3.

Don’t refrigerate the stool for ova

and parasites.
4. Stool for ova and parasites can be
Stool Examination - Part 1 - Stool Analysis , collected in formalin and polyvinyl
Stool for ova and parasite, Complete Stool alcohol. These are used as a fixative.
studies 5. If there is blood or mucus, that
should be included in the stool.
1. Sample Because most of the pathogens are
found in this substance.
 A random stool sample can be taken. 6. Exam the stool before giving
o More than 2 grams of the
antibiotic or other drugs.
stool is needed 7. Semi-formed stool should be
 To rule out worm infestation three examined within 60 minutes of
consecutive stools are tested. collection.
o Collect three stools in the
1. Liquid stool should be
span of 10 days. examined within the first 30
o Two samples on alternate
minutes.
days. 2. Solid stool should be
o One sample after purgation.
examined within the first
 Collect the sample in clean, dry urine hour of collection.
free container. 8. Trophozoites degenerate in liquid
 In the case of Infants, collect from stool rapidly, so exam the stool
the diaper. within 30 minutes.
9. In the case of constipated cases, use
non-residual purgative on the night
Precautions before the collection of the stool.

1. Advise patients for the following Stool preservatives are:

things for at least 48 hours before the
collection of the stool:
1. Avoid mineral oils. 1. Preservatives for the wet preparation
2. Do not take bismuth. are:
3. Antibiotics like tetracyclines. 1. 10% formol-saline for the
4. Anti-diarrheal drugs which wet preparation. This is best
are non-absorbent. preservatives as it kills the
5. Avoid anti-malarial drugs. bacteria and preserves the
6. The patient should not have a protozoa and helminths.
barium swallow examination 2. Sodium acetate formalin.
before the stool examination. 3. Methionate iodine formalin.
7. For occult blood stop iron- This is a good preservative
containing drugs, meat and for the field collection of the
fish at least 48 hours before stool.
the collection. 2. For staining use Polyvinyl alcohol.
2. Warm stools are better for the ova 3. Avoid preservatives for the culture
and parasites. of stool.
 1. Usually three parts of the 2. Presence of Red Blood Cells.
preservatives and one part of 3. Ova and parasites.
the stool. 4. Presence of meat fibers and
muscle fibers.
5. Presence of fat.
Indication
6. Yeast and molds.
7. Bacteria.
1. To evaluate the function and
integrity of the GI tract.
2. To rule out the presence of WBCs
and RBCs.
3. To find ova or parasites.
4. To see the presence of fat for
malabsorption syndrome.
5. For screening of colon cancer.
6. For asymptomatic ulceration of GI
tract.
7. Evaluate diseases in the presence of
diarrhea and constipation.
8. Summary of stool studies are done to
evaluate:
1. Intestinal bleeding.
2. Infestation.
3. Inflammatory diseases.
4. Malabsorption.
5. Different causes of diarrhea.

