Research includes several stages of study:
- Physical properties of feces;
- Chemical research;
- Microscopic examination;
- Bacteriological research;
Physical properties.
Chemical examination of stool.
Includes determination of the content of blood in stool, which is not visible to the naked eye, bilirubin, stercobilin, and other substances.
Bacteriological examination of stool.
If the stool becomes black in color and has a tarry consistency (melena), then these are signs of the duodenum. This occurs as a result of a rupture of a blood vessel at the bottom of the ulcer. Varicose veins of the esophagus, found in people with. If blood from the veins of the esophagus enters the stomach, black, tarry stool appears.
The appearance of fresh blood in the stool.
If, during a visual examination, fragments of fresh blood are visible, this indicates diseases such as anal fissures.
Change in stool odor.
The sharp, unpleasant smell of feces is a consequence of extensive reactions of rotting or fermentation. Occurs in diseases such as chronic pancreatitis. The disease is characterized by insufficient production of pancreatic juice, which is involved in the digestion of fats, proteins and carbohydrates. Insufficiently digested food contributes to the increase in putrefactive bacteria in the intestines, which release fetid substances. In addition to the putrid smell, feces contain many visible fragments of undigested food.
Dysbacteriosis is a disease in which the ratio of normal and pathological intestinal microflora is disrupted. The feces become mushy, with a strong unpleasant odor, and a high content of leukocytes.
Presence of protein in stool.
Presence of muscle fibers in feces.
Muscle fibers refer to elements of meat food that are not digested in the digestive tract and end up in the feces. If the presence of muscle fiber exceeds the norm, then this phenomenon is called creatorrhea. Occurs in diseases such as: Chronic atrophic gastritis - decreased stomach acidity. In this case, the release of hydrochloric acid is disrupted, and the elements of meat food are not subjected to the necessary processing, which further reduces their quality of digestion in the lower parts of the digestive tract.
Normally, when examining stool, the result should be negative. This indicates that there are no eggs, cysts, or larvae of worms. If the result is positive, it is indicated which type of helminth was detected.
Presence of lamblia in feces.
In children under one year of age receiving solid food, an increased content of muscle fibers, fats, and carbohydrates in the feces is allowed. As we grow older, food begins to be digested almost completely, and digestion returns to normal.
Microscopic examination makes it possible to determine the smallest remains of food, by which one can judge the degree of its digestion. Microscopy reveals cellular elements separating into the intestinal lumen: leukocytes, erythrocytes, macrophages, intestinal epithelium, tumor cells, as well as small lumps of mucus; finally, microscopy reveals helminth eggs and protozoa parasitizing the intestines.
Detritus
Detritus constitutes the main background during microscopy of normal feces. It is a mass of small particles of various sizes and shapes, consisting of cell breakdown products, food residues and bacteria. These particles are unrecognizable. The more completely the digestion of food occurs, the more detritus in the feces and the fewer differentiated elements it contains.
Muscle and connective fibers- the only remains of protein food recognized by microscopy.
Muscle fibers
Muscle fibers, or rather their fragments, have different appearances depending on the degree of exposure to proteolytic enzymes; muscle fibers that have not undergone digestion have a cylindrical shape and different lengths; their edges seem to be cut off at right angles. They are quite brightly colored golden yellow or brown; Only in acholic stool are they deprived of color by bile pigment and look gray. The most characteristic distinguishing feature of undigested muscle fiber remains is cross-striation. As the muscle fibers are digested, the transverse striations are replaced by longitudinal ones, which also then disappear and the muscle fiber becomes structureless. Simultaneously with the change in the internal structure, the outlines of the fibers also change: they are shortened, the corners at the ends are rounded, they seem to be ground away from the surface.
Small fragments of muscle fibers that have lost their striations and acquired an irregular shape cannot be reliably determined by simple microscopy. To identify the protein nature of such unformed lumps or particles, you can use simple chemical tests - biuret and xanthoprotein.
When examining the stool of a healthy person who has taken 150 g of meat per day with food, 1-2 pieces of altered muscle fibers can be found in the field of view of the specimen at low microscope magnification. Among them there are single fibers that have retained transverse striations. With heavy meat consumption, the number of structureless muscle fibers may be slightly larger.
Clinical significance. The appearance of a large number of muscle fibers, especially those that retain cross-striations, indicates insufficiency of gastric or pancreatic digestion. The main enzyme that digests muscle fibers is trypsin from pancreatic juice. Consequently, the abundance of muscle fibers in the stool (creatorrhea) is in most cases a sign of pancreatic insufficiency. But the sarcolemma that covers the muscle fibers and glues them together is dissolved mainly by gastric juice. Therefore, with gastric achylia, part of the muscle fibers, covered with a layer of sarcolemma, which is poorly susceptible to the action of trypsin, enters the intestine, so the muscle fibers remain unchanged. In such cases, microscopic examination reveals groups of striated muscle fibers (2-3 or more per specimen), closely adjacent to each other.
Connective tissue.
Connective tissue fibers - predominantly elastic tissue of ligaments and blood vessels - are detected by microscopy due to their sharp refraction of light. Loose connective tissue, which does not have such optical properties and has the appearance of shapeless lumps with fuzzy, disintegrated edges, may resemble lumps of mucus.
To distinguish loose connective tissue from mucus, a drop of acetic acid is added to the preparation. The connective tissue swells and loses its fibrous structure. After this treatment, the fibrous structure of the mucus appears more clearly. In addition, unlike mucus, connective tissue fibers are birefringent. This feature of connective tissue can be detected using a polarizing microscope or a polarizing attachment to a simple microscope. It should be borne in mind that a number of other birefringent substances may be found in feces: raw starch, fatty acids, crystals of calcium oxalates and tripelphosphates, plant fibers.
Clinical significance. The presence of undigested connective tissue in the stool indicates insufficient gastric function. Indigestible connective tissue includes the remains of bones, cartilage and tendons; these findings are not pathological.
