CLINICAL DIAGNOSIS B LAB ACTIVITY – STOOL ANALYSIS ORIENTATION

Far Eastern University – Nicanor Reyes Medical Foundation - Lifestyle, personal habits, environments may interfere with
CD B LAB ACTIVITY: STOOL ANALYSIS ORIENTATION proper sample procurement.
Dr. Esguerra, MD
NORMAL VALUES IN STOOL ANALYSIS
FECAL COMPOSITION MACROSCOPIC EXAMINATION
- Waste residue of indigestible material (cellulose during the - Amount: 100-200 g / day
previous 4 days) - Color: Brown
- Bile pigments and salts - Odor: Varies with pH of stool and dependent on bacterial
- Epithelial cells, intestinal secretions, including mucus fermentation
- Leukocytes that migrate from the bloodstream - Consistency: soft to formed
- Bacteria and Inorganic material (10-20%) chiefly calcium and
phosphates MICROSCOPIC EXAMINATION
- Undigested and unabsorbed food. - Fat: (Colorless, neutral fat (18%)and fatty acid crystals and
soaps)
INSTRUCTIONS TO PATIENTS - Undigested food: None to small amount
- Urinate before collecting the stool to avoid contaminating the - Meat fibers, Starch, Trypsin: None
feces. - Eggs and segments of parasites: None
- Pass stool into a dry wide-mouthed container and not from - Yeasts: None
the toilet bowl. - Leukocytes: None
- Do not mix, water, soap or tissue with the sample,
- Use applicator stick or spatula to pick a small amount (pea- CHEMICAL EXAMINATION
size) and place into the sample container. - Water: Up to 75 %
- Any stool consistency may be collected. Pick areas that has - pH: 6.5-7.5
mucus or blood. - Occult blood: Negative
- Use gloves in picking the sample. - Urobilinogen: 50-300 mg/24hr
- Replace the lid of the container - Porphyrins
- Label the container with your name, date of birth and the date o Coporphyrins: 400-1200mg/24hr
of collection. o Uroporphyrins: 10-40 mg/24hr
- Wash your hands thoroughly with soap and warm water - Nitrogen: <2.5 g/24hr
- Bile: Negative in adults/positive in children
COLLECTION NOTE - Trypsin: 20-950 units/g ( positive in small amounts in adults;
- Universal precaution present in greater amounts in normal children)
- Collect stool in a dry, clean container - Osmolarity: use 200-250 mOsm with serum osmolarity to
- uncontaminated with urine or other body secretions, such as calculate osmotic gap
menstrual blood - Sodium: 5.8-9.8 mEq / 24hr
- Collect the stool with a clean tongue blade or similar object. - Chloride: 2.5-3.9 mEq / 24 hr
- Deliver immediately after collection - Potassium: 15.7-20.7 mEq /24 hr
- Lipids: ( fatty acid) 0-6 g / 24 hr
OVA AND PARASITES COLLECTION
- Warm stools are best for detecting ova or parasites. CLINICAL IMPLICATIONS
o Do not refrigerate specimen for ova or parasites. Fecal Consistency may be altered in various disease states
- If the stool should be collected in 10 % formalin or PVA - Diarrhea mixed with mucous and red blood cells is associated
fixative, storage temperature is not critical. with
- Because of the cyclic life cycle of parasites, three separate o Typhoid
random stool specimens are recommended o Cholera
o Amoebiasis
INTERFERING FACTORS o Large bowel malignancy
- Patients receiving tetracyclines, anti-diarrheal drugs, barium, - Diarrhea mixed with mucus and white blood cells
bismuth, oil, iron , or magnesium may not yield accurate is associated with
results. o Ulcerative colitis
- Bismuth found in toilet tissue interferes with the results. o Regional enteritis
- Do not collect stool from the toilet bowl. A clean, dry bedpan o Shigellosis
is the best. o Salmonellosis
o Intestinal tuberculosis

