1.

Understanding Stool
Feces or in the ballpark language called poo is a byproduct of the digestive tract of
animals were removed through the anus or cloaca. In humans, the process of sewage can
occur (depending on the individual and conditions) between once every one or two days to
several times a day. Hardening of the feces or stool may lead to increased time and decreased
frequency of bowel movements between expenditure or disposal referred to as constipation.
And conversely, if the hardening of the stool or feces impaired, resulting in decreased time
and increased frequency of bowel movements is called with diarrhea.
Distinctive odor of feces or stool is caused by bacterial activity. The bacteria produce
compounds such as indole, skatole, and thiol (sulfur-containing compound), and hydrogen
sulfide gas. Food intake in the form of spices can add a distinctive odor of stool or feces. In
the market there are also several commercial products that can reduce the odor of stool or
feces.
2. Purposes of The Investigation
Examination of stool (feces) is one of the laboratory tests that have long been known to
help the clinician make the diagnosis of a disease. Although today has evolved a variety of
modern laboratory tests, in some cases, stool examination is required and can not be replaced
by other tests. Knowledge of a variety of diseases that require stool examination, the correct
way of sample collection and examination and the correct interpretation will determine the
accuracy of the diagnosis made by the clinician.
For the purposes of the investigation is a clinical pathology laboratory technical
personnel as well as students from various health studies program. Can improve and
understand a variety of diseases that require stool samples, understand how to collect stool
samples for examination correctly. Able to carry out the examination of faecal samples with
both, and in the end were able to make the interpretation of the results of stool examination
correctly.
3. Stool Examination Procedures Macroscopic and Microscopic
a. Macroscopic
Terms in the collection of stool samples for examination:
1) Sample containers clean, watertight, free from urine.

2) Should be checked 30-40 minutes since issued if there is a delay in the cupboard shelf
3)
4)
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8)

ice.
Not to be swallowed barium, bismuth and oil 5 days before the examination.
Taken from the most likely to give abnormality. Such parts or mucus mixed with blood.
Most good of spontaneous defecation or Rectal toucher as stool examination while.
Patients may be given a saline cathartic constipation first.
In case the method can be used Oxyuris schoth tape and glass objects.
To send a stool, good container is made of glass or other material essence that can not
be penetrated like plastic. If the hard stool consistency, paraffin-coated cardboard box

may also be used. The container should be wide mouthed.

9) Therefore pathologic elements usually can not be evenly distributed, then the test
results can not be assessed degree microscopy kepositifannya appropriately, quite
marked - (negative), (+), (++), (+++) only.
Here is a description of a wide variety of macroscopic examination of the stool
samples.
1) Examination Number
Under normal circumstances the amount of feces ranged 100-250gram per day. The
amount of feces affected by the type of food when eating lots of vegetables increases the
amount of feces.
2) Examination of Color
a) Normal stools yellow and brown colors can be changed becoming older with the
formation of urobilin more. In addition to the color of the stool urobilin is influenced by
a variety of foods, abnormalities in the gastrointestinal tract and the drug is eaten. The
yellow color can also be caused by milk, corn, fat and drug santonin.
b) green stool can be caused by chlorophyll-containing vegetables or in newborns caused
by biliverdin and porphyrin meconium.
c) The color gray is probably because there is no urobilinogen in the digestive tract
obtained in obstructive jaundice, the stool is called akholis. The situation may be
obtained on pancreatic enzyme deficiency as in steatorrhoe that causes foods contain a
lot of fat that can not be digested and also after administration of barium salt after
radiological examination.
d) The stool is pink can be caused by fresh bleeding distal section, possibly also by foods
such as beets or tomatoes.
e) The brown color may be due to the presence of gastrointestinal bleeding or proximal
part because foods such as chocolate, coffee and others. Dark brown color due to
excessive urobilin as in hemolytic anemia. While the black color can be due to drugs
containing iron, bismuth and charcoal or possibly by melena.
3) Examination odor

Indole, skatol and butyric acid causes abnormal odor in the stool. The stench was
obtained if the decay occurs in the gut undigested proteins and overhauled by kuman.Reaksi
feces into the leachate by such decay.
The stool that smells rancid or sour due to the fermentation of sugar that is not digested
as in diarrhea. Reaction feces on the circumstances it becomes acidic. Consumption of foods
with spices may result in the spices that add to the smell of feces undigested.
4) Examination of Consistency
The stool normally has a rather soft consistency and bebentuk. At the diarrhea becomes
very soft consistency or liquid, while the opposite hard stools or constipation skibala obtained
at. Fermentation of carbohydrates in the intestines produce soft stools and mixed gas.
Ribbon-shaped stool consistency was found in hisprung disease. very large stool and oily
bowel showed alabsorpsi.
5) Examination of Slime
Under normal circumstances there is little once the mucus in the stool. The presence of
mucus which means there are a lot of stimulation or inflammation of the intestinal wall.
Mucus located on the outside of the stool, the localization of the irritation may lie in the
large intestine. Meanwhile, when mucus mixed with feces may well occur in the small

intestine irritation.
In dysentery, intussusception and can be obtained ileokolitis mucus without stool.
Transparent mucus that sticks to the outside of the stool due to spastic colitis, mucous

colitis in anxiety.
Stools with mucus and blood mixed occurs in the anal rectal malignancy and

inflammation.
Stools with mucus mixed with pus and blood due to ulcerative colitis, bacillary

dysentery, ulcerative diverticulitis, intestinal tuberculosis.

