MLS 108 (LAB) – Parasitology (PRELIM)

L4: Examination of Stool

Stool
❖ normal fecal specimen contains bacteria, cellulose,
undigested foodstuffs, GI secretions, bile pigments,
cells from the intestinal walls, electrolytes, and water
❖ Approximately 100 to 200 g of feces is excreted in a
24-hour period.

Methods of Macroscopic Examination

A. Macroscopic or Physical Examination

B. Microscopic Examination
C. Chemical analyses

Macroscopic or Physical Examination

Consistency:
➔ Formed
➔ Formed or semi-formed samples – mostly cysts
➔ Semi-Formed
➔ Soft
➔ Loose
➔ Watery
◆ Protozoan trophozoites are generally found on
soft or liquid stools
◆ Helminth eggs and larvae are found in any type
of consistency but because of the dilution factor
in watery samples, there could be reduction in
number of eggs or larvae

Consistency Description

1. Hard Resist puncture

2. Formed Can be punctured

3. Soft Can be cut with an applicator

4. Mushy Can be cut with an applicator

5. Loose Shapes to container

6. Diarrheic Flows

7. Watery Pours
MLS 108 (LAB) – Parasitology (PRELIM)
Constipation
➔ Constipation can be indicated by types one & two.
Types three & four are considered normal stools five,
six & seven are indicative of Diarrhea and type 8 is
as described mucous-like consistency, with bubbles
and a foul odor
Diarrhea
➔ an increase in daily stool weight above 200 g,
increased liquidity of stools, and frequency of more
than three times per day
➔ classification factors: oillness duration, mechanism,
severity, and stool characteristics
Acute diarrhea
➔ diarrhea lasting less than 4 weeks
Chronic diarrhea
➔ diarrhea persisting for more than 4 weeks
Secretory diarrhea
➔ caused by increased secretion of water
➔ Bacterial, viral, and protozoan infections produce
increased secretion of water and electrolytes, which
override the reabsorptive ability of the large
intestine, leading to secretory diarrhea
➔ Enterotoxin
◆ producing organisms (Escherichia coli,
Clostridium, Vibrio cholerae, Salmonella,
Shigella, Staphylococcus, Campylobacter,
protozoa, and parasites such as
Cryptosporidium) can stimulate water and
electrolyte secretions
Osmotic Diarrhea
➔ poor absorption that exerts osmotic pressure across
the intestinal mucosa
➔ Incomplete breakdown or reabsorption of food
presents increased fecal material to the large
intestine, resulting in water and electrolyte retention
in the large intestine (osmotic diarrhea), which in
turn results in excessive watery stool.
➔ Maldigestion
◆ impaired food digestion
➔ Malabsorption
◆ impaired nutrient absorption by the intestine
Altered Motility
➔ conditions of:
◆ enhanced motility (hypermotility) or
◆ slow motility (constipation)
➔ Irritable bowel syndrome (IBS)
◆ a functional disorder in which the nerves and
muscles of the bowel are extra sensitive,
causing cramping, bloating, flatus, diarrhea, and
constipation
➔ IBS can be triggered by food, chemicals, emotional
stress, and exercise.
Color
➔ Can be an indicative for the presence of parasite
➔ The presence of blood should always be reported
➔ Dark-colored blood
◆ bleeding in the upper GIT
➔ Bright-colored blood
◆ bleeding in the lower GIT
➔ Blood in the mucus or watery samples may possibly
yield presence of trophozoites.
➔ Ingestion of other compounds like IRON can alter
the color of the stool.
HOW IS IT DEVELOPED?
➔ Some urobilinogen is absorbed by intestinal cells &
transported into the kidneys & excreted w/ urine.
➔ The remainder travels down the digestive tract & is
converted to stercobilinogen. This is oxidized to
stercobilin, which is excreted & is responsible for
the color of feces.
MLS 108 (LAB) – Parasitology (PRELIM)

Characteristic Features of an Ideal Stool

➔ Stool color should be light to medium brown.

➔ It should have the texture or consistency of peanut
butter.
➔ Its length should be between 4-8 inches.
➔ It should leave the body comfortably, without any
strain.

Any change in shape, size, consistency, pattern of

delivery and color of the stool indicates, many things
about the digestive health

➔ Stool color, changes mainly due to two factors:

◆ the type of food eaten, &
◆ the amount of bile that mixes with the stool
MLS 108 (LAB) – Parasitology (PRELIM)
Acholic Stool
➔ stool that presents a grayish-white, ashy gray, or
clay color
➔ usually of a soft salvelike consistency. It occurs (1) in
conditions in which there is a total absence of bile in
the intestine, and (2) whenever the absorption of fat
is greatly impaired.
What is the stool odor?
➔ Stool odor is the smell associated with stools, or
bowel movements. Stools normally have an
unpleasant odor.
➔ The distinctive odor of feces is due to bacterial
action. Gut flora produce compounds such as indole,
skatole, and thiols (sulfur-containing compounds), as
well as the inorganic gas hydrogen sulfide.These are
the same compounds that are responsible for the
odor of flatulence.
➔ Consumption of foods with spices may result in the
spices being undigested and adding to the odor of
feces.
Chemical Examination
➔ (pH below 5.5) Strongly acidic stool - excess of
carbohydrates in the diet; non–pathologic but, if
fermentation is present, (lactose intolerance) then,
it is pathologic.
➔ (pH - 5.8 to 7.5) Normal stools are slightly acidic,
slightly alkaline or neutral
➔ (pH above 7.5) Strongly alkaline stool - excess of
protein in the diet; non–pathologic.
➔ fecal pH test is one where a specimen of feces is
tested for acidity in order to diagnose a medical
condition.
➔ Human feces is normally alkaline.
➔ Acidic stool - indicate a digestive problem such as
lactose intolerance or a contagion such as E. coli or
rotavirus.
➔ Fecal pH - A patient must not be receiving
antibiotics. At least half a milliliter of feces is
collected & a strip of nitrazine paper is dipped in the
sample & compared against a color scale.
➔ A pH of less than 5.5 indicates an acidic sample.
Lactose intolerance
➔ consequence of lactase deficiency, w/c may be
genetic or environmentally induced.
➔ Bacteria in the colon can metabolize lactose, & the
resulting fermentation produces copious amounts of
gas (a mixture of hydrogen, carbon dioxide, and
methane) that causes the various abdominal
symptoms.
➔ The unabsorbed sugars and fermentation products
also raise the osmotic pressure of the colon,
causing an increased flow of water into the bowels
(diarrhea).
Fecal fat test
➔ diagnostic test for fat malabsorption condition,
which leads to excess fat in the feces.
➔ steatorrhea → 6 g per day
➔ Causes of steatorrhea
◆ Impaired intestinal absorption
◆ Deficiency of pancreatic digestive enzymes
◆ Deficiency of bile
Fecal fat
➔ Normal : 5-6% of the total fat intake/day
➔ Liver insufficiency – fat excretion increases up to
40-50% of the total daily fat intake
MLS 108 (LAB) – Parasitology (PRELIM)

Fecal fat test Fecal fat

➔ D-xylose – gold standard test for malabsorption ➔ Reference Values (Normal):
◆ Low urine D-xylose – malabsorption condition ➔ A. Qualitative
◆ Normal D-xylose – pancreatitis ◆ Neutral Fat : < 50 fat globules/HPF
◆ Fatty Acids : < 100 fat globules/HPF
➔ done over a period of 3 days, the patient collecting
all of their feces into a container Test for Blood
➔ The container is thoroughly mixed to homogenize ➔ 2-2.5 mL daily - normal
the feces, this can be done w/ a paint mixer. ➔ Principle: Based on the determination of the
➔ A small sample from the feces is collected. peroxidase & pseudoperoxidase activity of RBC
➔ The fat content is extracted w/ solvents and including Hgb
measured by saponification (turning the fat into ➔ In the presence of peroxidase or pseudoperoxidase
soap). + H2O2 the indicator will form a blue quinone
compound
Microscopy
➔ staining w/ a Sudan III or Sudan IV dye ("Sudan Test for Blood (Occult Blood)
staining") or Oil Red O ➔ False (+):
➔ Visible amounts of fat indicate some degree of fat ◆ Drugs
malabsorption ● Salicylates (aspirin)
➔ aliquot of stool + 2 drops 95% ethanol + 2 drops sat. ● Steroids
ethanolic sol’n of Sudan III ● Nonsteroidal Inflammatory Drugs (NSAIDS)
● Anticoagulants
➔ Oil red O – substitute since it permits substitution of ◆ Other substances
isopropanol for ethanol ● Boric acid
➔ Fatty Acids – lightly stained flakes or needle – like ● Bromide
crystals (unstained) ● Colchicine
➔ Soaps - unstained well-defined amorphous flakes or ● Iodine (Betadine)
rounded or coarse crystals ◆ Foods
➔ Neutral fats – large orange or red droplets ● Meat - avoid up to 4 days
● Vegetables & fruits w/ peroxidase activity
(turnips, horseradish, mushrooms, broccoli,
apples, radishes, bananas, cantaloupe)
◆ Other Conditions
● Bleeding hemorrhoids
● Menstrual period
● Hematuria
● Long-distance runners (23%)
● Toilet bowl cleansers

Test for Blood (Occult Blood)

➔ 60 or more of stained droplets of neutral -
➔ False (-)
steatorrhea
◆ Ascorbic Acid (Vit C) : >250mg/day
➔ Mineral oil or castor oil may mimic neutral fat
◆ Vit C –enriched foods & juices
➔ Repeated w/ 36% Hac to stool sample & warming of
◆ Iron Supplement w/ Vit. C > 250mg
slide over flame until boiling
➔ Neutral fats & soaps are melted to FA that stains
Test for Blood (Occult Blood)
strongly in Sudan III then examined while warm
➔ bleeding in the Upper GIT is likely to produce a
➔ Up to 100/HPF – normal
positive result than lower GIT bleeding since the
➔ >100/HPF – steatorrhea
pseudoperoxidase activity of Hgb tends to be altered
as it passes through the GI tract (Henry)
MLS 108 (LAB) – Parasitology (PRELIM)

➔ Reducing substances: They are generally found in

stools of infants suffering from diarrhea.
◆ 1 vol. stool + 2 vol dis. H2O
◆ 15 gtts. into a clinitest tablet test
◆ Up to 0.25 g/dL – normal
◆ 0.5 g/dL – suspicious
◆ >0.5 g/dL – abnormal

➔ Bile Pigment
◆ Fecal Stercobilinogen – 20- 25mg%
● initially increased in liver insufficiency
producing dark brown stool
● Decreased in later stages of liver
insufficiency producing pale-color stool

➔ Gmelin's test
◆ is a chemical test used for detecting the
presence of bile pigments
◆ named after Leopold Gmelin
◆ After precipitation of bile pigments by Barium
Chloride, it is oxidized by concentrated nitric
acid biliverdin, bilicyanin & choletelin
◆ Different colors (play of colors) are visible if bile
pigments are present as they are oxidized to
various chemical product
◆ Nitric acid is used as the oxidizing agent