CHAPTER 9

Stool Analysis

INTRODUCTION

The stool of a healthy adult on an ordinary mixed diet is well formed,

semisolid in consistency,reaction is alkaline or neutral, and brown
in color. The feces are normally, composed 25% of fecal matter
of
while rest of it is water.In certain the feces may contain such
diseases,
substances which are not normally present in healthy individual such
as blood, mucus, parasites,intestinal calculi, pus, and pathogenic
organisms (bacteria,fungi and viruses),etc.
The amountof adult stool is nearly 150 to 250 g/day. Stoolshould
be collected in a clean, dry covered container and should not be
mixed with urine.
The stool should be examined for macroscopic examination,
chemical examination, and microscopic examination.

MACROSOPIC EXAMINATION
Stool should be examined macroscopically for following points:

Color

Normal stoolis light, or dark brown in color.

Following abnormal colors are found:
Green--in infantile diarrhea.

Clay-in obstructive jaundice, excess of fat, tuberculous peritonitis.

Dark brouwn or bright red -bleeding from distal colon.

Streaks of brightred blood-piles, fissures, carcinoma of rectum.

Black-gastrointestinal bleeding, tuberculosis.
 Stool
Analyis 135
Odor
after use of oral antibiotics,
foul smelling
Odorless in acute
enterítis,
rin rectum and distal colon.
malignantulcer

Mucus
Mucus is seen in bacillary dysentery.

Pus

Pus with blood and mucus present in ulcerative colitis, bacillary

enteritis.
dysentery, regional

Calculus

Gall stones may be seen in feces.

Blood

Impart a dark red to black color and a terry consistency.

Parasites

Segments of tapeworm and roundworm may be seen in respective

infections.

CHEMICAL EXAMINATION

Normally, pH of stoolis 6.8to 7.3 on mixed diet. Excess ofcarbohydrate

diet produces acidityand excess of proteins produce alkalinity.

MICROSCOPIC EXAMINATION

odine or 1odine preparation should be made and examined with the

low and high power
objectives.
Various ova or
cystsS may be seen(Fig. 9.1) asabnormal constituents
of stool. This includes
ovas of following parasites:
i.
Hookworm iv. Taenia
ii. Ascaris
(Roundworm) V. E. vermicularis
ii. Trichuristrichiura vi. H. nana
136 Clinical Pathology, Hematology and Biood Barhing

Other Abnormalities

1. Vegetablecells and fibers-incase of indigestion.

2. Starch granules--incarbohydrate dyspepsia.

3. Muscle and elastic fiber.
4. Fats and fatty acidsin fatty dyspepsia.
pus cells,
5. Cells-abnormal cells in stool includes-epíthelial,
RBCS.
macrophages, short cells, eosinophils,

Crystals

The abnormal crystals includes:

phosphate crystals, fatty acid
crystals.
a. Calcium oxalate, triple
conditions of intensive
is seen in ulcerative
b. Needle shaped crystals
etc.
dysentery, malignant ulcers,

S68

AMOBIC
TROPHOoT

BLASTOCrs

Fig. 9.1: Common things found in stool

 Stool Analysis 137

various bacteria, protozoa, metazoa, yeast andfungi

Besides these,

mav also be seen in stoolexamination.

Concentration Methods for Ova and Cyst

Take about one gram of feces and thoroughly emulsify with super
sodium chloride solution in water in
a suitable
container.
saturated
should have diameter as well as depth i about oneof

The container
is so filled with the emulsion that a slide placed
inch. The container
this position for
on it just touches the preparation. The slideis kept in
about 25 minutes, and gently inverted. Ova of many
helminths will
Aoat and stick to the slide. A coverslip is placed
on the slide and the
Dreparation is examined under thelow power of microscope.

Occult Blood Test

Make a suspension offecesand boil fortwominutes to destroy,oxidize

and inactivate bacteria or enzymes. Cool and add2 mL of saturated
benzidine in glacialacetic acid, mix well and add lmi.
solution of

(30%)hydrogen peroxide. Orthotoldine or guaiac solution can be used

instead of benzidine solution.
A deep blue color indicates the presence of hemoglobin.
The presence of blood in the stool is of great significance in
diagnosing the diseaseofinflammatory, neoplasticor ulcerativeorigin
of gastrointestinal tract.

Iron may affect thetest, so patient should not take meat diet, green
vegetable, or iron in any form.