4/11/2016

Clinical Chemistry

Stool
Analysis
Sumarheni
Faculty of Pharmacy
2016

Formation of Feces/stool
• Waste residue of undigested materials
(fibre/cellulose) + excretory product (bile
pigments and salts, epithelial cells, intestinal
mucus, leukocytes) + bacteria + Undigested
and unabsorbed food+water  enter colon
(peristalsis)

• 90% of water + minerals are absorbed into

the bloodstream  faecal material becomes
more solid = faeces.

1
 4/11/2016

Defaecation : the elimination of faeces from the

body through anus

Faeces is stored temporarily in rectum full

 sphincter muscles relax  rectal wall
contracts  the faeces ejected via the anus.

Problem related GI tract

 Constipation
 Haemorrhoids (piles)
 Colon cancer
 Malabsorption syndrome

2
 4/11/2016

Problem related GI tract

• The difficulty or infrequent
evacuation of the bowels
(elimination of feces).

• Feces becomes dry & hard 

difficult to eliminate.

Constipation

Problem related GI tract

 Swollen veins in the rectum or
anus.
 Constipation  EXCESSIVE
pressure exerted on the veins.
 Itchiness, pain & rectal
bleeding when the veins
rupture.

Haemorroids (Piles)

3
 4/11/2016

Problem related GI tract

 Develops gradually.

 A cell divides actively  form a polyp 

malignant (month  years later).

 Symptoms : change in
frequency of bowel
movement, blood in faeces,
abnominal pain, discomfort,
weight loss.

Colon cancer

Stool Examination
• Determining the cause of symptoms affecting
the digestive tract, including prolonged
diarrhea, bloody diarrhea, an increased
amount of gas, nausea, vomiting, loss of
appetite, bloating, abdominal pain and
cramping, and fever.
• Primary screening for some types of digestive
system malignancy : colon cancer

Diagnosing condition

4
 4/11/2016

Stool Examination
• Detecting the presence of digestive system
infectious diseases: parasites, bacteria,
fungus or virus
• Detecting poor absorption of nutrients by the
digestive tract (malabsorption syndrome)
• Diagnosing diseases of the digestive tract,
liver, and pancreas (enzymes such as trypsin
or elastase) or some types of anemia

Diagnosing condition

Stool Examination
Examination of fresh specimens permits the observation
of motile trophozoites, but this must be carried out
without delay.
• Liquid specimens contain trophozoites  30 min
• soft specimens contain both trophozoites and cysts 
1 hr.
If delays cannot be avoided, the specimen should be
preserved (overnight refrigeration)
No preservative is added to the feces

Specimen prep.

5
 4/11/2016

STOOL EXAMINATION

Macros. Micros. others

•Consistency •Chemical
Composition Paracites •Culture
• Colour, weight,
shape, odor •Cellophane tape
•adult parasites blood, •Baeremann tech
•etc
fat,
permanent temporary
Fibers,
lWBC

direct saline Iodine Conc.

smear smear technique

Sedimentation Floatation

Macroscopic Examination
• Stool changes color with changes in diet and various
medical conditions.

• Normal color of stool from :

a) Urobilin and stercobilin derived from reduction of bilirubin
through the action of intestinal bacteria  yellow to dark
brown
b) nature of the diet
ex. Pigmented diet- green vegetables, meat, blood  dark
c) Drugs
ex. calomel  green bismuth  black
Santonin  yellow rifampisin  dark red

Color

6
 4/11/2016

Studying stool color

• indication of digested blood in the
stool
- Very dark stools may indicate an ulcerative
lesion in the higher digestive tract.
- Red stool indicates lower GI bleeding
• iron deficiency anemia, cirrhosis,
colorectal cancer, disseminated
intravascular coagulation, peptic
ulcer, or stomach cancer.
Note: False (+)  licorice, iron pills, pepto-bismol, blueberry
Should be tested for the presence of hidden blood.

Dark to Black-colored stool

Studying stool color

• May be seen in hepatitis, gallbladder
disorders, or malabsorption conditions.
• Malabsorption problems can cause
undigested fat in the stool (steatorrhea)
which is characterized by foul smelling,
light yellow to gray, greasy or frothy
stools. This may also be caused by low
bile output.

