Fecalysis • STERCOBILIN from stercobilinogen- the

chemical responsible for the normal brown

color of the human excreta.
• The consistency of a stool specimen, whether Color of Causes
formed, semi-formed, mushy, or liquid, is of Stool
great importance, giving an indication of the Brown, dark Normal color is due to oxidation
types of organisms, which it may contain. brown or of bile pigments.
• Trophozoites- are usually found in liquid or yellow-
soft stools, but almost never in fully formed brown
ones Gray color Ingestion of chocolate or
• Cysts- are rarely seen in liquid stools, unless Cocoa. Steatorrhea
as the result of the administration of a Black Iron or bismuth ingestion,
bleeding from the upper GI
cathartic or laxative. Cysts are usually found
tract/melena—black tarry stool
in fully formed specimens.
Very dark Diet high in meat.
• Helminth eggs- may be found in either brown
liquid or formed stools, but as the liquid Red color Diet high in beats, laxatives of
stool is usually very dilute, they may often be vegetable origin, Bleeding from
difficult to detect in such specimens. lower GI tract (recent)
• The stool should be broken up with applicator Green or Diet high in spinach, green
sticks to check for helminths. yellow-green vegetables, possible
• Freshly passed specimens are essential for Pseudomonas infection
the detection of trophic amoebae or Rust color May indicate breakdown of
flagellates. hemoglobin
• All liquid or soft stools must be examined Yellow color May indicate pus
within one-half hour of the time of passage
or preserved in an appropriate manner.
• The immediate examination of fully formed
Quantity
stool specimens is not so important, but
they should be kept under refrigeration or • Normally there is 100 to 200 g/day.
otherwise preserved if examination must be • Many disorders cause large, bulky stools
delayed. even in people who don’t eat a lot.
• Fecal specimens should never be incubated • The size of your stool has more to do with
at 37°C; this will promote disintegration of how well you digest your foods than how
trophozoites and cysts and maturation and much you eat.
hatching of hookworm eggs. • Some types of foods produce larger stools
• A stool should be collected in a tightly because they don’t break down completely.
covered, clean, container and must not be • Some gastrointestinal disorders also cause
contaminated with urine. poor food breakdown and absorption, which
leads to large, bulky stools.
Gross Stool examination includes:
Consistency
✓ Color
Consistency Appearance Description Indications
✓ Quantity Type
✓ Consistency TYPE 1 Separate Severe
✓ Odor hard lumps, constipation
✓ Mucous like nuts

By: Elly
 (hard to ✔Ulcerating malignancy of the
pass)
TYPE 2 Sausage- Mild
colon
shaped but constipation Mucus with blood ✔Malignancies of the colon
lumpy which is clinging ✔Inflammatory lesion of rectal
TYPE 3 Like a Normal to stool is seen in: canal
sausage but
with crack An excessive ✔Villous adenoma of the
on its amount of mucus colon
surface seen in:
TYPE 4 Like a Normal
sausage or
snake,
smooth and
soft
TYPE 5 Soft blobs Lacks fiber in • A simple and rapid procedure in diagnosing
with clear- diet common intestinal parasites and is routinely
cut edges
(passed performed in the clinical setting.
easily) • About 2 mg of stool (amount forming a low
TYPE 6 Fluffy Mild diarrhea cone at the tip of an applicator stick) is
pieces with
ragged comminuted thoroughly with a drop of 0.85%
edges, sodium chloride solution (NSS) and then
mushy stool covered with a cover slip.
TYPE 7 Watery, no Severe
solid diarrhea • This technique requires an isotonic solution
pieces; and a small amount of fecal sample.
entirely • D’ Antoni or Lugol’s iodine- A weak iodine
liquid
solution, is used to visualize diagnostic
protozoan cysts and demonstrate nuclei.
Odor • It is disadvantageous in cases of light
infection since it requires a small amount of
the fecal sample
• The foul odor is caused by the undigested
• Trophozoites appear very pale and
protein and by excessive intake of
transparent. It can be stained to demonstrate
carbohydrate.
the nuclear morphology using Nair’s
• A bad odor which is sickly produced by buffered methylene blue (BMB) solution.
undigested lactose and fatty acids. • Entamoeba cytoplasm- will stain pale blue
and the nucleus, darker blue.
Mucous • The cytoplasm will stain golden yellow, the
nucleus will be pale and refractile, and the
Pure mucous id ✓ Severe constipation glycogen will be deep brown.
translucent ✓ Mucous colitis
• Micrometry, as a tool to measure cysts and
gelatinous ✓ Excessive straining of the
material clinging stool ova, will be useful in specific species
to the surface of ✓ Emotionally unstable identification.
the stool. This patient
may be seen in: Materials
Mucous in ✔Bacillary dysentery
diarrhea with ✔Ulcerative colitis • Glass Slides
microscopically ✔Intestinal tuberculosis • 0.85% Normal saline solution
present with
RBCs and WBCs ✔Amoebiasis • Cover Slip
is seen in: ✔Enteritis • D’ Antoni or Lugol’s Iodine
✔Acute diverticulitis • Applicator Sticks
• Microscope

