Feces (synonym: feces, excrement, excrement) is the contents of the large intestine released during defecation.

A healthy person's stool consists of approximately 1/3 food debris, 1/3 organ secretions and 1/3 microbes, 95% of which are dead. Stool examination is an important part of the examination of a patient with. It can be general clinical or pursue a specific goal - detection of hidden blood, worm eggs, etc. The first includes macro-, microscopic and chemical examination. Microbiological examination of stool is carried out if an infectious intestinal disease is suspected. Feces are collected in a dry, clean container and examined fresh, no more than 8-12 hours after excretion, when stored in the cold. They look for protozoa in completely fresh, still warm feces.

For microbiological examination, stool must be collected in a sterile tube. When examining stool for the presence of blood, the patient should receive food without meat and fish products in the previous 3 days.

When studying the state of food digestion, the patient is given a common table (No. 15) with the obligatory presence of meat in it. In some cases, to more accurately study food absorption and metabolism, they resort to a trial diet. Before collecting stool, the patient is not given medications that change the character or color of stool for 2-3 days.

The amount of feces per day (normally 100-200 g) depends on the water content in it, the nature of the food, and the degree of its absorption. With lesions of the pancreas, intestinal amyloidosis, when food absorption is impaired, the weight of feces can reach up to 1 kg.

The shape of stool largely depends on its consistency. Normally, its shape is sausage-shaped, the consistency is soft; with constipation, the feces consist of dense lumps; with spastic colitis, it has the character of “sheep” feces - small dense balls; with accelerated peristalsis, the feces are liquid or mushy and unformed.

The color of normal stool depends on the presence of stercobilin in it (see).

If bile secretion is impaired, stool becomes light gray or sandy in color. If there is heavy bleeding in the stomach or duodenum, the stool is black (see Melena). Some medications and plant food pigments also change the color of stool.

The smell of feces is noted if it differs sharply from usual (for example, a putrid smell with a disintegrating tumor or putrefactive dyspepsia).

Rice. 1. Muscle fibers (native preparation): 7-fibers with transverse striations; 2 - fibers with longitudinal striations; 3 - fibers that have lost their striations.
Rice. 2. Undigested plant fiber (native preparation): 1 - fiber from cereals; 2 - vegetable fiber; 3 - plant hairs; 4 - plant vessels.

Rice. 3. Starch and iodophilic flora (staining with Lugol’s solution): 1 - potato cells with starch grains in the amidulin stage; 2 - potato cells with starch grains in the erythrodextrin stage; 3 - extracellular starch; 4 - iodophilic flora.
Rice. 4. Neutral fat (stained with Sudan III).

Rice. 5. Soaps (native preparation): 1 - crystalline soaps; 2 - lumps of soap.
Rice. 6. Fatty acids (native preparation): 1 - fatty acid crystals; 2 - neutral fat.

Rice. 7. Mucus (native preparation; low magnification).
Rice. 8. Potato cells, vessels and plant fiber (native preparation; low magnification): 1 - potato cells; 2 - plant vessels; 3 - vegetable fiber.

Microscopic examination (Fig. 1-8) is carried out in four wet preparations: on a glass slide, a lump of feces the size of a match head is ground with tap water (first preparation), Lugol's solution (second preparation), Sudan III solution (third preparation) and glycerin (fourth drug). In the first preparation, most of the formed elements of feces are differentiated: indigestible plant fiber in the form of cells of different sizes and shapes with a thick shell or groups of them, digestible fiber with a thinner shell, yellow muscle fibers, cylindrical in shape with longitudinal or transverse striations (undigested) or without striations (half-digested); , intestinal cells, mucus in the form of light strands with vague outlines; fatty acids in the form of thin needle-shaped crystals, pointed at both ends, and soap in the form of small rhombic crystals and lumps. A preparation with Lugol's solution is prepared to detect starch grains, which are colored blue or violet by this reagent, and iodophilic flora. In the preparation with Sudan III, bright, orange-red drops of neutral fat are found. The drug with glycerin is used to detect helminth eggs.

Chemical research in general clinical analysis comes down to simple qualitative samples. Using litmus paper, determine the reaction of the medium. Normally it is neutral or slightly alkaline. If the stool is light-colored, a test is performed: a lump of feces the size of a hazelnut is ground with a few milliliters of a 7% solution of sublimate and left for a day. In the presence of stercobilin, a pink color appears.

Determination of occult blood is the most important test for identifying an ulcerative or tumor process in the gastrointestinal tract. For this purpose, benzidine test (see), guaiac test (see).

When eating protein foods, especially meat, a small amount of muscle fibers may be found in the stool. This is not determined externally, but may become apparent during the test. A small amount of such fibers in feces is acceptable, but if there are pathologically many of them, we can talk about disturbances in the functioning of the gastrointestinal tract.

Three types of muscle fibers can be found in feces: undigested, digested and poorly digested. If the fibers are completely digested, they will look like lumps.

Low-digested fibers have the appearance of oval particles with transverse division and smoothed corners. Undigested fibers have pointed corners.

Muscle fibers in feces are considered pathological if the amount of low- and undigested fibers is too large.

