MARBEL NOTRE DAME DIOCESAN SCHOOLS

NOTRE DAME OF GLAN, INC.

STA. CATALINA AVENUE, POBLACION, GLAN, SARANGANI PROVINCE
Government Recognition No. 191 S. of 1961 : ndglan_191@yahoo.com /
09175063974
“All for Jesus, through Mary!”

Exercise no. 1
FECAL EXAMINATION
Collection of Specimen

I. INTRODUCTION:

Normal feces are chiefly made of water, nonpathogenic bacteria, food residues, intestinal and digestive
secretions and very limited number of epithelial cells and leukocytes. The normal 24 hour amount is 100-200
grams. Bacteria constitute about 1/3 of the total dry weight. Normally, the number of the gram-positive
organism remains below 5%. Leukocytes is large numbers are usually present in bacillary dysentery, ulcerative,
colitis, and other inflammatory and ulcerative conditions. These are few leukocytes conditions in the stool of
chronic amoeba dysentery, unless a secondary bacterial infection is present.
Examining the abnormal feces needs necessary care and proper procedure to avoid the contamination
and come up to an exact diagnosis.

II. OBJECTIVES:
1. To determine the importance of fecal examination.
2. To identify the procedure on collection of specimen for fecal examination.

III. IMPORTANCE OF FECAL EXAMINATION:

 To detect the presence of a specific disease agent such as intestinal parasites.
 To detects indirect evidence of malfunction of some portion of the gastrointestinal tract, the liver
or pancreas.
 To investigate gastrointestinal bleeding and the presence of blood. Examination of occult blood
may lead to early detection of carcinoma.
 To investigate presence of fats in stool. The quantitative determination is a definite test for
steatorrhea.
 Used as a clue in several medical and surgical diagnosis.

IV. COLLECTION OF SPECIMEN

 The specimen should be passed directly into the container or transferred into the container from
paper or bedpan.
 If the patient is in the hospital, an early morning specimen before breakfast is not convenient.
 To obtain purged specimen, saline cathartic (such as sodium sulfate, 15 gram or buffered sodium
phosphate) may be given. Glycerin suppository is preferred if the patient is at the office or clinic.
 A sufficient quantity of stool should be collected to permit detection of parasites, if in a low
concentration and to prevent rapid drying of stools, if possible the entire specimen should be
collected to make adequate gross in microscopic examination. If the whole fecal specimen is not
available about 4 mL (4cm) is sufficient.
 The specimen should be collected without any mixture of urine because urine kills tropozoites
and distort ova or cyst. If possible have the patient urinate first.
 The mixture of with the stool speeds up the growth of non pathogenic organisms and renders
examination more difficult. Water may even destroy motile tropozoites.
 A specimen may be collected any time, however, if an examination is to be made of amoeba or
other parasites. The specimen should be collected sufficiently early in the day so that it may be
taken to the laboratory and examination that day.
 Specimen must adequately identified ( patient’s name, source of specimen, physician, etc, as
well as the time the specimen was obtained).
V. DISCUSSION:
1. Why there is a need to follow procedure in collecting for fecal examination?

2. Suggest and explain necessary attitudes or character in performing fecal analysis.( at least five)

VI. CONCLUSION:
 MARBEL NOTRE DAME DIOCESAN SCHOOLS
NOTRE DAME OF GLAN, INC.
STA. CATALINA AVENUE, POBLACION, GLAN, SARANGANI PROVINCE
Government Recognition No. 191 S. of 1961 : ndglan_191@yahoo.com /
09175063974
“All for Jesus, through Mary!”

Exercise no. 2
FECAL MACROSCOPIC EXAMINATION

I. INTRODUCTION
The amount of feces varies greatly with diet and other factors the average amount is about 200 grams in
24 hours, but it is much larger when a vegetable diet is being used, while meat makes the amount less than usual
production. One or two stool in 24 hours may be considered normal, yet one in three or four days is common
among healthy persons. The individual habit should be considered in every case.

II. OBJECTIVES
1. To examine stool form consistency, color and odor.
2. To interpret fecal appearance.

III. PROCEDURE
Open container of stool sample and examine as to its color, form, consistency and odor. Note the
presence of parasites whole worms or their fragments, undigested food, blood or pus.