Pathophysiology
5. The chemical examination
includes:
1. The stool is examined: 1. Stool pH.
1. Grossly. 2. Reducing substances.
2. microscopically. 3. For occult blood.
3. Chemically. 4. Presence of fat, carbohydrate,
2. Gross Stool examination includes: and proteins.
1.
Color.
2.
Consistency. Normal components of the stool:
3.
Quantity.
4.
Odor. 1. Undigested food particles like:
5.
Mucous. 1. Vegetable cells.
6.
Helminths. 2. Vegetable fibers.
7.
Concretions (gallbladder 3. Muscle fibers.
stone rarely may be found). 4. Starch granules.
3. Microscopic examination includes: 5. Fishbones.
1. Presence of leukocytes (pus 2. Water.
cells).
 3. Bacteria. 14. The very hard stool is due to
4. Desquamated epithelial cells. excessive absorption of water due to
5. Digestive tracts products like: prolonged contact with colonic
1. Enzymes. mucosa.
2. Mucus.
3. Bile pigments products.
Color
6. Digested but not absorbed food.
7. Products produced by the
decomposition of the stool are: 1. Normal color is due to the presence
1. Skatole. of stercobilinogen.
2. Indole. 2. Yellow or yellow-green color is seen
3. Various gases like H2S, CO2, in diarrhea.
and nitrogen. 3. Black and tarry (related with
consistency) stools are due to
bleeding of upper GI tract from
The consistency of the Stool may be: tumors.
4. Maroon or pink color is from lower
1. Normal is soft and formed. GI tract due to tumors, hemorrhoids,
2. Loosely formed stools. fissure, or inflammatory process.
3. watery stools. 5. Clay-colored stools are due to biliary
4. Thin stools. tract obstruction.
5. Pellet-like stools. 6. Mucous in the stool indicate
6. Dry or hard stools found in constipation, colitis or malignancy.
constipated patients. 7. Pale color with greasy appearance is
7. Puttylike stools. due to pancreatic deficiency leading
8. small round hard stool is due to to malabsorption.
habitual constipation.
9. Pasty stools are due to high-fat
contents and seen in: The color of the stool
1. common bile duct
obstruction.
2. Celiac disease. stool looks
like aluminum paint.
3. Cystic fibrosis due to 1. Brown, dark brown or yellow-brown
pancreatic involvement and
are greasy.
10. Diarrheal stools are watery.
11. Steatorrhea stool is:
1. Large in amount.
2. Frothy. 2. Gray color
3. Foul smelling.
12. Constipated stools are firm and may
see spherical masses.
13. Ribbon-like stool suggests the
spastic bowel, rectal narrowing,
stricture, or partial obstruction.
 1. Like malabsorption
3. Green color syndrome, andIngestion of spinach, and chloro
carbohydrate
indigestion.
3. The size of your stools has more to
do with how well you digest your
foods than how much you eat.
4. Black (Taary black) 4. Some types of foods produce larger ingestion, bleed
Iron or bismuth
stools because they don’t break
down completely.
5. Some gastrointestinal disorders also
cause poor food breakdown and
absorption, which leads to large,
5. Very dark brown bulky stools. Diet high in meat.

Odor

1. The foul odor is caused by the

6. Red color Diet high in beats, laxatives of
undigested protein and by excessive
intake of carbohydrate.
1. Stool odor is caused by
indole and skatole which are
formed by the bacterial
7. Green or yellow-green fermentation and
Diet high in spinach, green veg
putrefaction.
2. A bad odor which is sickly produced
by undigested lactose and fatty acids.
3. The odor is increased due to excess
intake of proteins.
8. REd streaks of blood on feces Bleeding from the hemorrhoids
4. The putrid odor is due to severe
diarrhea of malignancy or
gangrenous dysentery.

Mucous

Quantity 1. Mucous is produced by the mucosa

of the colon in response to
1. Normally there is 100 to 200 G/day. parasympathetic stimulation
1. With vegetable diet may be 2. Pure mucous is translucent
250 g/day. gelatinous material clinging to the
2. Many disorders cause large, bulky surface of the stool. This may be
stools even in people who don’t eat a seen in:
lot. 1. Severe constipation.
2. Mucous colitis.
3. Excessive straining of the
stool.
 4. emotionally unstable patient. 6. Alkaline (Increased pH) stool is seen
3. Mucous in diarrhea with in:
microscopically present with RBCs 1. Colitis.
and WBCs is seen in: 2. Villous adenoma.
1. Bacillary dysentery. 3. Diarrhea.
2. Ulcerative colitis. 4. Antibiotic therapy.
3. Intestinal tuberculosis. 5. Excess intake of proteins.
4. amoebiasis. 7. Acidic (Decreased pH) stool seen in:
5. Enteritis. 1. Fat malabsorption.
6. Acute diverticulitis. 2. Disaccharidase deficiency.
7. ulcerating malignancy of the 3. Carbohydrate malabsorption.
colon. 4. Excess intake of
4. Mucus with blood which is clinging carbohydrates.
to stool is seen in: 8. Precautions for pH estimation:
1. Malignancies of the colon. 1. Barium intake and laxatives
2. Inflammatory lesion of rectal change the pH.
canal. 2. If the specimen is
5. An excessive amount of mucus seen contaminated with the urine,
in: will need to discard the
1. Villous adenoma of the sample.
colon.
2. This depends upon the
Reducing Substances
dietary intake.

