1. Waste residue of indigestible material (cellulose during the previous 4 days) 2. Bile pigments and salts 3. Intestinal secretions, including mucus 4. Leukocytes that migrate from the bloodstream 6. Bacteria and Inorganic material(10-20%) chiefly calcium and phosphates. Undigested and unabsorbed food. 1. Universal precaution 2. Collect stool in a dry,clean container 3. uncontaminated with urine or other body secretions, such as menstrual blood 4. Collect the stool with a clean tongue blade or similar object. 5. Deliver immediately after collection Ova and parasites collection 1. Warm stools are best for detecting ova or parasites. Do not refrigerate specimen for ova or parasites. 2. If the stool should be collect in 10 % formalin or PVA fixative, storage temperature is not critical. 3. Because of the cyclic life cycle of parasites, three separate random stool specimens are recommended. 1. Some coliform bacilli produce antibiotic substances that destroy enteric pathogen.Refrigerate specimen immediately. 2. A diarrheal stool will usually give accurate results. 3. A freshly passed stool is the specimen of choice. 4. Stool specimen should be collected before antibiotic therapy, or as early in the course of the disease. 5. If blood or mucous is present, it should be included in the specimen 1. Patients receiving tetracyclines, anti-diarrheal drugs, barium, bismuth, oil, iron , or magnesium may not yield accurate results. 2. Bismuth found in toilet tissue interferes with the results. 3. Do not collect stool from the toilet bowl.A clean, dry bedpan is the best. 4. Lifestyle, personal habbits, environments may interfere with proper sample procurement. Normal values in stool Analysis Macroscopic examination Normal value Amount 100-200 g / day Colour Brown Odour Varies with pH of stool and depend on bact- erial fermentation Consistency Plastic, not unusual to see fiber, vegetable skins. Size and shape Formed Gross blood,Mucous,Pus, Parasites None Normal values in stool analysis Microscopic examination Normal values Fat (Colorless, neutral fat (18%)and fatty acid crystals and soaps) Undigested food None to small amount Meat fibers, Starch, Trypsin None Eggs and segments of parasites None Yeasts None Leukocytes None Normal values in stool analysis Chemical examination Normal values Water Up to 75 % pH 6.5-7.5 Occult blood Negative Urobilinogen 50-300 g/24hr Porphyrins Coporphyrins:400-1200g/24hr Uroporphyrins:10-40 mg/24hr Nitrogen <2.5 g/24hr Normal values in stool analysis Chemical examination Normal values Bile Negative in adults:positive in children Trypsin 20-950 units/g( positive in small amounts in adults; present in greater amounts in normal children. Osmolarity used 200-250 mOsm with serum osmol- arity to calculate osmotic gap Sodium 5.8-9.8 mEq / 24hr
Normal values in stool analysis Chemical examination Normal values Chloride 2.5-3.9 mEq / 24 hr Potassium 15.7-20.7 mEq /24 hr Lipids ( fatty acid) 0-6 g / 24 hr 1. Fecal consistency may be altered in various disease states
a. Diarrhea mixed with mucous and red blood cells is associated with 1. Typhus 2. Typhoid 3. Cholera 4. Amebiasis 5. Large bowel cancer b. Diarrhea mixed with mucus and white blood cells is associated with 1. Ulcerative colitis 2. Regional enteritis 3. Shigellosis 4. Salmonellosi 5. Intestinal tuberculosis
C. Pasty stool is associated with a high fat content in the stool: 1. A significant increase of fat is usually detected on gross examination 2. With common bile duct obstruction, the fat gives the stool a putty- like appearance. 3. In cystic fibrosis, the increase of neutral fat gives a greasy, butter stool appearance. Normal value Varies with pH of stool and diet. Indole and sketole are the substances that produce normal odor formed by intestinal bacteria putrefaction and fermentation. Clinical implication. 1. A foul odor is caused by degradation of undigested protein. 2. A foul odor is produced by excessive carbohydrate ingestion. 