PRESENTED BYSYED BASHEER UDDIN

STOOL ANALYSIS

• A Stool analysis is a series of test done on a stool (feces) sample for differential diagnosis of certain diseases of digestive system.

• Stool analysis procedure is divided into: Physical Examination Chemical Examination Microscopic Examination

STOOL ANALYSIS• Physical Examination:-

A - Color: Normal feces has a dark brown color (Bilitubin in

the presence of bacteria will be oxidised to urobilin which give stool its color)

Abnormal color: Black color indicates blood of upper GIT origin.

Iron administration (in iron deficincy anemia) Bright Red color indicates blood of lower GIT

origin, Bleeding piles and Contamination with menstrual blood.

STOOL ANALYSIS Fresh blood & mucus: Amoebic dysentery

Bacillary dysentery Clay colored: Post hepatic jaundice , obstruction to

the

jaundice, obstruction to the flow of bile to intestine White color indicates yeast fermentation (Candida) and

after barium meal. Very pale color indicates biliary obstruction.

STOOL ANALYSIS Consistency and Forms:

Normal: Well formed Abnormal:

1. Pale, bulky, frothy - Steatorrhea (poor fat digestion)

2. Hard – Constipation

3. Flattened and ribbon like - Obstruction in the lumen of

the bowel.

4. Semi solid - Mild diarrhea, After taking laxatives &

Digestive upsets.

STOOL ANALYSIS 5. Watery - bacterial infection & purgatives

6. Rice water stools (Copious, thin with white flakes) Cholera • Chemical examination:

Determination of pH:1. Normal stool is slightly acidic, neutral or slightly alkaline.2. The pH values may range from 5.8 – 7.53. Strongly acidic stools (pH below 5.5)

Non-pathologic - Excess of carbohydrates in dietPathologic – Fermentation, may be due to lactose intolerance

4. Strongly alkaline stools (pH more than 7.5)Non-pathologic – Excess protein in the diet.

• Procedure: Dip pH paper in small quantity of the fecal material. Observe the color. Compare with the color chart and record the pH.

STOOL ANALYSIS• Microscopic Examination:

Saline specimen preparation:

1. Label the glass slide with a patient’s ID No.

2. Place a drop of isotonic saline on a glass slide.

3. Take a little fecal material with an applicator

stick and mix with the drop of isotonic saline.

4. Place a cover slip over it. Avoid formation of air

bubbles below the cover slip.

STOOL ANALYSIS Iodine specimen preparation:

1. Place a drop of Lugol’s iodine on the other side of the slide.

2. Mix little fecal material with the drop of iodine.

3. Place a cover slip over it.

4. Examine both the preparations under the high power of the microscope.

Note: The iodine stains the cysts (especially the

nuclear structure)

INTESTINAL PROTOZOA

INTESTINAL PROTOZOA

STOOL ANALYSIS

STOOL ANALYSIS

PLATYHELMINTHS

ROUND WORMS

OOL WORLD HOOK WORM

PIN WORMS

NEMATOHELMINTHS

RESULTS & INTERPRETATIONS. No Detection of Normal findings Abnormal findings Pathological

conditions

Cell identification

1. Cells

 

     

  Pus cells Present-few

 

Present many Bacillary dysentery

Ulcerative colitis

Epithelial cells -do- -do- Inflammation of the

bowel

Macrophages (Large Polymorphonuclear phagocytic

cells)

Occasional Many Bacillary dysentery,

ulcerative colitis

Erythrocytes Absent Present Lesion is in the

colon, rectum or

anus. They clump in

amoebiasis.

2. Crystals

 

     

  Triple phosphate and calcium oxalate Present due to

ingestion of certain

food i.e. spinach,

berries, tomatoes

- -

Charcot-Leyden crystals (pointed needle like) Absent Present Ulcerative

conditions,

amoebiasis.

