Stool

Examination
Prepared by: Eliazel G. Ocfemia
DEFINITI
ON
Stool Stool analysis
Waste residue Series of test done on stool
of indigestible sample
materials
Differential diagnosis of
diseases of digestive system
Clinical Significance
Diagnosis of digestive
system infections
Bacterial, parasites, Primary screening test
viral , fungi for:
Colon cancer and
Diagnosis of pancreas peptic ulcers
disorders Some types of anemia
(OCCULT BLOOD)
Malabsorption of
nutrients
 Specimen Collection
Collect in a clean container
Do not contaminate with urine
Types of specimens
Random
FOBT
3-day testing
Preservation
Physical- refrigeration
Chemical- formalin, 95%
ethanol, glycerol in NSS
Specimen Collection
 Stool Analysis Procedures

Color and pH and sugar content

Fat content and occult
consistency blood
2. Chemical 3. Microscopic
1. Physical examination:
examination examination
Normal Stool Physical Examination

Color Consistency
Solid to semi-
Dark brown solid ( soft to
well-formed)
Physical Examination
Abnormal color
Black- blood of upper GIT origin
Red- blood of lower GIT origin
White- yeast fermentation
Very pale – biliary obstruction or barium
Physical Examination
Consistency
Liquid stool- diarrhea
Ribbon like - irritable bowel syndrome
GIT obstruction
Fatty – mal-digestion; vitamins deficiency (A,D,E,K)
Chemical examination

pH: 7.0-7.5
Low pH indicate
carbohydrate mal-
absorption
Chemical examination
Sugar contents:
<0.25g/dl
Elevated sugar
indicates (>0.5g/dl)
Lactose intolerance
Chemical examination

Fat contents:
2-7g of fat /24h
High level of fats in stool:
Pancreatitis, Cystic fibrosis or
Celiac disease
Chemical examination
tEST
Add 95% ethanolic- Sudan Black-II
Stain:
60 red droplets of neutral fats HPF
Fat mal-absorption (Steatorrhea)
Chemical
Examination Occult blood
Stool guaiac test
BLUE in COLOR
COLORLESS
Hemoglobin + H2O2+ Guaiac oxidized guaiac + H2O
Microscopic examination
Fecal leukocytes

Neutrophils are associates with dysentery

Detected by stool smears stained (Grams stain)
 Chemical
Examination
Parasites

Wet mount smear or Iodine stained

Should be prepared for parasites identificat
1. Wet mount smear – motility of active
protozoa
2. Iodine smear – neucleus and karyosome
of protozoa
Direct fecal smear
 Amoeba dysentery:
Entamoeba histolytica (Rhizopoda)

Macroscopic: Feces mixed with blood

and mucus
Microscopic: RBC’s, pus, mucus
Entmoeba hystolitica cyt/and
tropozoite ( central karyosome )
Tropozoite show molitity in one
direction
MICROSCOPIC EXAMINATION
Entamoeba cyst
( infective and diagnostic stage)

Entamoeba tropozoite
(incfective and diagnostic
stage)

MICROSCOPIC EXAMINATION
 Balantidial dysentery:
Balantidium coli (ciliophora)
Kidney-shaped macroneucleus

Small microneucleus

Ingestion of contaminated pork meat

(food and water contaminated
by the cyst)

MICROSCOPIC EXAMINATION
Giardia intestinalis:
Gastrointestinal Mastigophora
Habitat: small intestine (Duodenum)
Disease: Fatty diarrhea especially in children
Morphology:Tropozoite: Four pairs of flagella

MICROSCOPIC EXAMINATION
 Helminths:
Trematoda
Schistosoma mansoni
Intestinal bilharziasis
Diagnosis :
Ova with lateral spine in the
stool

MICROSCOPIC
EXAMINATION
 Cysticercosis:
Taenia (cestoda) infection
Taenia saginata: Beef
tapeworm
Taenia solium: pork tapeworm
DIAGNOSTIC STAGE:
Gravid segmants
Hexacantho-embryonated
ova

MICROSCOPIC EXAMINATION
 Ascaris lumbricoides:
Nematoda
DIAGNOSTIC STAGE:
Fertilized , unfertilized ova
Embryonated ova
Adult stage

MICROSCOPIC EXAMINATION
 Hookworms:
Ancylostoma duodenale (nematoda)
Diagnostic stage:
4-8 cell stage Embyonated
ova

3. MICROSCOPIC EXAMINATION
 Enterobius vermicularis ( pinworm )
Nematoda
Most commonly affects school-age children
Present with itchy butt, worse at night

Diagnostic stage
D – shaped egg

3. MICROSCOPIC EXAMINATION
 Diagnosis (pinworm)
scotch tape method
Prepare a tape and a tongue depressor
Press to the skin around the anus
Observe under a microscope for Pinworm eggs

3. MICROSCOPIC EXAMINATION
 Trichuris trichuria (whipworm)

Diagnostic stage:
Egg in stool
Diagnosis:
Brine floatation
Direct fecal smear

3. MICROSCOPIC EXAMINATION
 Strongyloides stercoralis
Nematoda

Free – living nematoda

Diagnostic stage:
Rhabditiform larvae in stool

3. MICROSCOPIC EXAMINATION
 Stool
Examination
Prepared by: Eliazel G. Ocfemia