The following diseases can be the causes of creatorrhoea:

• Chronic pancreatitis. In chronic pancreatitis, the pancreas partially loses its functions. With a long course of the disease and lack of treatment, irreversible changes occur in the gland, as a result of which it produces insufficient pancreatic juice. Digestive function is impaired. The patient has to regularly take enzymes so that food is digested normally. Creatorrhea in chronic pancreatitis is very common.
• Gastritis. With gastritis (inflammation of the stomach lining), digestive disorders occur. Hypoacid gastritis with insufficient production of hydrochloric acid in the stomach is often accompanied by creatorrhoea. With a lack of hydrochloric acid, food in the stomach is poorly digested, the fibers are not completely broken down and enter the intestines in this form.
• Putrid dyspepsia. With this disease, proteins are not digested, they enter the body undigested and rot there. As a result, a favorable environment for the development of pathogenic microorganisms is created in the intestine. This leads to an inflammatory process.
• Achlorhydria, achylia. With achlogdydriia, the stomach cannot produce hydrochloric acid, which is necessary to digest food. Ahilia is the complete absence of acid and other enzymes in gastric juice.

Diagnostics: features of coprogram

To determine the presence of muscle fibers in the feces, you need to take a test. Muscle fibers are determined by microscopic examination of stool. Normally, fibers with striations (undigested) are absent in feces, and without striations may be present in small quantities.

In order for the result to be reliable, you must adhere to the rules of delivery:

• Before taking the test, you should not take laxatives or do enemas. Defecation should be natural. Various drugs speed up the passage of food through the intestines and leave traces in the analysis. After an enema, the analysis is completely unsuitable for examination.
• Before taking the coprogram, it is recommended to follow a diet for 2-3 days. It is not recommended to eat a lot of meat, spicy foods, or large quantities of chicken eggs. You can eat cereals, dairy products, fruits and vegetables.
• Feces should not be collected from the toilet, as some foreign substances may get into the analysis. To collect the analysis, it is recommended to purchase a sterile container and spatula from the pharmacy. Using a spatula, a small amount of feces is collected into a container and closed with a lid. The amount of feces is no more than a third of the container.
• Women are advised to insert a tampon into the vagina before defecation, even if they are not menstruating, so that mucus and discharge do not get into the analysis.

Useful video - signs of chronic pancreatitis:

The analysis must be taken to the laboratory as early as possible. The most informative examination is the morning stool, but if this is not possible, the latest evening stool is collected and stored in a cool place in a closed container.

Creatorrhea is a symptom, not a disease. After a coprogram, as a rule, further examination of the organs is prescribed.

Treatment of creatorrhea

Treatment of creatorrhoea begins with identifying its causes. The root cause is a gastrointestinal disease, which should be treated, then the phenomenon of creatorrhoea will disappear. In this case, a coprogram is often the initial stage of diagnosis. After all diagnostic procedures, the doctor will make a diagnosis and select the most effective therapy.

Treatment is complex and usually performed on an outpatient basis. Only severe cases require hospitalization and inpatient treatment. Treatment methods:

• Digestive enzymes. For pancreatitis, some forms of gastritis and other gastrointestinal diseases, it is recommended to take digestive enzymes, for example, Pancreatin, Festal, Mezim, Creon. All these drugs relieve stress on the stomach, promote complete digestion of food, and eliminate the feeling of heaviness in the stomach. They can be taken in long courses during or after meals. Long-term use of the drug should be agreed with your doctor.
• Diet. Any gastrointestinal disease requires diet. If you have indigestion, it is recommended to avoid hard-to-digest foods, spicy dishes, baked goods, fast food, alcoholic beverages, strong tea and coffee. During periods of exacerbation, complete fasting is required.
• Antibiotics. Antibacterial drugs are prescribed for gastritis and ulcers caused by bacteria, as well as for severe cases of inflammation. The drug and dosage are determined by the doctor. Along with antibiotics, it is recommended to take probiotics to maintain intestinal microflora.
• Surgical intervention. Surgery is required for perforation of a stomach ulcer, blockage of the bile duct, serious complications of pancreatitis and cholecystitis. If possible, laparoscopy is performed to avoid excessive blood loss and complications after surgery.

Possible consequences and complications

The consequences of creatorrhea also depend on the diagnosis and treatment. If the disease leading to creatorrhoea was not treated and became chronic, the likelihood of complications increases significantly:

• . There is a risk of internal bleeding with gastritis, ulcers and pancreatitis. Inflammation of both the pancreas and stomach can lead to the formation of ulcers, which can rupture and bleed. The danger of bleeding lies in blood loss and the possibility of infection entering the blood.
• Tumors. Inflammatory processes and ulcers increase the likelihood of the formation of benign and malignant tumors. The most commonly observed connection is “gastritis-ulcer-stomach cancer”, which has led to the belief that the ulcer is a precancerous condition. It is believed that it is dangerous precisely because it can lead to the development of tumors.
• Peritonitis. This is a serious and very dangerous complication of a stomach ulcer or a severe form of pancreatitis, when the wall of the organ becomes thinner and its contents enter, causing severe inflammation. Peritonitis begins with severe abdominal pain, vomiting, then the heart rate increases and falls. Without medical attention, this condition can be fatal.
• . There is an opinion that with chronic gastritis, the likelihood of appendicitis increases, since inflammation from the walls of the stomach can spread to the appendix. Appendicitis is accompanied by vomiting, elevated body temperature, and paroxysmal abdominal pain, which gradually shifts to the right side. Appendicitis requires immediate surgical intervention.

Complications of creative rhea can be avoided if gastrointestinal diseases are treated in a timely manner and undergo preventive examinations. Diet and a healthy lifestyle, physical activity, and giving up bad habits also help prevent complications.

