Stool AnalysisWhat is the stool or feces? 5. Epithelial cells that have been shade

Random Collection1.Universal precaution2.Collect stool in a dry,clean containeruncontaminated with urine or other body secretions, such as menstrual blood4.Collect the stool with a clean tongue blade or similar object.5.Deliver immediately after collection

Ova and parasites collectionWarm stools are best for detecting ova or parasites. Do not refrigerate specimen for ova or parasites.If the stool should be collect in 10 % formalin or PVA fixative, storage temperature is not critical.Because of the cyclic life cycle of parasites, three separate random stool specimens are recommended.

Enteric pathogen collectionSome 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.Stool specimen should be collected before antibiotic therapy, or as early in the course of the disease.If blood or mucous is present, it should be included in the specimen

Interfering factorsPatients receiving tetracyclines, anti-diarrheal drugs, barium, bismuth, oil, iron , or magnesium may not yield accurate results.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 AnalysisMacroscopic examination Normal valueAmount100-200 g / dayColourBrownOdourVaries with pH of stool and depend on bact-erial fermentationConsistencyPlastic, not unusual to see fiber, vegetable skins.Size and shape FormedGross blood,Mucous,Pus, Parasites None

Normal values in stool analysisMicroscopic examination Normal valuesFat (Colorless, neutral fat (18%)and fatty acid crystals and soaps)Undigested foodNone to small amountMeat fibers, Starch, TrypsinNoneEggs and segments of parasitesNoneYeastsNoneLeukocytesNone

Normal values in stool analysisChemical examinationNormal valuesWaterUp to 75 %pH6.5-7.5Occult bloodNegativeUrobilinogen50-300 g/24hrPorphyrinsCoporphyrins:400-1200g/24hrUroporphyrins:10-40 mg/24hrNitrogen

Normal values in stool analysisChemical examinationNormal valuesBileNegative in adults:positive in childrenTrypsin20-950 units/g( positive in small amounts in adults; present in greater amounts in normal children.Osmolarityused 200-250 mOsm with serum osmol-arity to calculate osmotic gapSodium 5.8-9.8 mEq / 24hr

Normal values in stool analysisChemical examinationNormal valuesChloride2.5-3.9 mEq / 24 hrPotassium15.7-20.7 mEq /24 hrLipids ( fatty acid)0-6 g / 24 hr

Clinical Implications1.Fecal consistency may be altered in various disease states

Diarrhea mixed with mucous and red blood cells is associated with1. Typhus2. Typhoid3. Cholera 4. Amebiasis5. Large bowel cancer

Clinical Implicationsb. Diarrhea mixed with mucus and white blood cells is associated withUlcerative colitis2. Regional enteritis3. Shigellosis 4. Salmonellosi5. Intestinal tuberculosis

Clinical ImplicationsC. Pasty stool is associated with a high fat content in the stool:1. A significant increase of fat is usually detected on gross examination2. With common bile duct obstruction, the fat gives the stool a putty- like appearance.3. In cystic fibrosis, the increase of neutral fat gives a greasy, butter stool appearance.

Stool OdorNormal valueVaries 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.A foul odor is caused by degradation of undigested protein.A foul odor is produced by excessive carbohydrate ingestion.A sickly sweet odor is produced by volatile fatty acids and undigested lactose

Stool pHNormal value : Neutral to acid or alkalineClinical implication1. Increased pH ( alkaline)a. protein break down b. Villous adenomac.Colitis d.Antibiotic use2. Decreased pH ( acid)a. Carbohydrate malabsorptionb. Fat malabsorptionc. Disaccharidase deficiency

Stool colorNormal value : BrownClinical implication:1. Yellow to yellow-green : severe diarrhea2. Green : severe diarrheaBlack: 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 found in pancreatic insufficiency.

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 StoolNormal value : NegativeClinical 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 bya. Carcinoma of colonb. Ulcerative colitisc. Adenoma d. Diaphramatic herniae. Gastric carcinomaf. Diverticulitisg. Ulcers

Mucous in StoolNormal value : Negative for mucousClinical Implication:1. Translucent gelatinous mucous clinging to the surface of formed stool occurs in a. Spastic constipationb. Mucous colitisc. Emotionally disturbed patientsd. Excessive straining at stool2. Bloody mucous clinging to the surface suggests a. Neoplasm b. Inflammation of the rectal canal

Mucous in Stool (con)3. Mucous with pus and blood is associated witha. Ulcerative colitisb. Bacilliary dysenteryc. Ulcerating cancer of colond. Acute diverticulitise. Intestinal tuberculosis

Fat in StoolNormal 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 :1. Increased fat or fatty acids is associated with the malabsorption syndromesa. Nontropical sprueb. Crohns diseasec. Whipples diseased. Cystic fibrosise. Enteritis and pancreatic diseasesf. Surgical removal of a section of the intestine

Urobilinogen in StoolNormal value :125-400 Ehrlich units / 24 hr 75-350 Ehrlich units/100 g Clinical Implication:Increased values are associated with Hemolytic anemiasDecreased values are associated with a. Complete biliary obstructionb. Severe liver disease, infectious hepatitisc. Oral antibiotic therapy that alters intestinal bacteria florad. Infants are negative up to 6 months of age

Bile in StoolNormal value : Adults negative: Children may be positiveClinical Implication:1. Bile may be present in diarrheal stools.2. Increased bile levels occur in Hemolytic anemia

Trypsin in StoolNormal value: Positive in small amounts in 95 % of normal persons.Clinical Implication : Decreased amounts occur inPancreatic deficiencyMalabsorption syndromesScreen for cystic fibrosis

Leukocytes in StoolNormal value : Negative Clinical Implication1. Large amounts of leukocytesa. Chronic ulcerative colitisb. Chronic bacilliary dysenteryc. Localized abscessd. Fistulas of sigmoid rectum or anus2. Mononuclear leukocytes appear in Typhoid

Leukocytes in Stool (con)3. Polymorphonuclear leukocytes appear ina. Shigellosisb. Salmonellosisc. Yersiniad. Invasive Escherichia coli diarrheae. Ulcerative colitis4. Absence of leukocytes is associated witha. Cholerab. Non specific diarrhea c. Viral diarrhead. Amebic colitise. Noninvasive E.coli diarrhea f. Toxigenic bacteria Staphylococci spp., Clostidium Cholera g. Parasites-Giardia,

Porphyrins in StoolNormal value : Coproporphyrin 400-1200 g / 24hr Urophorphyrin 10-40 g / 24 hr. These values vary from Lab to Lab.Clinical Implication:Increased fecal coproporphyrin is associated with a. Coproporphyria (hereditary)b. Porphyria variegata c. Protoporphyria d. Hemolytic anemia2. Increased fecal protoporphyrin is associated with a. Porphyria veriegata b. Protoporphyriac. Acquired liver disease

Stool ElectrolytesNormal values : Sodium 5.8-9.8 mEq / 24 hr Chloride 2.5-3.9 mEq / 24 hr Potassium 15.7-20.7 mEq /24 hrClinical Implication :Idiopathic proctocolitis Sodium and Chloride Normal PotassiumCholera Sodium and Chloride

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