid crystals ( as slender needles ) or soaps ( irregular
plaques with rolled edges)
Excess fats indicates deficient digestion , or absorption
5- Examination for parasites : examination should be made from specimens

Bacterial Examination
1- A gram stained film : Is useful to show moniliasis or severe staphylococcal
infection
2- Cultures : are made to identify pathogenic bacteria

Volume
Odour
Consistency
Mucus
Reaction
Undigested
food
Red cells

Normal Amoebic
Bacillary
dysentery dysentery
Normal
Normal

Normal Offensive Offensive

Soft
Loose
Watery
slimy
Excessive
Slight
Alkaline
Acidic
Alkaline
++
+
-

++++

Steatorrhoea
Large
Offensive
Loose

+
Alkaline

+++
-

Chapter-19

Pus cells
Fat content

--

Clinical Investigation

++
-

++

Excessive

Chapter-19

Clinical Investigation

Chemical Examination
1- Occult blood : to detect small amounts , not seen by naked
eyes .The test is simple using strips impregnated with
benzidine or guaiac which gives blue colour if positive .
2- Fat balance test : the patient is put on a diet containing 50 g
fat daily for 1 week . several estimation of faecal fat content is
made after the first 3 days :
Normally more than 90 % of the fat is absorbed
Reduced % indicates deficient absorption or digestion
of fats