If people consume large quantities of protein foods, especially meat, then they will have small amounts of muscle fibers in their feces. Their presence in feces cannot be determined with the naked eye, so patients learn about this fact from test results. In the case when a laboratory study of human biological material reveals a high content of muscle fibers, this fact may indicate the development of pathologies in the gastrointestinal tract.

Causes

An overestimated number of muscle fibers in the feces of an adult and a child is detected in the presence of a pathology such as creatorrhea.

When conducting a laboratory study of biological material, specialists can identify several types of fibers:

1. Undigested. Fragments found in stool will have sharp corners.
2. Overcooked. In appearance, the muscle fibers will resemble lumps.
3. Slightly digested. In this case, the laboratory assistant will detect the presence in the feces of individual particles that have smoothed corners, an oval shape and a transverse division.

Muscle fibers in the stool during creatorrhoea in an adult may appear for the following reasons:

Chronic form of cholecystitis

With a long course of this pathology, the pancreas begins to lose functionality. As a result, the iron will not be able to generate enough enzymes necessary for a complete digestive process. In order for the digestive tract to continue to process incoming food at the same rhythm, patients will be forced to take medications that contain enzymes. In the chronic form of pancreatitis, patients are often diagnosed with creatorrhea.

Gastritis

With the development of various forms of gastritis, patients experience inflammation of the gastric mucosa. As a result, digestive processes are disrupted. If a patient has gastritis with a low level of acidity, then creatorrhoea is often diagnosed in parallel. This is due to the fact that in the stomach, due to insufficient acid concentration, dietary fiber cannot be completely broken down and is redirected into the intestines in a semi-digested form.

Putrefactive dyspepsia

If a person develops this pathology, then putrefactive processes will constantly occur in his intestines. A feature of the disease is the inability of the stomach to digest protein foods. As a result, it penetrates unchanged into the intestines and becomes an excellent environment for the active reproduction of pathogenic microflora. In this category of patients, inflammation often occurs, which must be controlled through drug therapy.

Achylia and achlorhydria

With the first pathology in patients, both acids and digestive enzymes are completely absent from the gastric juice. With the development of the second disease in patients, the stomach is not able to generate the hydrochloric acid necessary for digesting food.

Muscle fibers in the coprogram

When carrying out diagnostic measures, due to disorders of the digestive processes, specialists prescribe to patients a stool analysis called a coprogram. The purpose of this laboratory research method is to identify diseased muscle fibers in biological material. In a healthy person, a small number of muscle fibers without striations will be detected. If there are problems with digestion, the laboratory technician will notice muscle fibers with striations under a microscope.

This test can be prescribed to a patient by a proctologist, gastroenterologist or therapist if the development of the following pathologies is suspected:

• impaired intestinal functionality;
• helminthic infestations;
• disruption of digestive processes;
• for prevention purposes.

Preparing for analysis

To get the most accurate result of a laboratory test of stool, a person must properly prepare for the test:

1. Before collecting biological material, patients are prohibited from using laxatives, as well as cleansing the intestines through enemas.
2. Two days before the study, you must follow a special diet that includes strict restrictions on protein foods.
3. It is necessary to collect feces during the natural act of defecation. They are immediately placed in a sterile container, which can be purchased at any pharmacy chain, and hermetically sealed with a lid.
4. The patient should transport the collected feces to the laboratory as quickly as possible. If the biological material was collected in the evening, the container is placed in the refrigerator overnight and delivered to the hospital in the morning.
5. In the laboratory, specialists examine stool under a microscope. To differentiate the microorganisms present in them, Lugol's solution is applied to the unstained flora in the stool, which acts as a contrast agent and makes it possible to detect different types of bacteria.

Treatment methods

After the result of a laboratory study of stool confirms the assumptions of highly specialized specialists about the presence of creatorrhoea, a drug therapy regimen is selected individually for patients. In this matter, the entire emphasis is on eliminating the root cause of the development of the pathological condition.

If creatorrhea is caused by a gastrointestinal disease, then in most cases patients are treated at home. In case of severe illness, they will be indicated for hospitalization and drug therapy under the supervision of medical personnel.

1. It is mandatory to prescribe medications that contain digestive enzymes. They are indicated for people who have been diagnosed with gastritis, pancreatitis and other gastrointestinal diseases. For example, tablets “Creon”, “Mezima”, “Festal”, “Pancreatin”, etc. Course use of such medications allows you to unload the pancreas, eliminate the feeling of heaviness in the stomach, and normalize digestive processes.
2. If gastrointestinal pathologies were provoked by the pathogenic bacterium Helicobacter, then specialists include antibiotics in the drug therapy regimen. In parallel, patients are prescribed probiotics to prevent the development of intestinal dysbiosis.
3. When undergoing drug therapy, patients must adhere to a strict diet that excludes any harmful and indigestible foods.
4. In case of severe pathologies, patients undergo surgical treatment. For example, with complicated pancreatitis, blockage of the bile duct, perforated or perforated ulcer.

Complications

If a large number of muscle fibers have been identified in the patient’s stool, he needs to undergo a course of therapy, through which the root cause will be eliminated.

In the case when the disease that provoked creatorrhea has become chronic, the patient may develop the following complications:

1. With gastritis, ulcerative lesions or pancreatitis, there is a possibility of bleeding.
2. With inflammation in the stomach and pancreas, there is a possibility of ulcerative lesions and malignant neoplasms.
3. With severe pancreatitis or perforation of ulcerative lesions, peritonitis develops, which is an extremely dangerous pathological condition requiring immediate surgical treatment.

