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Far Eastern University - Nicanor Reyes Medical Foundation: Clinical Diagnosis B Lab Activity - Stool Analysis Orientation

This document provides an orientation on stool analysis, including normal values and clinical implications. It discusses the typical composition and appearance of normal stool, as well as microscopic, chemical, and microscopic examination findings. Abnormal findings may indicate various gastrointestinal diseases. For example, increased fat in stool can suggest malabsorption syndromes like celiac disease. Bloody mucus may point to conditions like ulcerative colitis or cancer. Stool characteristics like pH, consistency, and odor also provide diagnostic clues. Multiple samples are generally needed due to the cyclic nature of some parasites or diseases.

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Karen Estavillo
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0% found this document useful (0 votes)
43 views

Far Eastern University - Nicanor Reyes Medical Foundation: Clinical Diagnosis B Lab Activity - Stool Analysis Orientation

This document provides an orientation on stool analysis, including normal values and clinical implications. It discusses the typical composition and appearance of normal stool, as well as microscopic, chemical, and microscopic examination findings. Abnormal findings may indicate various gastrointestinal diseases. For example, increased fat in stool can suggest malabsorption syndromes like celiac disease. Bloody mucus may point to conditions like ulcerative colitis or cancer. Stool characteristics like pH, consistency, and odor also provide diagnostic clues. Multiple samples are generally needed due to the cyclic nature of some parasites or diseases.

Uploaded by

Karen Estavillo
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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CLINICAL DIAGNOSIS B LAB ACTIVITY – STOOL ANALYSIS ORIENTATION

Far Eastern University – Nicanor Reyes Medical Foundation - Lifestyle, personal habits, environments may interfere with
CD B LAB ACTIVITY: STOOL ANALYSIS ORIENTATION proper sample procurement.
Dr. Esguerra, MD
NORMAL VALUES IN STOOL ANALYSIS
FECAL COMPOSITION MACROSCOPIC EXAMINATION
- Waste residue of indigestible material (cellulose during the - Amount: 100-200 g / day
previous 4 days) - Color: Brown
- Bile pigments and salts - Odor: Varies with pH of stool and dependent on bacterial
- Epithelial cells, intestinal secretions, including mucus fermentation
- Leukocytes that migrate from the bloodstream - Consistency: soft to formed
- Bacteria and Inorganic material (10-20%) chiefly calcium and
phosphates MICROSCOPIC EXAMINATION
- Undigested and unabsorbed food. - Fat: (Colorless, neutral fat (18%)and fatty acid crystals and
soaps)
INSTRUCTIONS TO PATIENTS - Undigested food: None to small amount
- Urinate before collecting the stool to avoid contaminating the - Meat fibers, Starch, Trypsin: None
feces. - Eggs and segments of parasites: None
- Pass stool into a dry wide-mouthed container and not from - Yeasts: None
the toilet bowl. - Leukocytes: None
- Do not mix, water, soap or tissue with the sample,
- Use applicator stick or spatula to pick a small amount (pea- CHEMICAL EXAMINATION
size) and place into the sample container. - Water: Up to 75 %
- Any stool consistency may be collected. Pick areas that has - pH: 6.5-7.5
mucus or blood. - Occult blood: Negative
- Use gloves in picking the sample. - Urobilinogen: 50-300 mg/24hr
- Replace the lid of the container - Porphyrins
- Label the container with your name, date of birth and the date o Coporphyrins: 400-1200mg/24hr
of collection. o Uroporphyrins: 10-40 mg/24hr
- Wash your hands thoroughly with soap and warm water - Nitrogen: <2.5 g/24hr
- Bile: Negative in adults/positive in children
COLLECTION NOTE - Trypsin: 20-950 units/g ( positive in small amounts in adults;
- Universal precaution present in greater amounts in normal children)
- Collect stool in a dry, clean container - Osmolarity: use 200-250 mOsm with serum osmolarity to
- uncontaminated with urine or other body secretions, such as calculate osmotic gap
menstrual blood - Sodium: 5.8-9.8 mEq / 24hr
- Collect the stool with a clean tongue blade or similar object. - Chloride: 2.5-3.9 mEq / 24 hr
- Deliver immediately after collection - Potassium: 15.7-20.7 mEq /24 hr
- Lipids: ( fatty acid) 0-6 g / 24 hr
OVA AND PARASITES COLLECTION
- Warm stools are best for detecting ova or parasites. CLINICAL IMPLICATIONS
o Do not refrigerate specimen for ova or parasites. Fecal Consistency may be altered in various disease states
- If the stool should be collected in 10 % formalin or PVA - Diarrhea mixed with mucous and red blood cells is associated
fixative, storage temperature is not critical. with
- Because of the cyclic life cycle of parasites, three separate o Typhoid
random stool specimens are recommended o Cholera
o Amoebiasis
INTERFERING FACTORS o Large bowel malignancy
- Patients receiving tetracyclines, anti-diarrheal drugs, barium, - Diarrhea mixed with mucus and white blood cells
bismuth, oil, iron , or magnesium may not yield accurate is associated with
results. o Ulcerative colitis
- Bismuth found in toilet tissue interferes with the results. o Regional enteritis
- Do not collect stool from the toilet bowl. A clean, dry bedpan o Shigellosis
is the best. o Salmonellosis
o Intestinal tuberculosis