IV. DISCUSSION
A. Form and consistency
Normal stool – soft and well formed
Abnormal stool
1. Soft and watery - one found in diarrhea irritation in the intestinal tract, or after the use of cathartics.
In early typhoid the stool is termed “ pea soap” brilliant red in later stage or typhoid and “rice water”
in cholera.
2. Hard and scyhalous stool – observed in pronlonged constipation. It is oftenly seen as ball shaped
sometimes grooved by the intestinal bands. Scybala known as “goat dropping” are also observable in
habitual spastic colitis and in atony of the colon. Scybala are due mainly bulk of feces and feces and
lack moisture.
3. Gaseous (fermentative) stools - are soft and mushy, and bubbles of gas may be present which
become more evident after stool stand in warm place for 12 hours. These type of stools are seen in
excessive carbohydrates fermentation and in typical sprue.
4. Flattened or ribbon-like-stool – also known as pipestem are seen in spastic colitis, obstruction in the
lower portion of the colon and commonly syphilitic structures, ulcer, tumor, and cancer or
carcinoma.
5. Small caliber stools – found in spasm; they either be due to hermorrhoids, carcinoma and ulcer.
6. Large caliber stool – found in constipation. If ever large in children, it indicates hirschsprung’s
disease.
B. Color
Normal – light to dark brown due to urobilin (stercolilin) which is a reduction product of bilirubin.
Diet and drugs cause marked changes in the color of stool.
Abnormal color
1. Yellow-mil diet, corn meal, rhubaro, santonin senna, fats.
2. Green-spinach, calomel, cook green chlorophyll from vegetables, unchanged buliverdin, diarrhea in
children and faulty carbohydrates digestion. Meconium and porphyrins (dark green).
3. Bright red (red) – due to bleeding low down intestinal tract such in hermorrhoids. Fissures,
carcinoma or similar lesion of the rectum or anus, undigested beets, tomatoes, and neo-prontosil.
Stool straked with blood are usually due to bleeding of lower portion of intestinal tract.
4. Dark red or chocolate brown – due to excess coffee, cocoa, chocolate, high red meat diet, excessive
excretion of urobilin in hemolytic anemia cherries.
5. Clay or putty (alcoholic) or tea color – due to absence of urobilin in obstructive jaundice, excess fat
(steatorrhea), in pancreatic disease, barium meal, in tuberculosis of the intestine and blockage of
common bile duct (pale and greasy stool)
6. Black or tarry (melena) color – due to iron, bismuth, suboxide charcoal, digested blood (cooked
blood). Blackberries, huckleberries, gastro-intestinal bleeding and bleeding of upper digestive tract.
7. Gray color – due to cocoa and chocolate.
 8. Golden yellow – due to unchanged bilirubin
9. Bulky pale and foamy – steatorrhea

C. Odor
Normal – peculiar offensive odor but not excessive foul. This is due to indole and skatole, which are the product
of protein purification in the intestine. Other product are paracresol, para-oxyphenyl propionic acids, hydrogen
sulfide, methane, methyl mercaptan, carbon dioxide, proteoses, peptone and peptides. Offensive odor is
markedly increased by meat diet, while vegetables diet makes it less offensive. Milk diet makes the normal odor
hardly noticeable.
Abnormal odors
1. Extremely foul odor – occurs in alkaline stool. It may be seen in some form of ulceration of intestine
and rectum, malignancy, syphilis or gangrenous dysentery and necrotic lesions in the intestines.
2. Putrid odor – found in ulcerated and malignant tumors of the lower bowel (sigmoid or rectum) and
in large hemorrhage.
3. Sour or rancid odor – indicates gas formation. Fermentation of carbohydrates, unabsorbed fatty acid
and acidity.
D. Mucus
Normal – very small, this can be detected only by microscopic examination.
Abnormal amount
1. Excessive quantity, which is easily detected with the naked eye-irritation or inflammation
2. Small in amount and intimately mixed with fecal material-lesion probably of small intestine.
3. Large amount that are not well mixed with fecal matter-inflammation of a large intestine.
4. Stool composed wholly of mucus-dysentery, ileocolitis intusseception.
5. Shred and ribbon of altered muces-mucus colic or membranous enteritis representing complete casts
or portion of bowel.
6. Hard and elastic mucus or leather-like hardness-mucous contaminated with albumin, fat and many
cells.
7. Pure mucus-seen in dysentery, intussusceptions and ileocolitis.
E. Concentration
There are sometimes seen in stool but are quite rare. True intestinal concretions also known as
enterolitis, are the gallstone, pancreatic calcili and intestinal sand which can be differentiated from coprollihts.
Coprolihts are lareg smaller intestinal concretion built up around blood, cloths, vegetable matter or
similar materials with layers of phosphate and intestinal detritus, although, all stones consists of cholesterol.
Among the enterolith, the gallstone is the most important. It is always a mixture of more than one
constituent. Cholesterol and calcium salt of the bile pigment are commonly present.
Another type of enteroith that draws much attention is the very minute sandy particles of unknown
origin – the intestinal sand which are chiefly made up calcium and organic matter. Studies however have
revealed that the majority of the presence of intestinal sand has been due to nervous disposition.