Experts say people can prevent the development of creatorrhea through regular preventive examinations. They should also lead a healthy lifestyle, play sports, and completely give up addictions. To avoid disruptions in the functioning of the digestive tract, experts recommend eating properly and regularly.

Microscopic examination in feces can reveal detritus, food debris, elements of the intestinal mucosa, crystals, and microorganisms.

Detritus represents the remains of food elements, microorganisms, disintegrated rejected intestinal epithelium, leukocytes, erythrocytes, etc. It has the appearance of small amorphous formations of a predominantly granular form. Since detritus makes up the bulk of feces, the largest amount is contained in formed feces and the smallest in liquid feces. The thinner the stool, the less detritus. By the amount of detritus one can judge the digestion of food. When recording microscopic examination data, the nature of the detritus is not noted.

Slime. During a macroscopic examination of stool, mucus may not be detected, since normally it covers the surface of the stool with a thin, barely noticeable layer. Microscopically, mucus is revealed as a structureless substance with single cells of columnar epithelium.

An increase in the amount of mucus in the stool in adults indicates a pathological condition. In newborns, small mucus flakes occur under physiological conditions.

Epithelium. In feces, squamous and columnar epithelial cells can be detected.

Squamous epithelial cells from the anal canal are located scattered or in layers. Detecting them has no practical significance.

Columnar epithelial cells enter the feces from all parts of the intestines. They may be unchanged or undergo degenerative changes. In the latter case, the epithelial cells are wrinkled, reduced, waxy, sometimes nuclear-free, and may have the appearance of matte grains.

Such epithelial cells are found in mucus from the colon. Normally, stool contains a small number of columnar epithelial cells. With catarrhal inflammation of the intestinal mucosa, epithelial cells can be found in significant numbers, individual cells and entire layers. Columnar epithelial cells can also be detected in large numbers in ribbon-like films with mucous colic (membranous colitis).

Leukocytes, predominantly neutrophilic granulocytes, are found either in the mucus or outside it. With catarrhal inflammation of the intestinal mucosa, the number of leukocytes is small; with an ulcerative process, it increases sharply, especially if it is localized in the distal parts of the intestines.

Eosinophilic granulocytes are observed in spastic colitis, amoebic dysentery, and some helminthiases. When a 5% aqueous solution of eosin is added to mucus, the grains turn bright orange. Charcot-Leyden crystals are often found along with eosinophilic granulocytes.

Macrophages found in stained preparations, of various sizes, most often large, with round nuclei, their cytoplasm contains inclusions: erythrocytes, neutrophil granulocytes (whole or their fragments). In dysentery, macrophages are found in small numbers, in amebiasis - in single numbers.

Red blood cells appear either unchanged or in the form of shadows that are difficult to recognize. They can be excreted in feces and in the form of amorphous disintegration, colored brownish. The presence of red blood cells usually indicates the presence of an ulcerative process. Unchanged red blood cells are usually found in the stool during bleeding from the lower parts of the alimentary canal (with hemorrhoids, rectal cancer, etc.) and with heavy bleeding from the upper parts of the alimentary canal. Sometimes red blood cells are detected in the stool along with mucus.

Plant fiber is present in feces constantly and often in large quantities, which is associated with the constant consumption of plant foods.

Digestible plant fiber According to its chemical composition, it belongs to polysaccharides. It consists of cells that have a delicate, thin, easily destroyed shell. Digestive enzymes easily penetrate the cell membrane of digestible fiber, even if it is not damaged, and break down their contents.

Plant fiber cells are interconnected by a layer of pectin, which dissolves first in the acidic contents of the stomach, and then in the slightly alkaline contents of the duodenum. With achylia, the cells of digestible fiber are not separated and are found in the feces in the form of groups (cells of potatoes, carrots, etc.). There is no digestible fiber in processed stool.

In indigestible plant fiber contains lignin, which gives it hardness and rigidity. Indigestible fiber cells have thick double-circuit membranes. The human digestive canal does not produce enzymes capable of breaking down the membranes of plant cells. The breakdown of fiber is facilitated by some microorganisms of the large intestine (clostridia, Bcellulosae dissolvens, etc.). The longer stool stays in the intestines, the less fiber remains in it. The structure of indigestible plant fiber is very diverse, most characteristic of it is the presence of legume plant remains in the form of narrow, long, parallel palisade cells that refract light; vessels of plants, spirals, hairs and needles, epidermis of cereals, etc.

Starch grains found in feces extracellularly and in the cells of potatoes, beans, etc. They are easily detected by adding iodine.

Starch grains located extracellularly lose their layering and look like irregular fragments. Depending on the stage of digestion, starch grains are colored differently when Lugol's solution is added: amylodextrin becomes purple, erythrodextrin becomes red-brown; The color of archodextrin does not change. Normally, there are no starch grains in feces. Incomplete breakdown of starch is observed in diseases of the small intestines and the associated accelerated evacuation of food.

Muscle fibers. Remains of protein food in the form of muscle fibers can sometimes be detected by macroscopic examination of stool. On microscopic examination, remains of muscle fibers are found in any preparation, even if the patient ate food with a small amount of meat.

Digested muscle fibers have the appearance of ovoid, non-striated fragments of various sizes. Insufficiently digested fibers are longitudinally striated, some of the corners are sharp. Unmodified muscle fibers have preserved transverse striations, all angles are sharp.

