This is the brief Notes on Stool Examination which may be useful in Routine clinical practice for practitioners.

2. STOOL EXAMINATION
PRESENTED BY:-
DR.RAJESH UIKEY
Assist. Prof
DEPT. OF ROG NIDAN EVAM VIKRITI VIGYAN

3. GENERAL INTRODUCTION
• Average healthy adults defecate from three times
a day to three time a week.
• Common pattern is once a day .
• The stool tends to be soft and bulky on a diet
high in vegetables and small and dry on a diet
high in meat.
• Two thirds of the stool weight is attributable to its
water content ,The normal brown color is of still
undetermined origin.
• The odour results from indole and skatole
produced by bacteria from tryptophan.

4. FECES ARE COMPOSED OF:-
1. Waste residue of indigestible material in food
2. Bile (pigments and salts).
3. Intestinal secretion ,including mucous.
4. Leucocytes that migrate from the blood stream
5. Shed epithelial cells
6. Large numbers of bacteria that make up to one
third of total solids
7. Inorganic material (10-20%) that is chiefly
calcium and phosphate
8. Digested food (present in very small quantities)

5. TYPE OF FECES
Bristol Stool Scale is a medical aid designed to classify
the form of human feces into seven categories.

6. STOOL COLLECTION
Universal precaution :-
• Collect stool in a dry ,clean container
• Faces should be urine free when collected.
and transfer to another container by a
the laboratory immediatetly after collection.
• Worm stool are best for detecting ova and
refrigerate for ova and parasites.

7. Continue:-
• Some coliform bacilli produce antibiotics
substances that destroy enteric pathogens.
• A diarrhoeal stool will usually give good
results
• A freshly passed stool is the specimen of
choice
• Preferably stool specimens should be collect
before antibiotics therapy is initiated and as
early in the course of disease as possible

8. Continue:-
• Only a small amount of stool is a needed the
size of walnut . If mucous and blood are
present ,they should be indicated in part of
the specimen to be examined.
• Do not use a stool that has been passed into
the toilet bowl or that has been contaminated
with barium or other x-ray
• Label all stool specimen with patients name,
date and reason for examination testing.

9. INTERFERING FACTORS
• Meat interferes with some tests and should
usually be omitted from the diet for 3 day
before a test for blood
• Stool specimen from patients receiving
barium, bismuth, oil, or antibiotics are not
satisfactory
• Bismuth from paper towels and toilet tissues
interferes with tests.

10. NORMAL VALUES IN STOOL ANALYSIS
PHYSICAL EXAMINATION NORMAL
Colour brown
odour Varies with pH stool and
depend upon bacterial
fermentation and
putrefaction
Consistency Plastic ,not unusual to see
seeds and veg. skin ,soft and
bulky in a high veg. diet ,
small and dry in a high meat
diet
PHYSICAL EXAMINATION

11. PHYSICAL EXAMINATION NORMAL
Size and shape Formed
Gross blood Absent
Mucous, Pus and Parasites Absent
Fat Colourless ,neutral fat and
fatty acid crystals and soaps
Undigested None to small amount food,
meat fibers, strach,trypsin
Eggs and Sags Absent
Yeasts and Leucocytes Absent

12. CHEMICAL EXAMINATION
CHEMICAL EXAMINATION NORMAL
pH Neutral to weakly alkaline
Adult= 7.0-7.5
New born= 5.0-7.0
Bottle fed infant= neutral to
slightly alkaline pH of=7.0-8.0
Breast fed infant=Slightly
acidic

13. CHEMICAL EXAMINATION NORMAL
Occult blood Negative
Urobilinogen 50-300mg/24hrs
Porphyrins Coproporphyrins<200µg/24hrs
Protoporphyrins,1500µg/24hrs
Uroporphyrin<100µg/24hrs
Nitrogen 1-2 gm/24 hrs
Bile Negative in adult,positive in
childeren
Trypsin Positive in small amount in
adult, in greater amount in
normal children

14. EXAMINATION BY INSPECTION
• A simple inspection of feces may lead to a
diagnosis of parasitic infection, obstructive
jaundice, diarrhoea, malabsorption,
rectosigmoidal obstruction ,dysentry or
ulccerative colitis or gastrointestinal tract
bleeding
TYPE OF STOOL LIKELY REASON
Watery stool Diarrhoea
Large amount of mushy, foul
smelling, gray stool that float
in water
Steatorrhoea

15. TYPE OF STOOL LIKELY REASON
Little firm ,spherical masses Constipation (irritable colon
syndrome, overuse of laxative)
Narrow ribbon like stool Spastic bowel or narrowing or
stricture
Clay Coloured Obstructive jaundice, or
present of barium sulfate
Reddish stool Blood from lower GIT, beets
consumption or BSP use
Black ,tarry stool Bleeding for upper GIT , iron,
bismuth or charcoal,
consumption