F. Parasites
Normally there should be no parasites in stool, in case of parasites infection adult parasites are easily seen, such
as tapeworm (segments) ascaris and vermicular is. Hookworm’s trichenella and trichuris can only be seen in
sedimention procedures and mixing with water and running it through a fine sieve and gauze.

V. RESULT:

Macroscopic examination Observation

Color
Form
Consistency
Odor
Presence of Parasites
Presence of undigested food
Concentration
Blood
Mucus

VI. CONCLUSION: (write it on the back)

 MARBEL NOTRE DAME DIOCESAN SCHOOLS
NOTRE DAME OF GLAN, INC.
STA. CATALINA AVENUE, POBLACION, GLAN, SARANGANI PROVINCE
Government Recognition No. 191 S. of 1961 : ndglan_191@yahoo.com /
09175063974
“All for Jesus, through Mary!”

Exercise no. 3
PREPARATION AND EXAMINATION OF A DIRECT FECAL SMEAR

I. OBJECTIVES:
To know the methods of preparing and learn the technique of examining a fecal smear.
II. MATERIALS:
Microscope
Slides
Cover slips
Wooden applicator stick
Normal saline solution
Lugo’s iodine solution

III. PROCEDURE
1. Take a slide and put 1 drop of NSS in the middle of the left half and 1 drop of iodine solution in the right
half.

2. Using an applicator stick, take a small of the stool. If stool are formed, take the portion from well inside the
sample and from various parts on the surface. If stool contain mucus or are liquid, take the portion form the
blood stained mucus on the surface or from the surface of the liquid.

3. Mix the sample with the drop of NSS on the slide to make a smooth uniform emulsion by rotary motion of
the applicator stick starting from the center and going towards the periphery.

4. Using the applicator stick, take a second portion of the stool from the specimen and mix it with the drop of
iodine solution.

5. Apply the cover slip over each drop and in so doing avoid air bubbles by placing the cover slip at the angle
with the slide at a close distance to the drop. Move the cover slip towards the emulsion till they meet then lower
the slide gently on the emulsion. (A toothpick maybe used to hold the cover slip while lowering it on the
emulsion.)

6. Adjust cover slip so that it is on its proper position. A too large drop of saline or iodine will give an
unsatisfactory preparation. This can be corrected by touching the emulsion, when properly prepared will allow
ordinary newspaper print to be barely legible through the preparation.

7. Make number of specimen on the slide with a marking pencil or pentel pen.

8. Examine the preparation under the microscope with 10x objective starting at the top left hand corner.

9. To ensure that no field is over looked, pick and object the edge of the field of view and move the slide across
the microscope stage examining the field until the object reaches the other edge of the field.

(Repeat the procedure over the whole area. For each field examined, change at least once to the 40x objective
to check for the presence of protozoa, which are very small. Examine the iodine preparation with the 40x
objective.

V. OBESERVATION:
1. Slide preparation
a. Fecal smear in NSS
 b. Fecal smear in iodine solution.

2. Result of microscopic examination

a. Fecal smear in NSS

b. Fecal smear in iodine solution

V. CONCLUSION: