Stool Examination - Part 1 - (Stool

Analysis , Stool for ova and

parasite, Stool studies)
Sample

 A random stool sample can be taken.

 To rule out worm infestation three consecutive stools are tested.

 Collect the sample in clean, dry urine free container.

 Infants, collect from the diaper.

Precautions

1. Warm stools are better for the ova and parasites.

2. Don’t refrigerate the stool for ova and parasites.

3. Stool for ova and parasites can be collected in formalin and polyvinyl alcohol.These are used as a
fixative.

4. If there is blood or mucus, that should be included in the stool.Because most of the pathogens are
found in this substance.

5. Exam the stool before giving antibiotic or other drugs.

6. Semi-formed stool should be examined within 60 minutes of collection.

7. Trophozoites degenerate in liquid stool rapidly, so exam the stool within 30 minutes.

Indication

1. To rule out the presence of WBCs and RBCs.

2. To find ova or parasites.

3. To see the presence of fat for malabsorption syndrome.

4. For screening of colon cancer.

5. For asymptomatic ulceration of GI tract.

 6. Evaluate diseases in the presence of diarrhea and constipation.

Pathophysiology
1. The stool is examined :

1. Grossly.

2. microscopically.

3. Chemically.

2. Gross Stool examination includes:

1. Consistency

2. Color.

3. Quantity.

4. Odor.

5. Mucous.

3.

The color of the stool Causes

1. Brown, dark brown or yellow-brown Normal color is due to oxidation of bile pigments.

2. Gray color Ingestion of chocolate or Cocoa. steatorrhea

3. Black Iron or bismuth ingestion, bleeding from the upper GI tract.

4. Very dark brown Diet high in meat.

5. Red color Diet high in beats, laxatives of vegetable origin, Bleeding fr

6. Green or yellow-green Diet high in spinach, green vegetables.

4. Microscopic examination includes:

 1. Presence of leukocytes.

2. Presence of Red Blood Cells.

3. Ova and parasites.

4. Presence of meat fibers and muscle fibers.

5. Presence of fat.

5. The chemical examination includes:

1. Stool pH.

2. Reducing substances.

6. Stool odor is caused by indole and skatole which are formed by the bacterial fermentation and
putrefaction.

7. Mucous is produced by the mucosa of the colon in response to parasympathetic stimulation.

8. pH of the stool depends upon the diet and bacterial fermentation in the small intestine.

1. Carbohydrate changes the pH to acidic while the protein breakdown changes to alkaline.

2. pH stool test helps to evaluate carbohydrate and fat malabsorption.

3. pH stool also helps to know disaccharidase deficiency.

Consistency Stool may be:

1. Loosely formed stools.

2. watery stools.

3. Thin stools.

4. Pellet-like stools.

5. Dry or hard stools.

6. Puttylike stools.

7. small round hard stool is due to habitual constipation.

8. Pasty stools are due to high-fat contents and seen in :

1. common bile duct obstruction.

 2. Celiac disease.

3. Cystic fibrosis due to pancreatic involvement.

9. Diarrheal stools are watery.

10. Steatorrhea stool is :

1. Large in amount.

2. Frothy.

3. Foul smelling.

11. Constipated stools are firm and may see spherical masses.

12. Ribbon-like stool suggests the spastic bowel, rectal narrowing, stricture, or partial obstruction.

Color
1. Normal color is due to the presence of stercobilinogen.

2. Yellow or yellow-green color is seen in diarrhea.

3. Black and tarry ( related with consistency) stools are due to bleeding of upper GI tract from tumors.

4. Maroon or pink color is from lower GI tract due to tumors, hemorrhoids, fissure, or inflammatory
process.

5. Clay-colored stools are due to biliary obstruction.

6. Mucous in the stool indicate constipation, colitis or malignancy.

7. Pale color with greasy appearance is due to pancreatic deficiency leading to malabsorption.

Quantity
1. normally there is 100 to 200 G/day.

2. Many disorders cause large, bulky stools even in people who don’t eat a lot.

3. The size of your stools has more to do with how well you digest your foods than how much you eat.

4. Some types of foods produce larger stools because they don’t break down completely.

5. Some gastrointestinal disorders also cause poor food breakdown and absorption, which leads to large,
bulky stools

Odor
 1. The foul odor is caused by the undigested protein and by excessive intake of carbohydrate.

2. A bad odor which is sickly produced by undigested lactose and fatty acids.

Mucous
1. Pure mucous id translucent gelatinous material clinging to the surface of the stool.This may be seen in
:

1. Severe constipation.

2. Mucous colitis.

3. Excessive straining of the stool.

4. emotionally unstable patient.