Plant fiber and starch
Plant fiber and starch are residues of carbohydrate foods that are recognizable by microscopic examination. To detect plant fiber, a native preparation is used, and c. In most cases, viewing the drug under low magnification (80-100 times) is sufficient. There are digestible and indigestible plant fibers. Digestible fiber consists of cells that have a thin, easily destroyed shell. Even if it remains intact, digestive enzymes can penetrate through this membrane, breaking down the contents of the cells. Cells of indigestible fiber are distinguished by thick double-circuit membranes, and pieces of plant tissue are distinguished by thick intercellular partitions.
The human digestive organs do not produce enzymes capable of breaking down the membranes of plant cells. Some microbes of the large intestine (clostridia, B. cellulosae dissolvens, B. mesentericus vulgatus) possess such enzymes and therefore break down fiber. At the normal rate of food movement through the gastrointestinal tract, microbes digest approximately 3/4 of all fiber, if it is not taken in excess. The more feces are in the large intestine, the more the impact of microbes on fiber, the less of it remains. With constipation, stool contains significantly less fiber than with normal stool and diarrhea.
Plant cells are connected to each other by a layer of pectin, the dissolution of which requires first the acidic reaction of the gastric juice, and then the slightly alkaline reaction of the duodenum. In the absence of HCl in the gastric juice, the cells of the digested fiber (for example, potatoes, carrots) do not separate and groups of them are found in the feces. In normally formed stool, digestible fiber is usually absent.
Each plant is characterized by a special type of cells, their size, shape, and color. The large oval cells of potatoes are digestible fiber. They stand out in the native preparation in the form of colorless ovals on a yellow or brownish background of detritus. They are located either singly or in small groups of 2-3-4 cells. An inexperienced microscopist, examining such groups under low magnification, may confuse them with lumps of mucus. Their difference from mucus is that the outlines of potato cells are clear and round, while the outlines of lumps of mucus are vague and their shape is uncertain. Using dissecting needles, digestible fiber is easily broken down and the mucus is stretched. The most convincing way to differentiate them is in a preparation stained with Lugol's solution. Before viewing, the drug should stand with the solution for 5-10 minutes; During this time, iodine penetrates into the cells and colors the starch grains, depending on the stage of their digestion, blue, purple or pink.
Testing for the presence of starch is carried out in a preparation treated with Lugol's solution. Uncolored starch grains usually cannot be recognized in feces, since their shape and characteristic eccentric layering are usually not preserved. Under the influence of iodine, starch grains, depending on the stage of their digestion, are colored differently: unchanged starch becomes blue-black, the products of its gradual breakdown - amylodextrin - purple, erythrodextrin - red-brown; further stages of cleavage, starting with achrodextrin, are no longer stained with iodine. Starch grains can be located either freely, often in the form of fragments, or inside plant cells, being there in different stages of digestion. The abundance of starch in feces and digestible fiber is usually accompanied by a rich iodophilic flora. The microbes belonging to it, feeding on the carbohydrates they break down, deposit granules inside themselves that are stained with iodine. The fermentation of carbohydrates caused by this flora leads to the formation of organic acids, which give the feces an acidic reaction.
Clinical significance. During normal digestion, there is no starch in feces. A series of amylolytic enzymes acting on it along the digestive tract, starting with ptyalin in saliva and ending with bacterial enzymes in the large intestine (mainly in the cecum), leads to its complete breakdown.
Diagnostic value. Incomplete digestion of starch occurs mainly in diseases of the small intestine and the associated accelerated movement of food chyme. Lesions of the pancreas, which significantly affect the digestion of fats and proteins, have relatively little effect on the absorption of starch, if they are not accompanied by diarrhea. The lack of amylase is compensated by amylolytic enzymes from other parts of the digestive tract and bacteria.
Remains of fatty foods - neutral fat and its breakdown products- recognized microscopically in native and stained preparations. The most commonly used stain is Sudan III. Neutral fat supplied with food, if taken in moderate quantities (no more than 100-150 g), is absorbed almost completely - 90-98%. The degree of fat absorption also depends on its quality: the lower the melting point of fat, the more completely it is absorbed.
Neutral fat
Neutral fat is found in the native preparation in the form of colorless drops that sharply refract light. Most often, the latter have a round shape, but can, merging with each other, form small “puddles” of irregular shape with round, smooth outlines. Refractory fats have the appearance of irregularly shaped lumps that easily change their shape when pressed on the cover slip. Since small drops of neutral fat may go undetected, and large drops can be confused with air bubbles, it is much easier to distinguish neutral fat using Sudan III staining. Neutral fat turns orange-red.
Fatty acids
Fatty acids are found in the form of drops (low-melting fatty acids), crystals, and less often lumps (high-melting fatty acids). Fatty acid crystals are shaped like thin needles, pointed at both ends; often they are grouped 2-3-4 together, forming small bunches. Sometimes such needles, arranged radially, are surrounded, as if in a halo, by drops of fat or fatty acids. After heating the native preparation and its subsequent cooling, the drops of neutral fat do not change. Drops of fatty acids, as well as lumps that turned into drops when heated, change their appearance as they cool, becoming uneven, lumpy, and partially turning into characteristic needle-shaped crystals. However, this process occurs slowly in low-melting fatty acids, which can make it difficult to differentiate them from neutral fat droplets.
Soap
Soaps are found in the form of crystals and yellow-brown clumps that are not stained by Sudan III in the cold. Soap crystals are similar to fatty acid needles, but shorter than the latter. Their shape resembles small elongated diamonds. When the native drug is heated, unlike fatty acid crystals, they do not fuse into droplets. However, fusion of soap crystals can occur if 1-2 drops of acetic acid are added before heating, under the influence of which soaps are broken down to release fatty acids.
To judge the total amount of fatty elements, a preparation with 1-2 drops of an acetic-alcohol solution of Sudan III, covered with a cover glass, is carefully heated until it begins to boil. Fatty acids and soaps are converted into drops, which, along with drops of neutral fat, are colored by Sudan. Heating is examined under a microscope. By comparing the number of Sudan-colored drops before and after heating, one can make a judgment about the number of drops added due to fatty acids and soaps. If fatty acid crystals were not detected in the native preparation, then the increase in the number of drops can be attributed mainly to soaps.