By: Elly
 • Dropper Charcot- Are released
• Pea-sized stool sample Leyden with the disintegration of
crystals eosinophils.
Procedure: They may indicate presence of
hypersensitivity or parasitic
infections,
1. On a glass slide, apply one drop of Normal
especially amebiasis.
Saline Solution. Using an applicator stick, Epithelial cell
acquire a small fecal sample and emulsify it with Eggs of may be
the isotonic solution in a rotary motion. arthropods, mistaken for human parasites.
2. Apply coverslip. To avoid trapping bubbles, plant
allow the edge of the coverslip to touch the nematodes,
mixture and let the coverslip slide down. The and other
transparency of the mixture must be clear and spurious
thin enough for a newspaper print to be read parasites
through it. Fungal may be
3. View under LPO. Examine for presence of spores mistaken for human parasites
eggs, larvae and protozoan cysts. coming from
4. Switch to HPO for a clearer view. Make sure Candida
spp., yeast,
that the entire slide has been viewed and
and yeast-
examined.
like fungi
Elements of a. plant cells/fibers
plant origin b. pollen grains
• Microscopic examination can reveal many which c. starch granules
elements present in the intestinal tract aside resemble d. vegetable spirals
from parasites and normal fecal constituents. some
parasites
• Some microscopic artifacts closely
include:
resemble parasites which makes it hard for a
Plant and May look like helminth larvae.
parasitologist to distinguished between a animal hairs
parasite and an artifact
• Some artifacts are known for just its dietary
intake correlations, there are some artifacts
that are also possible indication for certain
diseases other than parasitic infection.
• Kato and Miura (1954)- introduced the
Artifact Description cellophane method, a new method involving
White blood a. Polymorphonuclears (PMNs), the principle of direct fecal sampling. It is
cells which may indicate inflammation
different from the standard direct smear
b. Eosinophils, which may indicate
an immune response to a parasitic procedure in that a larger amount of fecal
infection sample is required; cellophane cut outs are
used as coverslips.
Red blood Which may indicate • 50 to 60 mg stool (approximately the size of
cells ulcerations or bleeding two mung beans) is placed over a glass
Macrophages Are usually present in slide and covered with cut cellophane paper
both bacterial and parasitic soaked in a mixture of glycerin and
infections. malachite green solution.
In actual practice, one can mistake • Glycerin is a clearing solution.
the active macrophages for amebic
trophozoites.

By: Elly
 • Malachite green is used to give a pale green 6. Proper disposal
background to the eggs and to minimize the
brightness of the microscopic field.
• The preparation is best examined within 10 to
20 minutes.
• The technique is simple and economical, and
is therefore useful in mass stool
examinations.
• It is very good in detecting eggs with thick
shells:
✓ Ascaris
✓ Tricuris
• Not eggs with thin shells:
✓ Hookworms
• If preparation is too long: Hookworms
become too transparent or distorted and
difficult to identify.
• This technique is also useful to formed to
well-formed stools and not in loose or
watery stools meaning, that this technique is
not useful in detecting protozoan cysts
and trophozoites.

Principle:
In this technique, an adequate amount of fecal
sample is pressed through a mesh screen to remove
large particles. A portion of the sieved sample is then
transferred to the hole of a template on a slide. After
filling the hole, the template is removed and the
remaining sample is covered with a piece of
cellophane soaked in glycerol mixture with a dye.
The glycerol clears the fecal material from around the
eggs. The eggs are then counted and the number
calculated per gram of feces.

Procedure:
1. Label the glass slide
2. Get a cellophane cut out and place it on top
of fecal material
3. Flip the slide and gently press the slide
evenly to spread the feces in a circle
4. Carefully flip the side back, make sure that
the cellophane cut out is still attached onto
the glass slide with the flattened stool sample
in place.
5. Check if preparation is thin enough that you
can read the newspaper.

By: Elly