3. A sickly sweet odor is produced by volatile fatty acids and undigested lactose Stool pH Normal value : Neutral to acid or alkaline Clinical implication 1. Increased pH ( alkaline) a. protein break down b. Villous adenoma c.Colitis d.Antibiotic use 2. Decreased pH ( acid) a. Carbohydrate malabsorption b. Fat malabsorption c. Disaccharidase deficiency Normal value : Brown Clinical implication: 1. Yellow to yellow-green : severe diarrhea 2. Green : severe diarrhea Black: resulting from bleeding into the upper gastrointestinal tract (>100 ml blood) 3. Tan or Clay colored : blockage of the common bile duct. 4. Pale greasy acholic (no bile secretion) stool found in pancreatic insufficiency. Stool color(con) 4. Maroon-to-red-to-pink : possible result of bleeding from the lower gastrointestinal tract (eg. Tumors, hemorrhoids, fissures,inflammatory process) 5. Blood streak on the outer surface of usually indicates hemorrhoids or anal abnormalities. 6. Blood in stool can arise from abnormalities higher in the colon. In some case the transit time is rapid blood from stomach or duodenum can appear as bright or dark red or maroon in stool. Normal value : Negative Clinical Implication : 1. Dark red to tarry black indicates a loss of 0.50 to 0.75 ml of blood from the upper GI tract. 2. Positive for occult blood may be caused by a. Carcinoma of colon b. Ulcerative colitis c. Adenoma d. Diaphramatic hernia e. Gastric carcinoma f. Diverticulitis g. Ulcers Normal value : Negative for mucous Clinical Implication: 1. Translucent gelatinous mucous clinging to the surface of formed stool occurs in a. Spastic constipation b. Mucous colitis c. Emotionally disturbed patients d. Excessive straining at stool 2. Bloody mucous clinging to the surface suggests a. Neoplasm b. Inflammation of the rectal canal 3. Mucous with pus and blood is associated with a. Ulcerative colitis b. Bacilliary dysentery c. Ulcerating cancer of colon d. Acute diverticulitis e. Intestinal tuberculosis Normal value : fat in stool will account for up to 20 % of total solids. Lipids are measured as fatty acids (0-6.0 g/24hr) Clinical Implication : 1. Increased fat or fatty acids is associated with the malabsorption syndromes a. Nontropical sprue b. Crohns disease c. Whipples disease d. Cystic fibrosis e. Enteritis and pancreatic diseases f. Surgical removal of a section of the intestine
Normal value : 125-400 Ehrlich units / 24 hr 75-350 Ehrlich units/100 g Clinical Implication: 1. Increased values are associated with Hemolytic anemias 2. Decreased values are associated with a. Complete biliary obstruction b. Severe liver disease, infectious hepatitis c. Oral antibiotic therapy that alters intestinal bacteria flora d. Infants are negative up to 6 months of age Normal value : Adults negative : Children may be positive Clinical Implication: 1. Bile may be present in diarrheal stools. 2. Increased bile levels occur in Hemolytic anemia
Normal value : Positive in small amounts in 95 % of normal persons. Clinical Implication : Decreased amounts occur in a. Pancreatic deficiency b. Malabsorption syndromes c. Screen for cystic fibrosis
Normal value : Negative Clinical Implication 1. Large amounts of leukocytes a. Chronic ulcerative colitis b. Chronic bacilliary dysentery c. Localized abscess d. Fistulas of sigmoid rectum or anus
2. Mononuclear leukocytes appear in Typhoid
Leukocytes in Stool (con) 3. Polymorphonuclear leukocytes appear in a. Shigellosis b. Salmonellosis c. Yersinia d. Invasive Escherichia coli diarrhea e. Ulcerative colitis 4. Absence of leukocytes is associated with a. Cholera b. Non specific diarrhea c. Viral diarrhea d. Amebic colitis e. Noninvasive E.coli diarrhea f. Toxigenic bacteria Staphylococci spp., Clostidium Cholera g. Parasites-Giardia, Porphyrins in Stool Normal value : Coproporphyrin 400-1200 g / 24hr Urophorphyrin 10-40 g / 24 hr. These values vary from Lab to Lab. Clinical Implication: 1. Increased fecal coproporphyrin is associated with a. Coproporphyria (hereditary) b. Porphyria variegata c. Protoporphyria d. Hemolytic anemia 2. Increased fecal protoporphyrin is associated with a. Porphyria veriegata b. Protoporphyria c. Acquired liver disease Stool Electrolytes Normal values : Sodium 5.8-9.8 mEq / 24 hr Chloride 2.5-3.9 mEq / 24 hr Potassium 15.7-20.7 mEq /24 hr Clinical Implication : 1. Idiopathic proctocolitis Sodium and Chloride Normal Potassium 2. Cholera Sodium and Chloride
"Nagtatae Siya 4 Days Na" As Verbalized by The Mother. Inatake of Causative Agents Irritation of The Stomach Inflammation of The Stomach Increase GI Motility Diarrrhea