Clinical significance. With normal digestion, feces contain no or almost no neutral fat. Residues of fatty foods are excreted mainly in the form of soaps. Impaired absorption of fat is associated in most cases with insufficient lipase activity or with insufficient flow of bile into the intestines. However, if fat is enclosed in connective tissue (adipose tissue), then sufficient digestion of the connective tissue in the stomach is necessary to release it, so disruption of this process can lead to steatorrhea.
When pancreatic secretion is completely turned off, almost exclusively neutral fat is found in the stool. The activity of intestinal lipase is low and its effect has virtually little effect on the absorption of fat. Intestinal bacteria also have little effect on the process of fat breakdown. A small amount of fatty acids, which are formed when pancreatic digestion is turned off, is completely absorbed by the intestine and fatty acids are not detected in feces.
Insufficient flow of bile into the intestines or its complete absence also dramatically affects the absorption of fats. Fats are insoluble in water and are not wetted by aqueous solutions of enzymes. Under the influence of bile acids, bile activates lipase and transforms fat into a thin emulsion, more accessible to enzyme action than large drops. The loss of these processes leads to only partial breakdown of fat. The resulting fatty acids also require the presence of hydrotropic bile acids for their dissolution and absorption, and alkalis for their saponification. If there is a deficiency or absence of bile in the intestines, a lot of neutral fat and fatty acids are found in the stool; the amount of soap depends on the alkali content. The worst conditions for fat absorption are created with tumors of the head of the pancreas.
Absorption of fats from the intestine occurs through the lymphatic pathways with active contractile activity of the villi, so fatty stools can also be observed when lymphatic drainage is impaired in the case of paralysis of the tunicae muscularis mucosae, as well as in tuberculosis and tumors of the mesenteric lymph nodes located on the path of lymph outflow.
The accelerated movement of food chyme through the small intestine leads to insufficient absorption of all foods, including fat, so if, along with fat, undigested muscle fibers and starch are found in the feces, then one must think about accelerated peristalsis as the cause of impaired fat absorption.
Elements separated by the intestinal wall constitute the second group of objects for microscopic examination. In addition to mucus, these are erythrocytes, leukocytes, tissue macrophages, intestinal epithelial cells, and malignant tumor cells. Squamous epithelium, captured occasionally during the passage of dense feces through the anus, has no diagnostic value.
Mucus
Mucus, detectable only microscopically, comes from those parts of the intestine where the feces are still so liquid that during peristalsis it mixes with them. In the case of formed feces, the origin of only microscopically detectable mucus should be attributed to the small intestine or cecum. With mushy and liquid stools, the origin of small mucus particles is more difficult to determine, but the absence of mucus simultaneously visible to the naked eye speaks rather against its origin from the large intestine. In general, the smaller the lumps of mucus and the more closely they are mixed with feces, the higher the place of their release.
Mucus lumps visible to the naked eye should be examined microscopically. Lumps of mucus are first carefully washed with water, freeing them from feces. In this case, red blood cells are hemolyzed. Under low microscope magnification, mucus appears as light lumps or strands with fuzzy, irregular outlines, interspersed with the main brown or yellow mass.
Intestinal epithelial cells
Intestinal epithelial cells are usually found embedded in clumps of mucus. Sometimes the cells turn out to be well preserved; more often they are deformed due to their impregnation with soaps or the onset of digestion. Single cells of the intestinal epithelium can also be found in normal feces as a result of physiological desquamation. Large groups of such cells should be regarded as a sign of inflammation of the intestinal mucosa. It is difficult to distinguish the epithelium of the small and large intestines. Semi-digested cells, stained with bile pigment, can most likely be attributed to the small intestine, cells found in round lumps of mucus - to the large intestine.
Leukocytes.
Single leukocytes in the field of view can also be found in normal stool. An increase in the number of leukocytes, especially their accumulation in mucus, indicates an inflammatory process. Significant accumulations of leukocytes (pus) are a sign of ulcerative lesions of the large intestine (dysentery, tuberculosis, cancer, ulcerative colitis, etc.); copious discharge of pus without mucus can occur when a paraproctal abscess breaks into the intestine.
In the acute period of bacterial dysentery, a large number of leukocytes in the mucus (90% or more) are segmented neutrophils with unchanged nuclei. In amoebic dysentery, segmented neutrophils make up 20-40%. The remaining 60-80% are neutrophils with pyknotic and pseudopyknotic nuclei. Epithelial cells, mononuclear cells, macrophages, and eosinophils are found in small quantities; The latter are more common in amoebic dysentery. Eosinophils in feces, in addition to amoebic dysentery, are sometimes found in helminthiases. They can be distinguished from other types of leukocytes in the native preparation by their relatively large granularity, which sharply refracts light.
Macrophages
Macrophages in the native preparation, as well as when stained with Lugol's solution, differ from leukocytes in their larger size, large round or oval nucleus, and the content of phagocytosis products in the protoplasm (cell fragments, red blood cells, fat droplets). If phagocytosed red blood cells are present, they are sometimes mistaken for dysenteric amoeba. To distinguish macrophages from protozoan cysts, with which they have some similarities, you should also resort to staining with Lugol's solution, in which a dark-colored membrane is noticeable in protozoan cysts, unlike macrophages. Macrophages in the stool are found during inflammation of the colon, especially with bacillary dysentery.
Red blood cells
Unchanged red blood cells are found in feces during bleeding from the colon, mainly from its distal parts due to ulcerative processes, tumor disintegration, the presence of fistulas and fissures of the anus, hemorrhoids. If a significant amount of time passes from the moment of bleeding to the release of blood in the feces, or if blood is released from the proximal parts of the colon, then the red blood cells are destroyed in most cases and can rarely be preserved in the form of shadows. In this case, it is not easy to recognize them under microscopy, especially if they are single and not located in clusters. As with the complete breakdown of red blood cells, the question of the presence of blood in such cases is resolved by chemical research. Red blood cells in water are hemolyzed, so the native drug should be prepared in an isotonic sodium chloride solution.