2. Mucous in diarrhea with microscopically present with RBCs and WBCs is seen in :

1. Bacillary dysentery.

2. Ulcerative colitis.

3. Intestinal tuberculosis.

4. amoebiasis.

5. Enteritis.

6. Acute diverticulitis.

7. ulcerating malignancy of the colon.

3. Mucus with blood which is clinging to stool is seen in:

1. Malignancies of the colon.

2. Inflammatory lesion of rectal canal.

4. An excessive amount of mucus seen in:

1. Villous adenoma of the colon.

Stool pH
1. This depends upon the dietary intake.

2. Normally stool is slightly acidic or alkaline.pH is 7.0 to 7.5 depending on the diet.
 3. Alkaline ( Increased pH ) stool seen in:

1. Colitis.

2. Villous adenoma.

3. Diarrhoea.

4. Antibiotic therapy.

4. Acidic ( Decreased pH ) stool seen in:

1. Fat malabsorption.

2. Disaccharidase deficiency.

3. Carbohydrate malabsorption.

Reducing Substances
Please see details of Reducing substances in the stool.

Microscopic Examination
This is the preliminary examination to find the cause of diarrhea.

1. Presence of Leukocytes Normally there is no WBC.

2. Make smear from the mucus area or from the watery stool.

3. Virus and parasites don’t cause WBCs in the stool.

4. Increased number of WBCs in the stool.

1. Bacillary dysentery.

2. chronic ulcerative colitis.

3. Shigellosis.

4. salmonella infection.

5. Yersinia infection.

6. Invasive E.coli diarrhea.

7. Fistula of anus or rectum.

8. Localized abscess.
 9. Few WBCs are seen in amoebiasis.

10. WBCs may appear in typhoid.

5. The absence of WBCs seen in some of the diarrhoeal conditions alike :

1. Cholera.

2. Viral diarrhea.

3. Drug-induced diarrhea.

4. Amoebic colitis.

5. Non-invasive E.coli diarrhoea.

6. Parasitic infestation.

7. Toxigenic bacterial infection.

6. Presence of Red Blood Cells in the stool. Blood in the stool can be :

1. Bright red from the bleeding in the lower GI tract.

2. Maroon in color.

3. Black and tarry from bleeding from the upper GI tract.

4. Occult (not visible to the naked eye).

7. Causes of blood in stool :

1. Hemorrhoids.

2. Cancer.

3. Dysentery.

4. Please see more details in the occult blood.

Stool findings possible Causes

1. Diarrhoea mixed with blood and mucous Typhoid, Amoebiasis and large colon carcinoma

2. Diarrhoea mixed with Pus and mucous Ulcerative colitis, Salmonellosis, Intestinal tuberculosis,
Shigellosis, Regional enteritis and acute diverticulitis
3. Patty stool with high-fat contents Cystic fibrosis and CBD - obstruction

4. Formed stool with attached mucous Constipation, Mucous colitis, and excessive straining

5. Small, hard dark balls like Constipation

6. Clay-colored, pasty and little odor Bile duct obstruction, and barium ingestion.

7. Black, tarry, sticky, watery, voluminous Upper GI tract bleeding, Noninvasive infections like Cho
Staphylococcal food poisoning and Toxigenic E. Coli and
Disaccharidase deficiency.

8. Ova and parasites. Normally there are no parasites or eggs in the stool sample.

1. Multiple stool sample is needed to rule out the parasitic infestation, at least three consecutive
days.

2. An abnormal result means parasites or eggs are present in the stool.Such infections include:

3. Roundworms: Ascaris lumbricoides.

4. Hookworms: Necator americanus.

5. Pinworms: Enterobius vermicularis.

6. Whipworm: Trichuris trichiura.

7. Tapeworms: Diphyllobothrium latum, Taenia saginata, and Taenia solium

8. Protozoa: Entamoeba histolytica (an amoeba), and Giardia lamblia (a flagellate)

9. Strongyloidiasis.

9. Presence of Fat.The fat in the stool shows the possibility of :

1. Malabsorption.

2. Deficiency of pancreatic digestive enzyme.

3. Deficiency of Bile.

10. Meat fibers. and muscle fibers are seen in the stool. Their presence show defect in the digestion.

11. The increased amount of meat fibers are found in :

 1. Malabsorption syndrome.

2. A pancreatic functional defect like cystic fibrosis.

Amoeba is living organism and is a single cell. Its cytoplasm contains various
inclusions like RBCs etc.

Taenia Saginata Egg with hooklets Hymenolepis Nana Egg showing

hooklets
 Giardia lamblia
Trophozoite gives the
Giardia Lamblia Cyst appearance of a human
face with two eyes and
nose.