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
bloodstream
shade
6.
Bacteria and Inorganic material(1020%) 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.

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.

Enteric pathogen
collection
1. 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, antidiarrheal drugs, barium, bismuth, oil, iron

,yield
,or
may
accurate
magnesium


false ste
not
results.
Anti-diarrheal drug stool
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

Normal values in
stool
Analysis
Macroscopic
examination
Normal value
Amount
day

100-200 g /

Colour

Brown

Odour
pH of stool
and depend on bact

erial fermentation

Varies with

Consistency
unusual to
see fiber, vegetable skins.

Plastic, not

Normal values in
stool analysis

Microscopic examination
Normal values
Fat (Colorless, neutral fat (18%)and
fatty acid crystals and soaps)
Undigested food
small amount

None to

Meat fibers, Starch, Trypsin

None
Eggs and segments of parasites
None

Normal values in
stool
analysis
Chemical
examination
Normal

values
Water
pH

Up to 75 %
6.5-7.5

Occult blood

Negative

Urobilinogen

50-300 g/24hr

Porphyrins
1200g/24hr

Coporphyrins:400Uroporphyrins:10-40

mg/24hr

Normal values in
stool
analysis
Chemical examination
Normal
values
Bile
Negative in
adults:positive in children

Trypsin
20-950
units/g( positive in small amounts
in adults; present in greater
amounts in
normal
children.
Osmolarity
used 200-250
mOsm with serum osmolarity to calculate osmotic gap

Normal values in
stool
analysis
Chemical examination

Normal values
Chloride
Potassium
/24 hr

Lipids ( fatty acid)

24 hr

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

Clinical
Implications
Fecal consistency may be altered in

1.
various disease states
a. Diarrhea mixed with mucous and red
blood cells is associated with
1. Typhus
Cholera

2. Typhoid
3.

4.Amebiasis
5.
Large
bowel cancer

Clinical
Implications

b. Diarrhea mixed with mucus and white

blood cells is associated with

1. Ulcerative colitis
2. Regional
enteritis ( )

3. Shigellosis
Salmonellosis

/
5. Intestinal tuberculosis

4.

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.

increase
3. In cystic fibrosis,
of neutral
the

fat 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.

Stool pH
Normal value : Neutral to acid or alkaline
Clinical implication
1. Increased pH ( alkaline)

a. protein break down

Villous
adenoma
c.Colitis
use

b.

d.Antibiotic

2. Decreased pH (
acid)


a. Carbohydrate malabsorption

Stool
color
Normal value : Brown
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

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
outer
the
on
,
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.

for

by
2. Positive
occult blood may be
caused
a. Carcinoma of colon
b.
Ulcerative
colitis

c. Adenoma
Diaphramatic hernia

d.

Mucous in Stool

Normal value : Negative for mucous

Clinical Implication:

1. Translucent gelatinous mucous clinging to

the surface of formed stool occurs in

a. Spastic constipation
b.

Mucous colitis

disturbed

c. Emotionally
patients
d. Excessive straining at stool
2. Bloody mucous clinging to the surface
suggests

Mucous in Stool
(con)

3. Mucous with pus and blood is

associated with
a. Ulcerative colitis
Bacilliary
dysentery

b.

c. Ulcerating cancer of colon

Acute diverticulitis

d.

Fat in Stool

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)
Clinical Implication :

is
associated

1. Increased fat or fatty acids

with the malabsorption syndromes
a. Nontropical sprue
disease

b. Crohns

c. Whipples disease
fibrosis

d. Cystic

e. Enteritis and pancreatic diseases

Urobilinogen in Stool

Normal value : 125-400 Ehrlich units / 24 hr

75-350 Ehrlich units/100 g
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:
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
b.
Chronic bacilliary dysentery

c. Localized abscess

of
sigmoid

d. Fistulas
rectum
or
anus
2. Mononuclear leukocytes appear in
Typhoid

Leukocytes in Stool (con)

3. Polymorphonuclear leukocytes appear in

a. Shigellosis

b. Salmonellosis

c. Yersinia
d. Invasive
Escherichia coli diarrhea
e. Ulcerative colitis
4. Absence of leukocytes is associated with
a. Cholera
diarrhea

b. Non specific

c. Viral diarrhea

d. Amebic colitis

e. Noninvasive E.coli diarrhea

Porphyrins in Stool
Normal value :
24hr

Coproporphyrin 400-1200 g /

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)
Porphyria variegata
c. Protoporphyria
anemia

b.

d. Hemolytic

Stool Electrolytes
Normal values :
Sodium
mEq / 24 hr
Chloride 2.5-3.9

5.8-9.8
mEq /

24 hr
Potassium

15.7-20.7 mEq /24

hr
Clinical Implication :
1. Idiopathic proctocolitis Sodium and
Chloride Normal Potassium