Gray-pale-putty or clay colored stool

7
 4/11/2016

Studying stool color

Green stools may be bacteria
or a green or blue food eaten.

Orange stools may be due to

certain medications:
- Beta-carotene (a form of
vitamin A)
- antacids containing aluminum hydroxide
- barium from recent barium enema test
- hepatitis

Green or orange colored stool

Studying stool consistency

• Normal : solid to semi
solid (depending on
diet)
• 80-170 g/day
• Hard stool indicates
constipacy
• Liquid stool indicates
diarrhea
(gastroenteritis)

8
 4/11/2016

Studying stool odor

• stools normally have an unpleasant odor  'typical'.
• an extremely bad, out- of-the-ordinary odor may be
associated with certain medical conditions, notably diet
• Extremely foul smelling stools can be due to :
- bacteria overgrowth which produce H2S or ammonia
- the putrifying debris in the gut.
- foods containing sulfur and have a yeast problem.
- supplements reported to produce a smell when not
absorbed and metabolized well are selenium and
glutathione
(sometimes also bad body odor and bad breathe even shortly after taking a
shower or brushing teeth.

Microscopic Examination
Materials :
• Microscope slides
• Cover slips
• Sodium chloride solution in
small
• bottle with pipette
• Wooden stick
• Fresh stool
• Gloves

Fresh stool exam. by wet-mount smear

9
 4/11/2016

Microscopic Examination
• Used Cleaned microscope
slides

• Place a drop of saline

Fresh stool exam. by wet-mount smear

Microscopic Examination
• Take a small amount of stool
with a wooden stick

Mistake

Fresh stool exam. by wet-mount smear

10
 4/11/2016

Microscopic Examination
• Mix stool with saline

• Place coverslip and avoid air

bubbles

Fresh stool exam. by wet-mount smear

Microscopic Examination
• Examination of helminth ova or larva : use 1-
10x objective

Schistosoma mansoni Tape-worm

(lateral 'rose-thorn' spine on egg) (hexacanthoembryonated ova)

Fresh stool exam.

11
 4/11/2016

Microscopic Examination

Eggs (micro)

Macro Mouth part

(micro)

Ascaris lumbricoides

Paracite exam.

Microscopic Examination

Tail part (micro)

Mouth part
(micro)

Macro
Egg & larvae (micro)

Ancylostoma duodenale
(hook worms)
Paracite exam.

12
 4/11/2016

Microscopic Examination

Makcro
Eggs (micro)
Macro
Trichuris trichiura

Paracite exam.

Parasite setup Procedure

http://www.practicalscience.com/stoolsetup.html

13
 4/11/2016

Microscopic Examination
• Examination of amoebae
• Press cover slip slightly,
remove excess liquid with
paper towel

• Use 50x objective with

oil immersion

Entamoeba coli

Fresh stool exam.

Microscopic Examination
The main pathogens that are commonly looked for
in feces include:
• Salmonella and Shigella
• Yersinia
• Campylobacter
• Aeromonas
• Candida (if the patient is immunosuppressed e.g.
AIDS or cancer treatment)
• E. coli O157 (if blood is visible in the stool
sample.)

Fresh stool exam.

14
 4/11/2016

Chemical Examination
• The pH : normal 7.0 – 7.5
• Contents:
- sugar : normal less than 0.25 g/dL or 13.9 mmol/L
Lactose intolerance  elevated > 0.5 g/dL
- Fat : normal  2-7 g/24 hrs
steatorrhea (pacreatitis, gluten allergy)  >>

• Blood

Fecal Occult Blood

• Approximately 10g of freshly collected faeces, from 3 successive

bowel motions, collected in separate containers.
• based on the catalyst activity of Haem in the oxidation of a-
guaiaconic acid by hydrogen peroxide
• Red meat, aspirin. Vit.C interfere the test
Screening for colorectal cancer or gastroenteritis

15
 4/11/2016

Quantitative Fecal Fat Test

• For metabolic balance studies, collections of
stool are usually made over a 72-hour period.
• When the collection is complete, the
container and feces are weighed, and the
mass of excreted feces is calculated.

• In the infant, fecal material for these tests is

usually recovered from the child's diaper.

Metabolic Balance Studies

Routine Check-up Can Prove To Be

Lifesavers

Thank you

16