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.

Enteric pathogen collection Some coliform bacilli produce antibiotic

substances that 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

Interfering factors
1. Patients receiving tetracyclines, anti-diarrheal drugs, barium, bismuth, oil, iron , or magnesium not yield accurate results. may ,
2. Bismuth found in toilet tissue interferes with the results.

Anti-diarrheal drug stool

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. 100-200 g / Brown Varies with and

Plastic, not see

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 Chemical examination Normal values

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

Uroporphyrins:10-40
<2.5 g/24hr

Normal values in stool analysis Chemical examination Normal values

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

values Chloride

Normal values in stool analysis Chemical examination Normal

2.5-3.9 mEq / 24 hr 15.7-20.7 mEq /24 hr 0-6 g / 24 hr

Potassium Lipids ( fatty acid)

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.

cancer 4. Amebiasis 5. Large bowel

Clinical Implications
b. Diarrhea mixed with mucus and white blood cells is associated with 1. Ulcerative colitis 2. Regional enteritis

( )
4. Salmonellosis

3. Shigellosis
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, the of neutral fat increase 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

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

b. Fat malabsorption

Normal value : Brown

Stool color

Clinical implication:
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.

Stool color(con)

4. Maroon-to-red-to-pink : possible result of bleeding from the lower gastrointestinal tract (eg. , , , Tumors, hemorrhoids, fissures,inflammatory process) 5. Blood streak on the outer , surface of usually 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 colitis

a. Carcinoma of colon

d. Diaphramatic c. Adenoma hernia

e. Gastric carcinoma g. Ulcers f. Diverticulitis

b. Ulcerative

Normal value : Negative for mucous

Mucous in Stool

Clinical Implication:
1. Translucent gelatinous mucous clinging to the surface of formed stool occurs in
a. Spastic constipation

c. Emotionally disturbed patients

d. Excessive straining at stool a. Neoplasm rectal canal

b. Mucous colitis

2. Bloody mucous clinging to the surface suggests

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 b. Bacilliary

d. Acute

e. Intestinal tuberculosis

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)

Fat in Stool

Clinical Implication :

1. Increased fat or fatty acids is associated with 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

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 bacilliary dysentery c. Localized abscess

b. Chronic

d. Fistulas of sigmoid rectum or anus

2. Mononuclear leukocytes appear in Typhoid

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. Salmonellosis

Leukocytes in Stool (con)

d. Invasive Escherichia

b. Non specific d. Amebic colitis

e. Noninvasive E.coli diarrhea

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

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