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 CLINICAL DIAGNOSIS B LAB ACTIVITY – STOOL ANALYSIS ORIENTATION
- ”Pasty” stool is associated with a high fat content in the o Colonic cancer
stool: o Ulcerative colitis
o A significant increase of fat is usually detected on gross o Adenoma
examination o Diaphramatic hernia
o With common bile duct obstruction, the fat gives the o Gastric carcinoma
stool a putty- like appearance. o Diverticulitis
o In cystic fibrosis, the increase of neutral fat gives a o Ulcers
greasy, “butter stool” appearance.
MUCOUS IN STOOL
STOOL ODOR - Normal: Negative for mucous
- Normal: - Clinical Implication:
o Varies with pH of stool and diet. o Translucent gelatinous mucous clinging to the surface
o Indole and sketole are the substances that produce of formed stool occurs in
normal odor formed by intestinal bacteria ▪ Spastic constipation
putrefaction and fermentation. ▪ Mucous colitis
- Clinical implication: ▪ Emotionally disturbed patients
o A foul odor is caused by degradation of undigested ▪ Excessive straining
protein. o Bloody mucous clinging to the surface suggests
o A foul odor is produced by excessive carbohydrate ▪ Neoplasm
ingestion. ▪ Inflammatory process in the rectum
o A sickly sweet odor is produced by volatile fatty acids o Mucous with pus and blood is associated with
and undigested lactose ▪ Ulcerative colitis
▪ Bacilliary dysentery
STOOL pH ▪ Ulcerating cancer of colon
- Normal value: Neutral to acid or alkaline ▪ Acute diverticulitis
- Clinical implication ▪ Intestinal tuberculosis
o Increased pH ( alkaline)
▪ protein break down FAT IN STOOL
▪ Villous adenoma - Normal: fat in stool will account for up to 20 % of total solids.
▪ Colitis Lipids are measured as fatty acids (0-6.0 g/24hr)
▪ Antibiotic use - Clinical Implication :
o Decreased pH ( acid) o Increased fat or fatty acids is associated with the
▪ Carbohydrate malabsorption malabsorption syndromes
▪ Fat malabsorption ▪ Nontropical sprue
▪ Disaccharidase deficiency ▪ Crohn’s disease
▪ Whipple’s disease
STOOL COLOR ▪ Cystic fibrosis
- Normal: Brown ▪ Enteritis and pancreatic diseases
- Clinical implication: ▪ Surgical removal of a segment of the intestine
o Yellow to yellow-green : severe diarrhea
o Green : severe diarrhea, bile UROBILINOGEN IN STOOL
o Black: resulting from bleeding into the upper - Normal value :
gastrointestinal tract (>100 ml blood) o 125-400 Ehrlich units / 24 hr
o Tan or Clay colored : blockage of the common bile o 75-350 Ehrlich units/100 g
duct. - Clinical Implication:
o Pale greasy acholic (no bile secretion) stool found in o Increased values are associated with Hemolytic anemias
pancreatic insufficiency. o Decreased values are associated with
▪ Complete biliary obstruction
BLOOD IN STOOL ▪ Severe liver disease, infectious hepatitis
- Normal value : Negative ▪ Oral antibiotic therapy that alters intestinal
- Clinical Implication : bacteria flora
- Dark red to tarry black indicates a loss of 0.50 to 0.75 ml of ▪ Infants are negative up to 6 months of age
blood from the upper GI tract.
- Positive for occult blood may be caused by

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 CLINICAL DIAGNOSIS B LAB ACTIVITY – STOOL ANALYSIS ORIENTATION
BILE IN STOOL
- Normal:
o Adults –negative
o Children may be positive
- Clinical Implication:
o Bile may be present in diarrheal stools.
o Increased bile levels occur in Hemolytic anemia

TRYPSIN IN STOOL
- Normal value
o Positive in small amounts in 95% of normal persons.
- Clinical Implication :
o Decreased amounts occur in
▪ Pancreatic deficiency
▪ Malabsorption syndromes
▪ Screen for cystic fibrosis

LEUKOCYTES IN STOOL
- Normal value : Negative
- Clinical Implication
o Large amounts of leukocytes
▪ Chronic ulcerative colitis
▪ Chronic bacilliary dysentery
▪ Localized abscess
▪ Fistulas of sigmoid rectum or anus
o Mononuclear leukocytes appear in Typhoid
o Polymorphonuclear leukocytes appear in
▪ Shigellosis
▪ Salmonellosis
▪ Yersinia
▪ Invasive Escherichia coli diarrhea
▪ Ulcerative colitis

POLYPHYRINS IN STOOL
- Normal value :
o Coproporphyrin 400-1200 mg / 24hr
o Urophorphyrin 10-40 mg / 24 hr.
o These values vary from Lab to Lab.
- Clinical Implication:
o Increased fecal coproporphyrin is associated with
▪ Coproporphyria (hereditary)
▪ Porphyria variegata
▪ Protoporphyria
▪ Hemolytic anemia
o Increased fecal protoporphyrin is associated with
▪ Porphyria veriegata
▪ Protoporphyria
▪ Acquired liver disease

Notes from Lab PPT only

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