Hematoidin crystals (Yellowish rhombic) - Present Intestinal

hemorrhage

RESULTS & INTERPRETATIONS. No Detection of Normal findings Abnormal findings Pathological conditions

3 Vegetable matter      

Vegetable cells, spiral, fibres, hairs etc Present, residual

constituents

- -

4 Animal matter      

Connective tissue, muscle fibres and elastic

tissue

Present, residual contents

or undigested fibres

- -

5 Undigested ingredients      

  Starch Absent Present in high proportion Indigestion

Fat Absent Present in high proportion Indigestion

6 Other findings      

  Yeast cells Present especially

Blastocystis hominis.

Also present sometimes in

cases of mild diarrhea and

abdominal distension

-

  Bacteria Constitute about one third

of the weight of dried feces

- -

Organism Type Microscopic observation (under high power) Identify the cellsEntamoeba Histolytica, cysts

Pathogenic Size 12 – 15 µm

Shape Round

Nuclei 1 – 4 nuclei

Membrane Thin, regular circular

Karyosome Small, compact central dot

Cytoplasm Yellowish-grey (in iodine olution)

Chromatoid bodies Oblong, rounded at ends

Vacuole Large glycogen vacuole (stained reddish-brown by iodine solution)

Entamoeba coli, cysts Non-Pathogenic Size 12 – 20 µm

Shape Round, oval, or irregular

Nuclei 1 – 8 nuclei

Membrane Irregular,thick in parts

Cytoplasm Pale yellow (in iodine solution)

Chromatoid bodies Sharp or needle shaped ends

Vacuole Sometimes a very large vacuole

Giardia intestinal, cysts

Pathogenic Size 8 – 12 µm

Shape Oval, appears with a double wall, one pole is more rounded then other.

Nuclei 2 – 4 oval nuclei

Membrane Very fine

Cytoplasm Refractile, clear, pale yellow when stained in iodine solution.

Fibril Refractile, hair like line, placed length wise in S shape.

Trichuris trichiura (whip worm)

Pathogenic

- OvaSize 50 µm

Shape Barrel type

Shell Thick, smooth, two layers

Content Uniform granular massOther feature At each pole a rounded transparent plug

 

Ascaris lumbricoides (round worms)                       

Pathogenic                            

  Fertilized egg with double shell  Size About 70 µm

Shape Oval

Shell External: rough, brown covered with little lumpsInternal: Smooth, thick colorless

Color External : Shell : BrownContent: Pale yellow 

  Unfertilized egg with double shell

Size 80 – 90 µm

Shape Elliptical, elongatedShell External: Brown with jagged lumps

Internal: ThinContent Full of round refractile granules

   

  Semi-decorticated fertilized egg without external shell

 

Shell Single, thick colorlessContent Round, colorless granular central mass

  Semi-decorticated fertilized egg     

Shell Single, smooth, thin, double lined colorless

Content Large, round, refractile, granules

1) Taenia Saginata2) Taenia solium

(Tape worms)

Pathogenic Note OvaThe eggs of these tape worms are identical

Size 30 – 40 µm

Shape Round

Shell Thcik, smooth, transverse lnes

Color Yellowish-brown

Content Round granular mass, enclosed by fine membrane3 pairs of refractile, lancet shaped hooklets

Ancylostoma duodenale (hook worm)

Pathogenic   Ova

Size 50 – 60 µm

Shape Oval, flattened poles

Shell Very thin

Color Cell in side (turn) dark brown in iodine solution otherwise pale grey

Content Varies according to maturity (four cells)

Enterobius vermicularis (pinworm)

Pathogenic   Ova

Size 50 – 60 µm

Shape Oval, asymmetrical

Shell Smooth, thin, double line

Content Small granularMassEmbryo, curled up larva

Color Transparent, colorless

Note: The egg (ova) is usually found in the folds of the skin round the anus.

Plant cells

Air bubblePlant hairs

Plant fibre

Pollen grains

Non-human coccidial oocysts Fat droplets

Soapy plaquesStarch cell Charcot leyden crystals Muscle fibers

Fatty acids MacrophageEpithelial cells

THANK YOU

SYED BASHEER UDDIN