Malignant tumor cells
Malignant tumor cells can be found in the stool of rectal tumors. With a higher localization of the tumor, the cells undergo changes that prevent their recognition. These cells can be identified if they are not single, but are found in groups in the form of tissue scraps with characteristic atypia. The peculiarity of tumor cells is, first of all, polymorphism: different size and shape, random arrangement, sometimes in the form of strands on a fibrous connective tissue basis. The cells are often large with a large nucleus containing nucleoli; the protoplasm is often vacuolated with signs of fatty degeneration.
Detection of tumor cells in stool is very difficult. If a tumor is suspected, it will be more effective to perform sigmoidoscopy with cytological or histological examination of material from suspicious areas.
Crystal formations
Crystalline formations in feces are often found. Crystals of tripel phosphates (ammonium phosphate-magnesium phosphate), often in the form of coffin lids, are found in sharply alkaline feces with increased putrefactive processes. If stool is collected incorrectly, they can get into it from urine. Tripelphosphates are distinguished from other crystals and formations by their good solubility in acetic acid.
Calcium oxalates
Calcium oxalates (oxalate of lime) in the form of octahedrons (“mail envelopes”) are found when eating large quantities of vegetables. Normally, stomach HCl converts calcium oxalates into calcium chloride, so their presence in stool can be a sign of decreased gastric acidity. Calcium oxalate crystals are insoluble in acetic acid, and under the action of sulfuric acid they gradually turn into gypsum crystals.
Cholesterol crystals
Cholesterol crystals that enter the intestines with bile do not have much diagnostic value. They are colorless flat tablets in the shape of a rhombus or parallelogram with broken off corners, often layered on top of each other in steps.
Charcot - Leiden crystals
Charcot-Leiden crystals occur in cases where there are many eosinophils in the stool, in particular with amoebic dysentery, some helminthiasis and intestinal localization of Loeffler's syndrome. In appearance they do not differ at all from those found in sputum during bronchial asthma. These are colorless elongated octahedra of varying sizes, resembling the shape of a double-sided spear. Most often they are found in mucus, sometimes directly in the feces. In the latter case, they are well stained with eosin (mucus prevents paint from penetrating into them).
Bilirubin crystals
Bilirubin crystals - with profuse diarrhea, sometimes crystals of bilirubin are found in the mucus, which has not had time to be reduced to stercobilin due to its rapid passage through the intestinal tract. They look like very small needle-shaped orange crystals pointed at both ends, mostly arranged in groups.
Hematoidin crystals
Hematoidin crystals found in stool after intestinal bleeding are somewhat similar to bilirubin crystals. Their shape can also be needle-shaped or rhombic, but the color is reddish-brown.
From insoluble drugs most often found in feces barium sulfate, used in x-ray examination of the gastrointestinal tract. The smallest grains of this substance, covering the entire field of view, make feces unsuitable for microscopic examination.
Bismuth preparations form compounds in the intestines that precipitate in the form of dark brown, almost black crystals, shaped like rectangles, rhombuses or sharpening stones.
After reception carbolene in the feces, particles of coal are found that have an angular irregular shape, are colored black and are not amenable to the action of solvents. With an appropriate dose of carbolene, the feces become black. A similar coloration of stool is observed after taking iron supplements, which are converted in the intestines under the influence of hydrogen sulfide into iron sulfide or black ferric oxide. The grains of these compounds look like amorphous grains or lumps of different sizes.
Laboratory research methods in the clinic: Handbook / Menshikov V.V. M.: Medicine, - 1987 - 368 p.
Feces, like urine, are the end product of human life. It is formed in the large intestine as a result of a number of biochemical processes. Feces include water, undigested food debris, metabolic byproducts, bacteria, and so on.
Do not underestimate stool testing. Sometimes it is this analysis that makes it possible to identify pathologies of the digestive tract, liver disease, and pancreas in adults and children. This examination is prescribed not only for the purpose of diagnosing diseases, but also to monitor the treatment being carried out.
What a coprogram (stool analysis) shows:
- study of the physical and chemical properties of feces (color, consistency);
- microscopy of material;
- bacteriological examination (detection of pathogenic microbes and analysis of intestinal microflora);
- detection of helminth eggs;
- detection of occult blood in the stool.
How to prepare for a stool test?
Preliminary preparation for submitting the material for children and adults normally lasts 3-4 days. It is aimed at cleansing the intestines and preventing food debris, muscle and plant fibers from entering the feces. With special training, laboratory assistants will be able to detect even a small degree of disruption of the evacuation and digestive functions of the digestive tract.
The essence of preparation is to follow a special diet with a certain content of proteins, fats and carbohydrates. Two types of diets are suitable for this purpose: according to Pevzner and according to Schmidt.
Pevzner's diet
It involves eating black and white bread, meat (boiled or fried), sauerkraut, rice and buckwheat porridge, fresh apples, potatoes (in any form), and butter. The total energy value is about 3000 kcal per day.
Diet according to Schmidt
She is gentle. It is recommended to eat 5 times a day, mainly dairy products (milk, butter), a couple of eggs, meat, potatoes, oatmeal (mucus broth). Daily caloric intake should be limited to 2200-2400 kcal.
Feces for occult blood
- Before examining stool for occult bleeding, patients are not recommended to eat foods that may cause a false-positive reaction to blood. These include: all varieties of green vegetables (cucumber, cabbage), fish, meat, eggs, tomatoes.
- Patients should also refrain from taking medications containing iron (ferrum-lek, ferrumbo).
If you urgently need to get tested or your health condition does not allow you to follow a diet, it is recommended not to drink alcoholic beverages, tea, or coffee for at least 24 hours.