Stools with mucus that is very much due to vilous colon adenoma.
Blood examination.
The presence of blood in the stool can be pink, brown or black. The blood may be

present on the outside of the stool or mixed with feces.

1) In the proximal gastrointestinal bleeding blood will be mixed with feces and black color,
this is called melena as in gastric ulcer or varices in the esophagus.
2) On the bleeding in the digestive tract of the distal part contained blood on the outside of
the stool pink found on hemorrhoids or rectal carcinoma. The more proximal source of
bleeding the color black.

6) Examination of Pus
On examination of the stool can be found pus. It is found in the chronicles of disease
ulcerative colon, sigmoid colon fistula, Local abses.Sedangkan on bacillary dysentery pus is
not found in significant amounts.
7) Examination of Parasites
Also examined the presence of ascaris worms, anylostoma and other worm species that
may be found in the feces.
8) Examination of their leftovers
Almost always be found makana residual undigested, not the existence but the numbers
indicate that abnormalities in certain circumstances connected with something abnormal.
The rest of the food was mostly derived from food leaves and some foods of animal origin, as
well as muscle, elastic fibers and other substances.
For further identification of fecal emulsion mixed with Lugol's solution, the starch
(amylum) are not perfectly digested grains appear as blue or red. The addition of a saturated
solution of Sudan III or Sudan IV in 70% alcohol to make a neutral fat droplets appear as red
or orange.
b. Microscopic
1) Microscopic examination includes examining protozoa, worm eggs, leukocytes, eritosit,
epithelial cells, crystals, macrophages and yeast cells. From all of this examination is
the most important examination of protozoa and worm eggs. Protozoa. Usually found in
the form of cysts, when a new liquid stool consistency is obtained form trophozoites.
2) Worm eggs
Worm eggs that may be obtained, namely Ascaris lumbricoides, Necator americanus,
Enterobius vermicularis, Trichuris trichiura, Strongyloides stercoralis, and so on.
3) Leukocytes
Under normal circumstances can be seen a few leukocytes in the whole preparation. In
bacillary dysentery, colitis and inflammatory ulserosa obtained an increase in the
number of leukocytes. Eosinophils may be found on the slimy stools in patients with
allergic channel backside. To facilitate observation of leukocytes can acetate acid plus 1
drop 1 drop of 10% in feces emulsion on glass objects.
4) Erythrocytes
Erythrocytes only visible when there are lesions in the colon, rectum or anus.
Meanwhile, when a more proximal localization of erythrocytes have been destroyed.
The presence of erythrocytes in the stool necessarily abnormal.
5) Epithelium
Under normal circumstances can be found some lyaitu epite cells derived from the

distal bowel wall. Epithelial cells derived from the proximal part of the cell is rarely
seen because inibiasanya been damaged. The number of epithelial cells multiply when
there is stimulation or inflammation of the distal part of the intestinal wall.
6) Crystal
The crystals in the stool does not make much sense. In normal stool may look crystal
triple phosphate, calcium oxalate and fatty acids. Triple phosphate crystals and calcium
oxalate obtained after eating spinach or strawberries, while the fatty acid crystals
obtained after eating a lot of fat.
As abnormalities may be found Charcoat Leyden crystals Feces, beads and crystals
hematoidin starch. Charcoat Leyden crystals obtained in the gastrointestinal tract such
as ulcers caused amubiasis. In the digestive tract bleeding may be obtained crystals
hematoidin.
7) Macrophages
The large nucleated cells with phagocytosis, can often be seen in the cytoplasm of
bacteria other than erythrocytes, leukocytes .Bentuknya resembles an amoeba but not
moving.
8) Yeast cells
Special Blastocystis hominis is rarely obtained. The importance of knowing the
structure is considered lest amebic cysts.
9) Fungus
Examination of KOH
KOH examination is the examination of feces by using a solution of KOH (potassium
hydroxide) to detect the presence of the fungus, while the routine fecal examination is
the examination of the stool is usually done by using Lugol. To distinguish between
Candida in the normal state with candidiasis Candidiasis is, in addition to symptoms of
candidiasis, the results of the examination can be found which is a form pseudohyphae
invasive form of Candida in stool preparation. Incidence of candidiasis may also be
facilitated by the presence of risk factors such as diabetes mellitus, AIDS, anti-cancer
treatment, and long-term antibiotic use. If it is positive candidiasis and there are
symptoms of candidiasis, it usually can be cured with drugs such as fluconazole fungus,
but of course if there are risk factors should also be addressed. Swap is rubbed mucous
or mucous membrane or pseudomembrane then proceeds smears examined
microscopically, while the biopsy is the removal of tissue or cells for microscopic
examination as well.
4. Tools and Materials
Object glass, deckglass, eosin, microscope.

5. Summary
Stool examination is often performed in clinical laboratories and hospital laboratories.
Stool examination is one of the parameters that are used to aid in diagnosis of disease as well
as investigating a disease in more depth. Stool examination is divided into three kinds of
examination is the examination of macroscopic, microscopic and chemical.
a. The macroscopic examination consists of inspection number, color correction, proofing
odor, consistency checks, checks mucus, pus darah.pemeriksaan examination, inspection
and examination of the presence of parasites leftovers.
b. Microscopic examination of stool consists of an examination of the protozoa, worm eggs,
leukocytes, erythrocytes, epithelial, crystals, macrophages, cells of yeast, and fungi.
c. Blood chemical examination includes examining vague, urobilin, urobilinogen and
bilirubin.