When there is insufficient flow of bile into the duodenum, the muscle fibers are pale colored. Under the influence of hydrochloric acid of gastric juice, muscle fibers of food origin are freed from the intermuscular connective layers and sarcolemma. In this case, the structure of muscle fibers, their transverse and longitudinal striations are disrupted. In this state, most of the muscle fibers enter the duodenum. The final digestion of muscle fibers occurs mainly under the influence of pancreatic juice. The appearance in the feces of a large number of groups of muscle fibers with preserved transverse and longitudinal striations indicates insufficient digestion of food in the stomach.

A large number of muscle fibers (creatorrhoea) can be a consequence of:

• achylia (the presence in the preparation of groups of striated, or striated, muscle fibers);
• insufficient secretion of the pancreas (the presence in the preparation of sufficiently and insufficiently digested, separately located muscle fibers);
• pathologically accelerated evacuation of food (presence of undigested fibers);
• nutritional overload, which should not happen after a trial diet. The method of preparing meat and the condition of the chewing apparatus also matters.

Connective tissue. In feces, highly diluted with water, particles of connective tissue look like scraps and strands of grayish color of irregular shape with shaggy torn edges. When examined microscopically, they are characterized by a delicate fibrous structure, but differ from mucus in their sharper outlines, denser consistency and opacity. After adding acetic acid, the structure of the connective tissue disappears, and layering and striations appear in the mucus. When eating poorly fried and cooked meat, the presence of connective tissue in the feces is a physiological phenomenon.

The detection of connective tissue after a trial diet (especially the Schmidt diet) indicates insufficient digestion of food in the stomach.

Fat. Normally, feces always contain small amounts of fatty acids and their salts. There is no neutral fat.

In the native preparation, neutral fat has the form of round or oval colorless or slightly yellowish drops. When pressing on the cover glass, the droplets change shape. If there is a lot of fat, they merge. In the preparation stained with methylene blue, drops of neutral fat are colorless, and in the preparation treated with Sudan III they are bright red.

Fatty acid found in feces in the form of long, pointed needles (crystals), sometimes folded into bunches, as well as in the form of lumps and drops, sometimes with spikes.

If needles and lumps are found in the native preparation, it is heated, without bringing it to a boil, and examined under a microscope. When heated, fatty acids form droplets, which, when cooled, again turn into lumps. Warming can be repeated several times. Drops of fatty acids are stained blue with methylene blue.

Soaps (fatty acid salts) found in the form of lumps and crystals, similar to crystals of fatty acids, but shorter, often arranged in bunches.

If, when heating the preparation, the needles and lumps do not form drops, it is necessary to heat the preparation with acetic acid (20-30%) to a boil. The formation of droplets indicates the presence of soaps: acetic acid breaks down soaps and releases fatty acids, which melt to form droplets.

In the digestion and absorption of fat, the most important role is played by pancreatic juice lipase and bile. Violation of pancreatic secretion leads to the fact that fats are not broken down and are excreted in large quantities in the feces. If bile does not enter the duodenum, then fatty acids formed from neutral fat under the action of lipase are not absorbed and are present in large quantities in the feces. Feces with a significant fat content (steatorrhea) have a peculiar pearlescent sheen, grayish color and the consistency of an ointment. Pieces of undigested fatty tissue may also be found in it. This is observed when digestion is disrupted in the stomach, where normally fat is released from connective tissue.

Crystals. Tripelphosphates in the form of crystals they are most often found in liquid feces and mucus. The stool reaction is alkaline. Their detection only in freshly excreted feces is of diagnostic value. Usually the appearance of these crystals is associated with increased putrefactive processes in the feces and the admixture of urine in it.

Oxalates found in feces when eating large amounts of plant foods. Normally, hydrochloric acid converts calcium oxalate into calcium chloride, so the presence of oxalates in stool may indicate low acidity of gastric juice.

Cholesterol crystals in feces are difficult to recognize and have no diagnostic value.

Charcot-Leyden crystals observed in feces when eosinophilic granulocytes enter it. With amoebiasis, these crystals sometimes reach large sizes.

Bilirubin crystals can be detected during profuse diarrhea, when bilirubin does not have time to be reduced to stercobilin due to the rapid evacuation of food through the intestines. They are small yellowish-brown needle-shaped crystals, pointed at both ends, arranged in bunches.

Hematoidin crystals appear in the stool after intestinal bleeding in the form of long needles and rhombic tablets. Their color ranges from golden yellow to brownish orange.

Microflora. There are a large number of microorganisms in the human intestines. They make up 40-50% of the mass of feces and are part of detritus. The detection of iodophilic flora and mycobacterium tuberculosis in feces is of practical importance.

TO iodophilic flora include microorganisms (cocci and rods of various lengths and thicknesses) that have the property of being stained black with Lugol's solution due to the presence of granulosa in them. Iodophilic flora grows on media containing carbohydrates, which it assimilates.

Under physiological conditions, iodophilic flora is found in the lower part of the ileum and cecum. Normally, its content in feces is very small, and with constipation it is absent. An increase in the content of iodophilic flora in feces is combined with an acidic reaction, accelerated release of chyme from the intestines and the appearance of fermentation processes. During pronounced fermentation processes, long, slightly curved sticks are found in feces, arranged in piles and chains - leptothrix and thick spindle-shaped bacilli, sometimes with a swelling at one end (in the form of a drumstick) - clostridia, forming groups and chains, and sometimes lying intracellularly. Clostridia are stained with iodine either entirely or only in the middle part.