It is strictly prohibited before the examination
- do a cleansing and siphon enema;
- take medications that affect intestinal motility (laxatives or antidiarrheals);
- insert suppositories or other forms of medication into the anus;
- use medications that change the color of the material (barium sulfate, bismuth preparations).
How to take a coprogram?
The material should be collected in a clean container after spontaneous bowel movement in the morning. 10-15 g of feces is enough for the study. In rare cases, your doctor may order a 24-hour stool test. In this case, the patient must collect stool for 24 hours.
If the patient suffers from prolonged constipation and cannot empty himself, it is recommended to massage the colon. If this procedure does not bring results, the patient should undergo a cleansing enema. In this case, a solid piece of feces is taken from the washing water.
Analysis collection method:
- In the morning after sleep, the patient is advised to defecate in a pot or vessel
- then, using a special stick or spatula, take a small amount of feces into a clean, dry jar and close the lid tightly.
- It is advisable to immediately deliver the analysis to the laboratory. The deadline is 8-10 hours. After this time, the material may deteriorate and become unsuitable for examination.
- Stool is stored at a temperature of 3-6 0 C.
When examining for worm eggs the material must be completely fresh, that is, delivered to the laboratory warm.
Stool sampling for bacteriological examination performed with the help of a laboratory assistant. The patient is asked to lie on his right side or lean forward while standing. The laboratory assistant spreads the patient's buttocks and inserts a metal loop with a cotton swab wrapped around it into the anus. The insertion should be carried out with rotational movements, very carefully so as not to damage the mucous membrane of the anus. The loop is also carefully removed and then placed in a sterile tube.
Coprogram analysis
Norm of indicators |
Microscopic examination |
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Dense |
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None |
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Decorated |
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Single |
| Brown |
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None | |
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Unsharp, specific feces |
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|
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From 6.01 to 8.01 |
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|
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Small quantity |
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Small quantity |
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None |
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Single fibers |
|
|
Absent | |
|
Positive |
|
Small number |
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Negative |
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None |
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Decoding stool analysis in middle-aged and older children and adults
Quantity
- Normally, a person excretes 150-200 g of feces per day 1-2 times.
- For children, the weight of feces is 80-150 g per day
The volume of bowel movements depends on the amount of food eaten and its quality composition. For example, if a person eats meat or dairy products, the amount of feces decreases. Plant foods, on the contrary, increase its volume. Pathological reasons for changes in the amount of feces in the table:
Consistency and shape
Stool of a dense consistency and shaped (sausage-shaped) is considered normal. Loose, unformed stools are called diarrhea. This condition is usually accompanied by increased bowel movements and polyfecal loss. Diarrhea occurs:
- osmotic - occurs due to impaired absorption of osmotically active substances (potassium, sodium) and proteins - pancreatitis, Crohn's disease, sprue, taking magnesium sulfate;
- secretory - usually caused by inflammatory processes in the intestines (enteritis, colitis);
- motor – occurs with increased peristalsis of the digestive tube (laxatives);
- mixed – due to all of the above factors.
The peculiar ribbon-like shape of feces can be caused by spasms in the rectum and sigmoid colon. When the evacuation of food from the intestines is impaired, a person experiences constipation. In this case, feces become hard, dense, similar to sheep balls. Its hardness is due to excessive absorption of water.
Color
Normal stool is brown in color. This is due to the presence of stercobilin in it, a breakdown product of bilirubin, which is released into the intestines with bile. The change in color of the material may be due to various factors:
| Stool color | What causes |
| Light yellow | Occurs when consuming large amounts of dairy products. |
| Bright yellow | The reason is the accelerated evacuation of food from the intestines (diarrhea of infectious and non-infectious origin) or treatment with medications from hay. |
| Dark brown (pleiochromia) |
|
| Black (tarry) – melena |
|
| Greenish | Eating a lot of lettuce, asparagus, celery, sorrel. |
| In the form of "rice water" | Transparent stool with flakes is observed with cholera. |
| In the form of "pea soup" | Such material indicates the presence of typhoid fever in the patient. |
| Red, reddish | Occurs when bleeding from the lower intestines (rectum and colon). |
| Discolored, clayey (acholic) | Feces lose their color due to the cessation of stercobilin entering the intestines. This happens when:
|
| Light |
|
Smell
Normal stool has a mild, specific odor. This is due to the processes of bacterial fermentation that occur in the intestine. During the breakdown of proteins, indole, skatole, phenol and cresol are formed, and they form the odor of feces.
Reduces odor stool with a plant-based diet and constipation, and increases with a meat diet and diarrhea.
Strong foul odor speaks of putrefactive processes in the intestines. The sour aroma of excrement indicates the presence of an increased amount of fatty acids (propionic, butyric).
Visible impurities
Normally, the stool should not contain blood, mucus, undigested food residues, stones, helminths, and so on. Their presence indicates a pathological process in the gastrointestinal tract.
| Impurity | What does it mean |
| Lumps of undigested food |
Normally, feces may contain small bones, peels of vegetables and fruits, cartilage, cucumbers, and nuts. |
| Fat | This may occur due to insufficient pancreatic function. In this case, the feces become shiny, ointment-like, with white lumps. |
| Mucus |
Normally, a small amount of mucus is allowed in the stool. Its abundance indicates inflammatory processes in the intestine, both infectious (dysentery, salmonellosis) and non-infectious (ulcerative colitis). Mucus may be mixed with stool or located on its surface. |
| Blood |
The release of small portions of blood is usually invisible to the human eye and can only be detected by microscopic examination. An admixture of scarlet blood indicates bleeding from the lower intestines or from the initial sections, if motility is increased. |
| Pus | Pus appears in feces during severe inflammatory pathologies (dysentery, intestinal tuberculosis), rupture of an abscess into the intestinal lumen, or suppuration of a tumor. |
| Worms | Some helminths (whipworms, pinworms, roundworms) can be excreted in the stool entirely or in fragments. |
| Stones | Coprolites (fecal stones), gallstones, pancreas. |
pH
In a healthy person with a normal diet, feces have a neutral or slightly alkaline reaction (pH 6.87-7.64). Change in stool pH:
- acidic reaction (pH 5.49-6.79) – occurs when the absorption of fatty acids in the small intestine is impaired;
- sharply acidic reaction (pH less than 5.49) - occurs with excessive activity of fermentation microflora or lactose intolerance;
- alkaline reaction (pH 7.72-8.53) - occurs when proteins rot (excessive consumption of meat);
- sharply alkaline reaction (pH more than 8.55) - indicates.
