STOOL EXAMINATION

COLLECTION
Clean ,sterile 2 oz container with screw caps. Ask patient to not pass urine simultaneouslyharmful effect on protozoa. Do not over fill

container

Contd..
Timed stool collection-24 hr fecal excretion-

done over 3 consecutive days Entire stool collection/no of days.

MACROSCOPIC EXAMINATION
Quantity-normal 100-200 g/day Form-narrow ribbon like

stricture/narrowing/spastic bowel Colour pH(reaction) Consistency Mucus Gross blood Naked eye parasite

Gross examination Color Normal: Brown color is the normal color of stool Why stool color is brown? The characteristic brown color of feces is due to stercobilin and urobinin, both of which are produced by bacterial degradation of bilirubin.

Abnormal: Black color: indicate iron medication (for treatment of anemia),bismuth,charcoal,stool longstanding,exposed to air or (tarry) upper GIT bleeding (due to peptic ulcer, stomach carcinoma or esophageal varices). Bright red color: indicate lower GIT bleeding (due to piles and anal fissure).,also beet ingestion. Clay color(gray-white): indicate obstructive jaundice,barium sulphate. Red brown color: indicate drugs as Tetracyclines, and Rifampicin antibiotics Green color: indicate medications as Diathiazine, Mercurous chloride also vitamins cause green color of stool and in some cases of intestinal putrefaction ,spinach/green veggies

pH ( reaction ) Normal: Normally variable Abnormal: High alkaline stool Physiological High protein diet Pathological Poor fat absorption High acidic stool Physiological High carbohydrate diet

Pathological Poor absorption of sugars as in lactose intolerance

Consistency Normal: Abnormal: Normally well formed

Abnormal consistency may be graded as follow: Very hard: seen in cases of constipation Semi formed: seen in the cases of parasitic infection Mushy,foul smelling,floats on water: seen in steatorrhea Watery: mostly seen in cases of diarrhoea

Normal:

Mucus

Normally undetectable amount produce by GIT and found in the stool. Abnormal: Abnormal mucus in the sample appears as white patches spastic constipation,mucous colitis,villous adenoma According to the amount of mucus it can be graded using signs (+, ++, +++)

Pus cells
Plenty-chronic ulcerative colitis Scanty-amoebic colitis,viral gastroenteritis

Normal: Normally few amounts of pus (0-5) are seen under high power field of microscope. Counting:

Pus is counted under HPF of microscope and the range of count is written as in the case of RBCs

Note: if pus count is over 100 stool culture is recommended

Gross blood

Normal:
Normally no blood seen in the stool (you cannot see it by naked eye). Abnormal:

Abnormal fresh blood seen in cases of lower GIT bleeding caused by: anal fissure pile

Naked eye parasite Normal: no parasites or larva appear in the stool Abnormal:

In some cases the whole worm or parts of its body appear in the stool and can be seen by naked eye. Three worms can be seen by naked eye in the stool: Ascaris lumbericoides Entrobius vermicularis Taenia sp.

Preparation methods
Direct smear Concentration technique
Sedimentation method Saline sedimentation Tech. Formal Ether Concentration Tech. Floatation method

Kato technique

Microscopic examination

Epithelial cells Pus cells Starch Fat Fibre Vegetable cells Crystals Leukocytes Ova/cysts(parasites)

Microscopic examination
Fat-stain with Sudan black,Oil-O-Red Procedure-small suspension+two drops of

95% ethanol+2 drops sat. sudan III >60 Globules =steatorrhea

Yeast cells

Parasites-

Ancylostoma(hook worm)

Amoeba

strongyloidis

trichuris

Ascaris(round worm)

Giardia

Cysts and trophozoites

Schistosoma

Fecal Occult blood testing

Chemical(guaic method) Hemoporphyrin Immunological method

Guiac method
Guiac is naturally occuring phenolic

compound oxidised to quinone by hydrogen peroxidase=colour change positive test Detect pseudoperoxidase activity of haem. Not specific for human hb False positive-red meat,fruits ,vegs Positive.20ml/day of blood Specimen -3 consecutive stool samples,2 slides prepared within 7 says of collection.

Lactose tolerance test

Overnight fast,oral 50g of lactose dissolved in

400ml of water. Draw fasting blood samples at 30,60 and 120 minutes after ingestion 5 hr stool sample collected-ph ,appearance ,consistency Pts with lactase defeciency show peak rise of ,20mg/dl Flat tolerance curves-repeat test in two days