If fermentation is not pronounced and is combined with the process of decay, small cocci and sticks can be found in the feces. Yeast fungi are stained yellowish with Lugol's solution. Finding them in large quantities in fresh feces indicates candidiasis.

Mycobacterium tuberculosis found in stool during intestinal tuberculosis. Preparations for research on the special prescription of a doctor are prepared from mucous, muco-bloody and purulent lumps, in the absence of mucus, blood, pus - from feces thoroughly mixed with water, fixed and stained according to Ziehl-Neelsen.

Feces are formed in the large intestine. It consists of water, remnants of food taken and secretions of the gastrointestinal tract, products of the transformation of bile pigments, bacteria, etc. For the diagnosis of diseases associated with the digestive organs, stool examination in some cases can be crucial. A general stool analysis (coprogram) includes macroscopic, chemical and microscopic examination.

Macroscopic examination

Quantity

In pathology, the amount of feces decreases with prolonged constipation caused by chronic colitis, peptic ulcers and other conditions associated with increased absorption of fluid in the intestines. With inflammatory processes in the intestines, colitis with diarrhea, and accelerated evacuation from the intestines, the amount of feces increases.

Consistency

Thick consistency - with constant constipation due to excessive absorption of water. Liquid or mushy consistency of stool - with increased peristalsis (due to insufficient absorption of water) or with abundant secretion of inflammatory exudate and mucus by the intestinal wall. Ointment-like consistency - in chronic pancreatitis with exocrine insufficiency. Foamy consistency - with enhanced fermentation processes in the large intestine and the formation of a large amount of carbon dioxide.

Form

The form of feces in the form of “large lumps” - when feces remain in the colon for a long time (hypomotor dysfunction of the colon in people with a sedentary lifestyle or who do not eat rough food, as well as in cases of colon cancer, diverticular disease). The form in the form of small lumps - “sheep feces” indicates a spastic state of the intestines, during fasting, stomach and duodenal ulcers, a reflex nature after appendectomy, with hemorrhoids, anal fissure. Ribbon or “pencil” shape - for diseases accompanied by stenosis or severe and prolonged spasm of the rectum, for rectal tumors. Unformed feces are a sign of maldigestion and malabsorption syndrome.

Color

If staining of stool by food or drugs is excluded, then color changes are most likely due to pathological changes. Grayish-white, clayey (acholic feces) occurs with obstruction of the biliary tract (stone, tumor, spasm or stenosis of the sphincter of Oddi) or with liver failure (acute hepatitis, cirrhosis of the liver). Black feces (tarry) - bleeding from the stomach, esophagus and small intestine. Pronounced red color - with bleeding from the distal parts of the colon and rectum (tumor, ulcers, hemorrhoids). Gray inflammatory exudate with fibrin flakes and pieces of the colon mucosa (“rice water”) - with cholera. The jelly-like character is deep pink or red in amoebiasis. In typhoid fever, the stool looks like “pea soup.” With putrefactive processes in the intestines, the feces are dark in color, with fermentative dyspepsia - light yellow.

Slime

When the distal colon (especially the rectum) is affected, the mucus occurs in the form of lumps, strands, ribbons, or a glassy mass. With enteritis, the mucus is soft, viscous, mixing with feces, giving it a jelly-like appearance. Mucus, covering the outside of formed feces in the form of thin lumps, occurs with constipation and inflammation of the large intestine (colitis).

Blood

When bleeding from the distal parts of the colon, the blood is located in the form of streaks, shreds and clots on formed stool. Scarlet blood occurs when bleeding from the lower parts of the sigmoid and rectum (hemorrhoids, fissures, ulcers, tumors). Black feces (melena) occur when there is bleeding from the upper digestive system (esophagus, stomach, duodenum). Blood in the stool can be found in infectious diseases (dysentery), ulcerative colitis, Crohn's disease, disintegrating colon tumors.

Pus

Pus on the surface of the stool occurs with severe inflammation and ulceration of the mucous membrane of the colon (ulcerative colitis, dysentery, disintegration of an intestinal tumor, intestinal tuberculosis), often together with blood and mucus. Large amounts of pus without mucus are observed when opening paraintestinal abscesses.

Leftover undigested food (lientorrhea)

The release of undigested food residues occurs with severe insufficiency of gastric and pancreatic digestion.

Chemical research

Fecal reaction

An acidic reaction (pH 5.0-6.5) is observed when iodophilic flora is activated, producing carbon dioxide and organic acids (fermentative dyspepsia). An alkaline reaction (pH 8.0-10.0) occurs with insufficient digestion of food, with colitis with constipation, sharply alkaline with putrefactive and fermentative dyspepsia.

Reaction to blood (Gregersen reaction)

A positive reaction to blood indicates bleeding in any part of the gastrointestinal tract (bleeding from the gums, rupture of varicose veins of the esophagus, erosive and ulcerative lesions of the gastrointestinal tract, tumors of any part of the gastrointestinal tract in the stage of decay).

Reaction to stercobilin

The absence or sharp decrease in the amount of stercobilin in the feces (the reaction to stercobilin is negative) indicates obstruction of the common bile duct with a stone, compression by a tumor, stricture, stenosis of the common bile duct, or a sharp decrease in liver function (for example, in acute viral hepatitis). An increase in the amount of stercobilin in feces occurs with massive hemolysis of red blood cells (hemolytic jaundice) or increased bile secretion.