Reaction to occult blood
Hidden blood is called blood that is not visible to the human eye (macroscopically) and under a microscope. Normally, the reaction can be positive if you eat meat, fish, blood sausage, iron supplements, vigorously brush your teeth, or get menstrual blood into your stool. Pathologies that cause the appearance of blood in feces:
- gum disease (gingivitis, periodontal disease);
- peptic ulcer of the stomach and duodenum;
- ingestion of blood from the upper respiratory tract (nosebleeds);
- bleeding tumors;
- varicose veins of the esophagus and rectum;
- Mallory-Weiss syndrome;
- helminthic infestation;
- intestinal tuberculosis;
- dysentery;
- colitis;
- Stevens-Jones syndrome;
- haemorrhoids;
- intestinal polyposis;
- typhoid fever.
Reaction to protein
Normally, the reaction to protein is always negative. It can be positive if:
- inflammatory diseases of the gastrointestinal tract (gastritis, duodenitis, enteritis);
- dysbacteriosis;
- celiac disease.
Reaction to stercobilin
Stercobilin is a breakdown product of bilirubin, which gives stool a brown color. It is secreted into the duodenum with bile. Normally, 100 g of feces contains 75-100 mg of stercobilin. Changes in the content of stercobilin in stool can occur in various diseases:
Reaction to bilirubin
Bilirubin can normally be detected in the stool of a breastfed infant. It gives feces a greenish color. In an adult, only bilirubin breakdown products are excreted in feces. Detection of bilirubin in stool occurs when:
- diarrhea;
- severe dysbacteriosis while taking antibiotics.
Microscopic examination of stool
| What is discovered | What pathologies does it indicate? |
| Muscle fibers with and without striations (creatorhoea) |
|
| Connective tissue (connective tissue fibers) | It is detected when there is a deficiency of pepsin in gastric juice and diarrhea. The detection of bones and cartilage in the stool is not a pathology. |
| Plant fiber |
|
| Starch |
|
| Fat and its products (fatty acids, salts of fatty acids) |
|
| Intestinal epithelium (squamous and columnar) |
|
| Leukocytes | Neutrophils:
|
| Red blood cells | Their detection indicates bleeding into the lumen of the digestive tract. |
| Crystal formations | Human feces may contain:
|
| Protozoa |
|
| Worm eggs | In cases of helminthiasis, whipworm, roundworm, and pinworm eggs are released in feces. |
| Bacteria and fungi |
Bacteria found in feces can be pathological (Escherichia coli, Proteus) or part of the normal microflora (lacto- and bifidobacteria). Among fungi, the detection of Candida mycelium is of diagnostic importance. |
Coprogram in a newborn and infant
Features of stool after the birth of a child
- In the first couple of days after the baby is born, he produces a special stool called meconium. Meconium is dark green or olive in color and is a thick, homogeneous mass.
- After a week, mucus and lumps appear in the baby’s stool, and stools become more frequent and loose. The color of feces also changes: dark green gives way to yellow and yellow-brown.
Analysis of stool in children of such a young age has a number of features. At birth, the baby’s intestines are not yet sufficiently developed and are not adapted to receiving regular adult food. Therefore, proper feeding is a very important factor in the development of a baby.
In the first days of life, the baby receives all the necessary microelements, nutrients and vitamins through mother's milk. Also, during feeding, the baby's intestines are contaminated with lacidobacteria and bifidobacteria, which are necessary for the production of feces.
If a pediatrician orders a baby to undergo a stool test, the mother must follow a certain diet for 2-3 days, since what the mother eats must enter the baby’s body with milk.
Features of mommy's diet (see):
- exclude all possible allergens (eggs, citrus fruits, chocolate);
- do not drink alcohol, do not smoke;
- It is preferable to eat slimy porridges (oatmeal, rice), vegetable soups, steamed cutlets;
- do not abuse fatty foods or easily digestible carbohydrates.
However, the mother cannot always provide the baby with enough milk. Recently, infants are starting to be supplemented with formula feeding from the first months or are immediately transferred to artificial feeding.
Main differences
The coprogram for natural and artificial feeding of children may differ. No matter how balanced the formula is, it will never replace breast milk in quality. This is also reflected in the functioning of the baby’s digestive system, the product of which is feces.
| Options |
When feeding formulas |
When feeding with milk |
| Daily amount | Up to 35-45 grams | The normal amount is considered to be 45-55 grams |
| Color | Light brown | Yellow with a greenish tint (this color is due to the presence of bilirubin in the stool, which is considered normal) |
| Smell | More putrid | More sour |
| pH | Slightly alkaline (7.58-7.74) | Slightly acidic (5.52-5.89) |
| Fats and fatty acids | Drops of neutral fat | Fatty acids and their salts (provide acidic stool) |
| Mucus | None or small amount | |
| Blood | Absent | |
| Leftover undigested food | Possibly a small amount due to immature intestinal microflora | |
| Reaction to stercobilin | Positive | |
| Reaction to bilirubin | ||
| Reaction to protein | Negative | |
| Reaction to occult blood | ||
| Muscle fibers | Possibly in small quantities | |
| Leukocytes | In small quantities | |
| Intestinal epithelium | ||
| Red blood cells | None | |
Muscle fibers in the stool indicate a disruption in the digestive process. Based on the composition of stool, we can conclude which organ has ceased to perform its functions.
If the coprogram notes that muscle fibers are found in the stool, then what could this mean?
Reasons for appearance
Digestion is a complex mechanism in which many organs are involved, united under the general concept of “gastrointestinal tract”.