16. TYPE OF STOOL LIKELY REASON
Green stool Ingestion of spinach etc,
calomel, presence of biliverdin,
seen in patients taking
antibiotic orally

17. MICROSCOPIC EXAMINATION
COVERSLIP PREPARATION FOR MICROSCOPIC EXAMINATION:-
Normal saline
one drop
Iodine
solution one
drop
1.On a clean and dry slide add one drop each of normal
saline and iodine solution

18. 2. By using an applicator stick take a small portion
•From formed sample:-portion from well inside and surface
•From liquid stool containing mucus. Take blood stained
mucus and other small portion

19. 3. Mix the sample with the drop of sodium chloride on the
Slide .Mix the sample with iodine solution drop

20. 4.Place a coverslip over each drop (apply coverslips as
Shown to avoid the formation of air bubbles)

21. 5. Label the slide with identification number

22. 6. Examine the preparation under the microscopic
•First under – low power objective and afterwards
With high power objective

23. CONCENTRATION METHOD OF MICROSCOPIC EXAMINATION
Method:- When stools are mixed with a saturated solution of
sodium chloride the ova float to surface.
This method is recommended for ova of round worm
hookworm, whipworm, hymnolopis nana, Tenia etc
The method is not suittable for ova of schistosomes
and Flukes and protozoa cysts

24. 1. Place small portion of stool in a penicillin bottle .
Add saturated sodium chloride (half bottle)
2. Mix by using applicator stick and add a saturated sodium
chloride and fill the bottle completely

25. 3. Place a coverslip on the bottle mouth
4. Remove the coverslip with care , a drop of liquid should
On it. Place it on the glass slide

26. 5.Examine under microscope(first under low power objective
And afterwards under high power objective)

27. MICROSCOPIC ANALYSIS
NO. DETECTION
OF
NORMAL
FINDING
ABNORMAL
FINDING
PATHOLOG.CONDI
TION
DIAGRAM
1 CELLS:-
Pus cells
Present , few Present ,
many
Bacillary dysentry ,
ulcerative colitis
Epithelial cells -do- -do- Inflammation of
the bowel
macrophages Occasional many Bacillary dysentry,
ulcerative colitis
Erythrocytes Absent Present Lesion is in the
colon , rectum or
anus, the clump in
amoebiasis

28. NO. DETECTION OF NORMAL
FINDING
ABNORM
AL
FINDING
PATHOLOG.CON
DITION
DIAGRAM
2 Crystals:-
Triple phosphate
and calcium oxalate
Present due to
indigestion of
certain food I,e.
spinach, berries,
tomato etyc
- -
Charcot-leyden
crystals
Absent Present ulcerative
colitis
amoebiasis
Haematoidin
crystals
Absent Present Intestinal
haemorrhage
3 Vegetable matter:-
Vegetable cells,
spirals, fibers, hairs
etc
Present in
residuel
constituent
- -

29. NO. DETECTION OF NORMAL FINDING ABNORMAL
FINDING
PATHOLOG.
CONDITIO
N
DIAGRAM
4 Animal matter:-
Connective tissue,
musle fibers and
elastic tissue
Present in residuel
constituent or
undigested fibers -
-
-
5 Undigested
ingredients:-
starch
Absent Present in
high
proportion
Indigestion
Fat Absent Present in
high
proportion
Indigestion
6 Other Findings:-
Yests
Present especialy
blastocystis
hominis
- -
Bacteria Constitute about
one third of the
weight of dried
faces
- -

30. INTESTINAL PROTOZOA
ORGANIUM TYPE DIAGRAM
Entamoeba histolytica cyst Pathogenic
Entamoeba coli cyst Non pathogenic
Giardia lamblia cyst Pathogenic

31. ORGANIUM TYPE DIAGRAM
Balantidium coli cyst Pathogenic
Enterobius vermicularis (pin
worm)
pathogenic
Trichiura (wipworm) Pathogenic

32. ORGANIUM TYPE DIAGRAM
Ascaris lumbricoides (round
worm)
Pathogenic
Ancylostoma duodenale (hook
worm)
pathogenic
Necator americanus Pathogenic

33. ORGANIUM TYPE DIAGRAM
Strongyloides stercoralis Pathogenic
Taenia solium (tape worm) pathogenic
Schistosoma haematobium Pathogenic

34. References
1. Godkar Praful B., Godar Darshan P, Text book
of medical laboratory technology, Parasitology
and faeces Examination 42, Second ed,
Mumbai: Balwani publishing house, 2003.