Reaction to bilirubin

The detection of unchanged bilirubin in the stool of an adult indicates a disruption in the process of bilirubin recovery in the intestine under the influence of microbial flora. Bilirubin can appear during rapid evacuation of food (sharp increase in intestinal motility), severe dysbiosis (syndrome of bacterial overgrowth in the colon) after taking antibacterial drugs.

Vishnyakov-Triboulet reaction (for soluble protein)

The Vishnyakov-Triboulet reaction is used to identify a hidden inflammatory process. The detection of soluble protein in stool indicates inflammation of the intestinal mucosa (ulcerative colitis, Crohn's disease).

Microscopic examination

Muscle fibers - with striations (unchanged, undigested) and without striations (changed, digested). A large number of changed and unchanged muscle fibers in the feces (creatorrhoea) indicates a violation of proteolysis (protein digestion):

• in conditions accompanied by achlorhydria (lack of free HCl in gastric juice) and achylia (complete absence of secretion of HCl, pepsin and other components of gastric juice): atrophic pangastritis, a condition after gastric resection;
• with accelerated evacuation of food chyme from the intestines;
• in case of violation of the exocrine function of the pancreas;
• with putrefactive dyspepsia.

Connective tissue (remnants of undigested vessels, ligaments, fascia, cartilage). The presence of connective tissue in the feces indicates a deficiency of proteolytic enzymes of the stomach and is observed with hypo- and achlorhydria, achylia.

Fat is neutral. Fatty acid. Salts of fatty acids (soaps)

The appearance of large amounts of neutral fat, fatty acids and soaps in the stool is called steatorrhea. This happens:

• with exocrine pancreatic insufficiency, a mechanical obstruction to the outflow of pancreatic juice, when steatorrhea is represented by neutral fat;
• if the flow of bile into the duodenum is impaired and if the absorption of fatty acids in the small intestine is impaired, fatty acids or salts of fatty acids (soaps) are found in the feces.

Plant fiber

Digestible - found in the pulp of vegetables, fruits, legumes and grains. Indigestible fiber (the skin of fruits and vegetables, plant hairs, the epidermis of cereals) has no diagnostic value, since there are no enzymes in the human digestive system that break it down. It is found in large quantities during rapid evacuation of food from the stomach, achlorhydria, achylia, and the syndrome of bacterial overgrowth in the colon.

Starch

The presence of a large amount of starch in the feces is called amilorrhea and is observed more often with increased intestinal motility, fermentative dyspepsia, and less often with exocrine insufficiency of pancreatic digestion.

Iodophilic microflora (clostridia)

With a large amount of carbohydrates, clostridia multiply intensively. A large number of clostridia is regarded as fermentative dysbiosis.

Epithelium

A large amount of columnar epithelium in the feces is observed in acute and chronic colitis of various etiologies.

Leukocytes

A large number of leukocytes (usually neutrophils) are observed in acute and chronic enteritis and colitis of various etiologies, ulcerative necrotic lesions of the intestinal mucosa, intestinal tuberculosis, and dysentery.

Red blood cells

The appearance of slightly changed red blood cells in the stool indicates the presence of bleeding from the colon, mainly from its distal parts (ulceration of the mucous membrane, disintegrating tumor of the rectum and sigmoid colon, anal fissures, hemorrhoids). A large number of red blood cells in combination with leukocytes and columnar epithelium is characteristic of ulcerative colitis, Crohn's disease with damage to the colon, polyposis and malignant neoplasms of the colon.

Worm eggs

Eggs of roundworms, tapeworms, etc. indicate a corresponding helminthic infestation.

Pathogenic protozoa

Cysts of dysenteric amoeba, Giardia, etc. indicate a corresponding invasion by protozoa.

Yeast cells

Found in feces during treatment with antibiotics and corticosteroids. Identification of the fungus Candida albicans is carried out by culturing on special media (Sabouraud's medium, Microstix Candida) and indicates a fungal infection of the intestine.

Calcium oxalate (oxalic lime crystals)

Detection of crystals is a sign of achlorhydria.

Triple phosphate crystals (ammonium phosphate-magnesia)

Triple phosphate crystals found in feces (pH 8.5-10.0) immediately after defecation indicate increased protein putrefaction in the colon.

Norms

Macroscopic examination

Parameter	Norm
Quantity	A healthy person produces an average of 100-200 g of feces per day. Normally, feces contain about 80% water and 20% dry matter. With a vegetarian diet, the amount of feces can reach 400-500 g per day; when using easily digestible food, the amount of feces decreases.
Consistency	Normally, formed feces have a dense consistency. Pasty feces can occur normally and are caused by the intake of predominantly plant foods.
Form	Normally cylindrical.
Smell	Normally, stool has a mild odor, which is called fecal (ordinary). It may intensify with the predominance of meat products in the diet, with putrefactive dyspepsia and weaken with a dairy-vegetable diet, constipation.
Color	Normally, stool is brown in color. When eating dairy foods, stool turns yellowish-brown, and meat stool turns dark brown. Ingestion of plant foods and some medications can change the color of stool (beets - reddish; blueberries, blackcurrants, blackberries, coffee, cocoa - dark brown; bismuth, iron color stool black).
Slime	Normally absent (or in scanty quantities).
Blood	Normally absent.
Pus	Normally absent.
Leftover undigested food (lientorrhea)	Normally none.