The gastrointestinal tract begins with the oral cavity, where food is crushed and its digestion begins under the action of salivary enzymes.
The digestive tract ends with the anus, where food debris that the body could not absorb comes out.
By examining this substance, we can tell how the digestion process proceeded - normally or with deviations, and what stages of the digestive process were disrupted.
Feces are a homogeneous mixture of a variety of substances:
- products produced by the gastrointestinal tract;
- digested and semi-digested food;
- cells of the mucous membrane of the tract;
- microorganisms that make up the intestinal microflora.
Leftover food in stool is called detritus. These are very small particles consisting of food debris, bacteria and dead upper layer of intestinal epithelium.
With a good digestion process, there is always a lot of detritus in the feces and no undigested substances. The feces themselves are a soft but well-formed mass. There is little detritus in liquid feces, which indicates digestive disorders.
If digestion proceeds normally, then only single muscle fibers can be found in the feces.
With poor functioning of the gastrointestinal tract, all coprogram indicators differ sharply from normal values.
Each laboratory has its own standards, determined by the accuracy of equipment and reagents. In the laboratory test form, they are indicated in the “reference values” column.
A large amount of digested or undigested muscle fibers in the stool is called creatorrhea.
Muscle fibers found in feces indicate the following pathologies:
- increased secretion of enzymes in the colon;
- poor performance of the PJ;
- lack of bile;
- poor digestion in the small intestine;
- accelerated colonic motility.
A large number of undigested muscle fibers in feces may indicate:
- chronic pancreatitis - a disease of the pancreas, leading to a decrease in the production of enzymes necessary for the breakdown of proteins;
- chronic atrophic gastritis;
- hepatitis or cholelithiasis;
- dysbacteriosis (fermentative dyspepsia, putrefactive dyspepsia);
- colitis (ulcerative or with constipation).
If the muscle fibers come out of the intestines completely undigested, then this indicates poor functioning of the stomach.
If fiber digestion is poor, we can confidently talk about defects in the functioning of the pancreas.
If the muscle fibers are well digested, but look like orange lumps, then this indicates insufficient production of enzymes in the small intestine.
Transformation of muscle fibers in the gastrointestinal tract
To understand why muscle fibers appear in feces, you need to know what happens to meat products in the human gastrointestinal tract.
Digestion of meat in the human body is very difficult due to the presence of fibers and tissues in this product. To decompose them, the gastrointestinal tract must produce many specific enzymes.
In the mouth, the meat is only crushed, but not digested at all. Digestion begins in the stomach.
The basis of meat is fiber - these are large protein molecules that the body needs to divide into smaller fragments.
In the stomach, fibers are acted upon by pepsin and chymosin - two enzymes that can work under conditions of increased acidity of gastric juice.
Next, the semi-digested and crushed piece of meat, which still has a large amount of fibers and films, enters the intestine, where it is affected by the enzymes of the small intestine and pancreas: trypsin, elastase and others.
After contact with these enzymes, meat can already be absorbed by the body in the form of amino acids, fatty acids and mineral components.
Difficult-to-digest parts (cartilage, tendons and skin) pass further into the large intestine, and then leave the gastrointestinal tract with feces.
The degree of digestion of muscle fibers is indicated by a special indicator - striations. Usually in the coprogram form there are separate columns for muscle fibers with and without striations.
Muscle fibers with striations are fragments of meat food, partially processed in the stomach and intestines.
Under a microscope, striated fibers appear as long cylindrical structures with smooth corners. Stripes are clearly visible across or along them, indicating an insufficient effect of enzymes.
Fibers without striations are completely digested and look like small lumps. Normally, the striations should disappear in the stomach under the influence of gastric juice. The striations should finally disappear in the duodenum when bile reaches the chyme.
The main enzyme for digesting meat in the intestines is pancreatic elastase.
It automatically begins to be produced in the pancreas when the body gives a signal that protein food has entered the stomach.
From PJ, elastase, as part of pancreatic juice, enters the intestine, where it breaks down protein into amino acids that can be absorbed by the intestinal wall and assimilated.
Passing through the gastrointestinal tract, pancreatic elastase does not change chemically at all. In stool, the enzyme is in the same form in which it was synthesized by the pancreas, therefore, by analyzing stool for pancreatic elastase, one can conclude about the functioning of the pancreas.
In newborns, the content of elastase is low, but already from two weeks of age in the stool of infants, the content of the enzyme reaches adult levels.
In newborns, a stool test for elastase is taken to diagnose or exclude cystic fibrosis, a genetic disease that results in a change in the structure of gland cells, which is manifested by damage to the lungs, gastrointestinal tract, and disorders of the digestive mechanisms.
Testing newborn feces for elastase allows you to diagnose cystic fibrosis at an early stage and prevent death.
What to do if muscle fibers are found in stool?
If muscle fibers are detected in the feces, the study must be repeated. The fact is that meat is a difficult-to-digest food.
The reason for the appearance of muscle fibers in feces may not be health problems, but other factors that make digestion difficult: insufficient heat treatment of the product, poor grinding of it in the oral cavity, or excessive consumption.
A mixed diet makes it difficult to digest meat and fish.
Proponents of separate nutrition are right - meat is digested easier, faster and more completely when it is in the stomach without carbohydrate products, together with the same protein or raw plant foods containing a lot of fiber and natural enzymes.
The norm is the complete absence of muscle fibers in the feces. The exception is children under one year of age, whose complementary foods include meat and fish.
In the feces of babies there may be a lot of underdigested or undigested muscle fibers - this is due to the unpreparedness of the digestive system. Over time, the child’s body will learn to digest meat foods.
Creatorrhea in an adult indicates problems with the functioning of the pancreas and stomach. The doctor may suggest additional examinations of these organs.
The pancreas can be examined using plain radiography or computed tomography. The most informative method is magnetic resonance imaging.
With the help of this study, chronic pancreatitis, tumors and other pancreatic pathologies can be detected with maximum reliability.