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CLINICAL DIAGNOSIS B LAB ACTIVITY – STOOL ANALYSIS ORIENTATION
- ”Pasty” stool is associated with a high fat content in the o Colonic cancer
stool: o Ulcerative colitis
o A significant increase of fat is usually detected on gross o Adenoma
examination o Diaphramatic hernia
o With common bile duct obstruction, the fat gives the o Gastric carcinoma
stool a putty- like appearance. o Diverticulitis
o In cystic fibrosis, the increase of neutral fat gives a o Ulcers
greasy, “butter stool” appearance.
MUCOUS IN STOOL
STOOL ODOR - Normal: Negative for mucous
- Normal: - Clinical Implication:
o Varies with pH of stool and diet. o Translucent gelatinous mucous clinging to the surface
o Indole and sketole are the substances that produce of formed stool occurs in
normal odor formed by intestinal bacteria ▪ Spastic constipation
putrefaction and fermentation. ▪ Mucous colitis
- Clinical implication: ▪ Emotionally disturbed patients
o A foul odor is caused by degradation of undigested ▪ Excessive straining
protein. o Bloody mucous clinging to the surface suggests
o A foul odor is produced by excessive carbohydrate ▪ Neoplasm
ingestion. ▪ Inflammatory process in the rectum
o A sickly sweet odor is produced by volatile fatty acids o Mucous with pus and blood is associated with
and undigested lactose ▪ Ulcerative colitis
▪ Bacilliary dysentery
STOOL pH ▪ Ulcerating cancer of colon
- Normal value: Neutral to acid or alkaline ▪ Acute diverticulitis
- Clinical implication ▪ Intestinal tuberculosis
o Increased pH ( alkaline)
▪ protein break down FAT IN STOOL
▪ Villous adenoma - Normal: fat in stool will account for up to 20 % of total solids.
▪ Colitis Lipids are measured as fatty acids (0-6.0 g/24hr)
▪ Antibiotic use - Clinical Implication :
o Decreased pH ( acid) o Increased fat or fatty acids is associated with the
▪ Carbohydrate malabsorption malabsorption syndromes
▪ Fat malabsorption ▪ Nontropical sprue
▪ Disaccharidase deficiency ▪ Crohn’s disease
▪ Whipple’s disease
STOOL COLOR ▪ Cystic fibrosis
- Normal: Brown ▪ Enteritis and pancreatic diseases
- Clinical implication: ▪ Surgical removal of a segment of the intestine
o Yellow to yellow-green : severe diarrhea
o Green : severe diarrhea, bile UROBILINOGEN IN STOOL
o Black: resulting from bleeding into the upper - Normal value :
gastrointestinal tract (>100 ml blood) o 125-400 Ehrlich units / 24 hr
o Tan or Clay colored : blockage of the common bile o 75-350 Ehrlich units/100 g
duct. - Clinical Implication:
o Pale greasy acholic (no bile secretion) stool found in o Increased values are associated with Hemolytic anemias
pancreatic insufficiency. o Decreased values are associated with
▪ Complete biliary obstruction
BLOOD IN STOOL ▪ Severe liver disease, infectious hepatitis
- Normal value : Negative ▪ Oral antibiotic therapy that alters intestinal
- Clinical Implication : bacteria flora
- Dark red to tarry black indicates a loss of 0.50 to 0.75 ml of ▪ Infants are negative up to 6 months of age
blood from the upper GI tract.
- Positive for occult blood may be caused by

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CLINICAL DIAGNOSIS B LAB ACTIVITY – STOOL ANALYSIS ORIENTATION
BILE IN STOOL
- Normal:
o Adults –negative
o Children may be positive
- Clinical Implication:
o Bile may be present in diarrheal stools.
o Increased bile levels occur in Hemolytic anemia

TRYPSIN IN STOOL
- Normal value
o Positive in small amounts in 95% of normal persons.
- Clinical Implication :
o Decreased amounts occur in
▪ Pancreatic deficiency
▪ Malabsorption syndromes
▪ Screen for cystic fibrosis

LEUKOCYTES IN STOOL
- Normal value : Negative
- Clinical Implication
o Large amounts of leukocytes
▪ Chronic ulcerative colitis
▪ Chronic bacilliary dysentery
▪ Localized abscess
▪ Fistulas of sigmoid rectum or anus
o Mononuclear leukocytes appear in Typhoid
o Polymorphonuclear leukocytes appear in
▪ Shigellosis
▪ Salmonellosis
▪ Yersinia
▪ Invasive Escherichia coli diarrhea
▪ Ulcerative colitis

POLYPHYRINS IN STOOL
- Normal value :
o Coproporphyrin 400-1200 mg / 24hr
o Urophorphyrin 10-40 mg / 24 hr.
o These values vary from Lab to Lab.
- Clinical Implication:
o Increased fecal coproporphyrin is associated with
▪ Coproporphyria (hereditary)
▪ Porphyria variegata
▪ Protoporphyria
▪ Hemolytic anemia
o Increased fecal protoporphyrin is associated with
▪ Porphyria veriegata
▪ Protoporphyria
▪ Acquired liver disease

Notes from Lab PPT only

VISION 20|20
AD ASTRA PER ASPERA 3 OF 3

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