Chemical research

Parameter	Norm
Fecal reaction	Normally neutral, less often slightly alkaline or slightly acidic. Protein nutrition causes a shift in the reaction towards the alkaline side, while carbohydrate nutrition causes the reaction to shift towards the acidic side.
Reaction to blood (Gregersen reaction)	Normally negative
Reaction to stercobilin	Normally positive.
Reaction to bilirubin	Normally negative.
Vishnyakov-Triboulet reaction (for soluble protein)	Normally negative.

Microscopic examination

Parameter	Norm
Muscle fibers	Normally absent or single in the field of view.
Connective tissue (remnants of undigested vessels, ligaments, fascia, cartilage)	Normally absent.
Fat is neutral. Fatty acid. Salts of fatty acids (soaps).	Normally there are no or scanty amounts of fatty acid salts.
Plant fiber	Normally, there are single cells in the p/z.
Starch	Normally absent (or single starch cells).
Iodophilic microflora (clostridia)	Normally, single in rare areas (normally, iodophilic flora lives in the ileocecal region of the large intestine).
Epithelium	Normally, there are no or single columnar epithelial cells in the p/z.
Leukocytes	Normally, there are no or single neutrophils in the p/z.
Red blood cells	Normally none.
Worm eggs	Normally none.
Pathogenic protozoa	Normally none.
Yeast cells	Normally none.
Calcium oxalate (oxalic lime crystals)	Normally none.
Triple phosphate crystals (ammonium phosphate-magnesia)	Normally none.

Diseases for which a doctor may prescribe a general stool test (coprogram)

1. Crohn's disease

   With Crohn's disease, you may find blood in your stool. The Vishnyakov-Triboulet reaction reveals soluble protein in it. Crohn's disease affecting the colon is characterized by the presence in the feces of a large number of red blood cells in combination with leukocytes and columnar epithelium.

2. Colon diverticulosis

   With diverticular disease, due to the long stay of stool in the colon, it takes the form of “large lumps”.

3. Duodenal ulcer

   With a duodenal ulcer, the feces have the form of small lumps (“sheep feces” indicates a spastic condition of the intestines).

4. Stomach ulcer

   With a stomach ulcer, the feces have the form of small lumps (“sheep feces” indicates a spastic condition of the intestines).

5. Chronic pancreatitis

   In chronic pancreatitis with exocrine insufficiency, stool may have a pasty consistency.

6. Hemolytic anemia

   With hemolytic jaundice (anemia), due to massive hemolysis of red blood cells, the amount of stercobilin in the feces increases.

7. Benign neoplasms of the colon

   With a tumor accompanied by bleeding from the distal colon, the stool may have a pronounced red color. With disintegrating colon tumors, blood may be found in the stool. Pus on the surface of the stool occurs when there is severe inflammation and ulceration of the colon mucosa (disintegration of an intestinal tumor), often along with blood and mucus. When a colon tumor is in the stage of decay due to bleeding, the reaction to blood (Gregersen reaction) is positive.

8. Intestinal helminthiases

   With helminthic infestation, the feces contain eggs of roundworms, tapeworms, etc.

9. Cirrhosis of the liver

   In liver failure, including liver cirrhosis, the stool is grayish-white, clayey (acholic).

10. Ulcerative colitis

    With colitis, there is mucus covering the outside of the stool in the form of thin lumps. With ulcerative colitis, blood may be found in the stool; pus on the surface of the stool, often along with blood and mucus; soluble protein in the Vishnyakov-Triboulet reaction; a large number of leukocytes (usually neutrophils); a large number of red blood cells in combination with leukocytes and columnar epithelium.

11. Constipation

    With prolonged constipation caused by chronic colitis, peptic ulcers and other conditions associated with increased absorption of fluid in the intestine, the amount of feces decreases. With constant constipation due to excessive absorption of water, the consistency of stool is dense. With constipation, there may be mucus covering the outside of the stool in the form of thin lumps.

12. Malignant neoplasm of the colon

    The form of feces in the form of “large lumps” - when feces remain in the colon for a long time - is noted in colon cancer. Pronounced red color of stool - with a tumor accompanied by bleeding from the distal parts of the colon and rectum. Blood in the stool can be found in disintegrating colon tumors. Pus on the surface of the stool occurs when there is severe inflammation and ulceration of the colon mucosa (disintegration of an intestinal tumor), often along with blood and mucus. A positive reaction to blood (Gregersen reaction) indicates bleeding with a tumor of the colon in the stage of decay. A large number of red blood cells in combination with leukocytes and columnar epithelium is characteristic of malignant neoplasms of the colon.

13. Irritable bowel syndrome, chronic colitis

    With colitis with diarrhea, the amount of feces increases. The amount of feces decreases with prolonged constipation caused by chronic colitis. Mucus covering the outside of formed feces in the form of thin lumps is found in colitis. An alkaline reaction (pH 8.0-10.0) occurs in colitis with constipation. A large number of leukocytes (usually neutrophils) are observed in colitis of various etiologies.

14. Cholera

    In cholera, stool looks like a gray inflammatory exudate with fibrin flakes and pieces of the colon mucosa (“rice water”).

15. Amoebiasis

    With amebiasis, the stool is jelly-like, deep pink or red.

16. Typhoid fever

    In typhoid fever, the stool looks like “pea soup.”

17. Peptic ulcer of the stomach and duodenum

    With prolonged constipation caused by peptic ulcers, the amount of feces decreases. With an ulcer of the duodenum and stomach, the feces have the form of small lumps (“sheep feces” indicates a spastic condition of the intestines).