FGDS is used to examine the stomach. During the examination, a probe with a video camera at the end is inserted into the patient's stomach, which allows the doctor to see with his own eyes what is happening inside the stomach and, if necessary, take a tissue sample for analysis. In addition to FGDS, the stomach can be examined using ultrasound, computed tomography and MRI.
Pathologies of the small intestine are detected using endoscopy and colonoscopy.
There is a method for examining the intestines, and at the same time the stomach, using a capsule with a built-in video camera.
Passing through the gastrointestinal tract, the capsule video camera records pathologies of the gastrointestinal tract: polyps, tumors.
Thus, by analyzing stool for muscle fibers, it is possible to identify diseases of the gastrointestinal tract, which for a long time can be practically asymptomatic, including such dangerous ones as stomach cancer and chronic pancreatitis.
To diagnose many diseases of the stomach, intestines, and pancreas, gastroenterologists prescribe, or coprogram. Examination of feces by chemical, physical and microscopic methods is carried out to determine several indicators. Their changes may be signs of diseases of the digestive system. The totality of such deviations of the coprogram from the norm, or scatological syndromes, provides the doctor with valuable information about the diagnosis.
Coprogram indicators
Feces are examined by physical, chemical and microscopic methods. Identified deviations from normal indicators may indicate a particular disease of the digestive system.In children and adults, when examining stool, the following indicators are determined:
Normal coprogram indicators in children and adults
| Indicator | Norm | ||||
| In adults | In children | ||||
| Under 1 year | Over 1 year old | ||||
| Acidity (pH) | 6,0 – 8,0 | 4.8 – 6.0, with artificial feeding – up to 7.5 | 7,0 – 7,5 | ||
| Muscle fibers | No or isolated | There may be some undigested | None or individual overcooked | ||
| Connective tissue | No | ||||
| Neutral fat | No | In small quantities | No | ||
| Fatty acids | No, there may be a small amount of fatty acid salts | In small quantities | No | ||
| Plant fiber | Indigestible can be in different quantities depending on the volume of plant food; digestible – single cells or their clusters | ||||
| Starch | No | In small quantities | No | ||
| Epithelium | No, single columnar epithelial cells are acceptable | No | |||
| Mucus | No | ||||
| Leukocytes | No or single neutrophilic leukocytes | ||||
| Red blood cells | No | ||||
| Stercobilin | The reaction is positive | ||||
| Bilirubin | No | Eat | No | ||
| Iodophilic flora | No or single cells | ||||
| Protozoa, mushrooms, worm eggs | No | ||||
When quantitatively measuring chemical indicators, the standards are as follows:
- stercobilin 200–600 mg/day (according to Adler) or 30–100 mg/day (according to Terven);
- the ratio of urobilin and stercobilin (Adler coefficient) from 1:10 to 1:30;
- total nitrogen 2 – 2.5 n/day;
- sucrose – up to 300 U/g;
- trypsin – up to 670 U/g;
- lipase – up to 200 U/g;
- amylase – up to 600 U/g;
- enterokinase – up to 20 U/g;
- alkaline phosphatase – up to 150 U/g;
- trypsin 80 – 742 g/day;
- chymotrypsin 75 – 839 g/day.
Deviations from the norm
Before moving on to a microscopic and biochemical study of stool, the laboratory assistant will note its appearance and properties.
- Too dense stool is a sign, liquid stool is a symptom of inflammation and.
- When the pancreas is underactive, there is a lot of undigested fat in the feces, so they become greasy.
- Bubbles in liquid intestinal contents are a symptom of fermentative dyspepsia.
- If the material for the coprogram is small, dense round lumps, this is the so-called sheep feces. It is observed during fasting.
- Feces in the form of a ribbon or long cord often serve as a sign.
- Finally, unformed stool occurs when.
Changes in the color of feces may appear when consuming certain foods or medications (for example, beets). Green stool in a formula-fed baby is a normal phenomenon caused by the characteristics of the formula used, in particular, the iron content in it.
In other cases, they serve as signs of pathological conditions or dietary features:
- bleached: ;
- black: taking bismuth-based medications;
- yellow: fermentative dyspepsia;
- brown-red: blood, as well as cocoa consumption;
- greenish-black: ;
- green: plant-based diet, increased peristalsis;
- orange-yellow: milk nutrition.
In case of digestive disorders, deviations in the microscopic results of the coprogram are possible:
Often in a coprogram there are deviations of several indicators at once. There are various combinations of such deviations, which are caused by different reasons and are called scatological syndromes. Detection of such a syndrome when deciphering a coprogram helps the doctor make the correct diagnosis.
- Oral syndrome is associated with pathology of teeth, gums, and salivary glands. As a result of these diseases, a person cannot chew food well, process it thoroughly with saliva, and it is not completely absorbed in the gastrointestinal tract. Microscopy reveals a characteristic sign - the remains of undigested food.
- Gastrogenic syndrome is associated with diseases of the stomach and pancreas, mainly atrophic gastritis and chronic pancreatitis with reduced enzymatic function. In the coprogram there is a sharply alkaline reaction, creatorrhoea, lientorrhea, salts (oxalates), the presence of microorganisms is possible.
- Pyloroduodenal syndrome develops with insufficient function of the stomach and duodenum, most often with dyskinesia. It is characterized by creatorrhea, lientorrhea, and a slightly alkaline reaction.
- Pancreatic insufficiency develops with severe pancreatitis, duodenitis, opisthorchiasis. The digestion of fats and proteins is impaired. As a result, the coprogram shows a yellow-gray color and a large amount of liquid spotting feces, type I steatorrhea, and creatorrhea.
With anomalies in the development of the biliary tract, their dyskinesia, cholecystitis, insufficient bile is released into the intestine, which is necessary for the digestion of fats. A stool analysis reveals type II steatorrhea. Bilirubin contained in bile does not enter the intestinal lumen, does not turn into stercobilin and does not color feces. Due to this, the feces become light gray. The same changes occur in liver failure due to hepatitis.
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