 Please see details of Reducing

pH substances in the stool on the
following link.
1. Normally stool is slightly acidic or o http://www.labpedia.net/test/
alkaline or neutral. 128
1. pH is 7.0 to 7.5 depending on
the diet.
Microscopic Examination
2. Newborn pH = 5.0 to 7.5.
2. pH of the stool depends upon the diet
and bacterial fermentation in the  This is the preliminary examination
small intestine. to find the cause of diarrhea.
3. Carbohydrate changes the pH to
acidic while the protein breakdown 1. Presence of Leukocytes Normally
changes to alkaline. there are no WBCs.
1. Breastfed infants pH has a 1. WBCs only appear in
slightly acidic stool. infection or inflammation.
2. Bottle fed infants have a 2. Their presence is important in
slightly alkaline stool. case of diarrhea or dysentery.
4. pH stool test helps to evaluate 3. >3 WBCs /high field are seen
carbohydrate and fat malabsorption. in ulcerative colitis and
5. pH stool also helps to know bacterial infection.
disaccharidase deficiency. 4. Greater numbers of WBCs
indicate invasive pathogens.
2. Virus and parasites don’t cause
WBCs in the stool. Stool findings (Physical features)
3. Increased number of WBCs in the
stool.
1. Bacillary dysentery.
2. chronic ulcerative colitis.
3. Shigellosis. 1. Diarrhea mixed with blood and mucous
4. salmonella infection.
5. Yersinia infection.
6. Invasive E.coli diarrhea.
7. Fistula of anus or rectum.
8. Localized abscess.
4. Few WBCs are seen in amoebiasis. 2. Diarrhea mixed with Pus and mucous
1. Also, WBCs are seen in
typhoid.
5. The absence of WBCs seen in some
of the diarrhoeal conditions alike:
1. Cholera. 3. Patty stool with high-fat contents
2. Viral diarrhea.
3. Drug-induced diarrhea.
4. Amoebic colitis.
5. Non-invasive E.coli
diarrhoea.
6. Parasitic infestation. 4. Formed stool with attached mucous
7. Toxigenic bacterial infection.
6. Presence of Red Blood Cells in the
stool. Blood in the stool can be:
1. Bright red from the bleeding
in the lower GI tract.
5. Small, hard dark balls like
2. Maroon in color.
3. Black and tarry from
bleeding from the upper GI
tract.
4. Occult blood (not visible to
the naked eye). 6. Clay-colored, pasty and little odor
5. Causes of blood in stool:
1. Hemorrhoids.
2. Cancer.
3. Dysentery.
7. Make smear from the mucus area or
7. Black, tarry, sticky, watery, voluminous
from the watery stool.
1. Please see more details in the
occult blood.
8. Ova and parasites. Normally there
are no parasites or eggs in the stool
sample.
1. Multiple stool sample is
needed to rule out the
parasitic infestation, at least
three consecutive days.
2. An abnormal result means
parasites or eggs are present
in the stool. Such infections
include:
3. Roundworms: Ascaris
lumbricoides.
4. Hookworms: Necator
americanus.
5. Pinworms: Enterobius
vermicularis.
6. Whipworm: Trichuris
trichiura.
7. Tapeworms:
Diphyllobothrium latum,
Taenia saginata, and Taenia
solium
8. Protozoa: Entamoeba
histolytica (an amoeba), and
Giardia lamblia (a flagellate)
9. Strongyloidiasis.
9. Presence of Fat. The fat in the stool
shows the possibility of :
1. Malabsorption.
2. Deficiency of pancreatic
digestive enzyme.
3. Deficiency of Bile.
10. Meat fibers. and muscle fibers are
seen in the stool. Their presence
show defect in the digestion.
1. The increased amount of
meat fibers are found in:
1. Malabsorption
syndrome.
2. A pancreatic
functional defect like
cystic fibrosis.