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Waste residue of indigestible material (cellulose during the previous 4 days). 2. Bile pigments and salts. 3. Intestinal secretions, including mucus. 4. Leukocytes that migrate from the bloodstream.

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Stool analysis

2. Bile pigments and salts

3. Intestinal secretions, including mucus

4. Leukocytes that migrate from the bloodstream

6. Bacteria and Inorganic material(10-20%) chiefly calcium and phosphates. Undigested and unabsorbed food.

Stool Analysis

What is the stool or feces?

5. Epithelial cells that have been shade

Random collection
Random Collection the previous 4 days)

  • 1. Universal precaution

  • 2. Collect stool in a dry,clean container

  • uncontaminated with urine or other body secretions, such as menstrual blood

  • 4. Collect the stool with a clean tongue blade or similar object.

  • 5. Deliver immediately after collection

Ova and parasites collection
Ova and parasites collection the previous 4 days)

  • Warm stools are best for detecting ova or parasites.

  • Do not refrigerate specimen for ova or parasites.

  • If the stool should be collect in 10 % formalin or PVA

  • fixative, storage temperature is not critical.

  • Because of the cyclic life cycle of parasites, three

  • separate random stool specimens are recommended.

Enteric pathogen collection
Enteric pathogen collection the previous 4 days)

  • Some coliform bacilli produce antibiotic substances that

  • destroy enteric pathogen.Refrigerate specimen immediately.

  • 2. A diarrheal stool will usually give accurate results.

  • 3. A freshly passed stool is the specimen of choice.

  • Stool specimen should be collected before antibiotic therapy, or

  • as early in the course of the disease.

  • If blood or mucous is present, it should be included in the

  • specimen

Interfering factors
Interfering the previous 4 days)factors

  • Patients receiving tetracyclines, anti-diarrheal drugs, barium, bismuth, oil, iron , or magnesium may not yield accurate results.

  • 2. Bismuth found in toilet tissue interferes with the results.

  • 3. Do not collect stool from the toilet bowl.A clean, dry bedpan is the best.

  • 4. Lifestyle, personal habbits, environments may interfere with proper sample procurement.

บิสมัส เตตร้า เหล็กทำให้อีเปลี่ยนสี, น้ำมันทำให้เกิด false steatorrhea

Anti-diarrheal drug ทำให้ลักษณะของ stool เปลี่ยนจากจริง

Normal values in stool analysis
Normal values in stool Analysis the previous 4 days)

Macroscopic examination Normal value

Amount 100-200 g / day

Colour Brown

Odour Varies with pH of stool and depend on bact- erial fermentation

Consistency Plastic, not unusual to see fiber, vegetable skins.

Size and shape Formed

Gross blood,Mucous,Pus, Parasites None


Normal values in stool analysis1
Normal values in stool analysis the previous 4 days)

Microscopic examination Normal values

Fat (Colorless, neutral fat (18%)and fatty acid crystals and soaps)

Undigested food None to small amount

Meat fibers, Starch, Trypsin None

Eggs and segments of parasites None

Yeasts None

Leukocytes None

Normal values in stool analysis2
Normal values in stool analysis the previous 4 days)

Chemical examination Normal values

Water Up to 75 %

pH 6.5-7.5

Occult blood Negative

Urobilinogen 50-300 g/24hr

Porphyrins Coporphyrins:400-1200g/24hr

Uroporphyrins:10-40 mg/24hr

Nitrogen <2.5 g/24hr

Normal values in stool analysis3
Normal values in stool analysis the previous 4 days)

Chemical examination Normal values

Bile Negative in adults:positive in children

Trypsin 20-950 units/g( positive in small amounts in adults; present in greater amounts in normal children.

Osmolarity used 200-250 mOsm with serum osmol- arity to calculate osmotic gap

Sodium 5.8-9.8 mEq / 24hr

Normal values in stool analysis4
Normal values in stool analysis the previous 4 days)

Chemical examination Normal values

Chloride 2.5-3.9 mEq / 24 hr

Potassium 15.7-20.7 mEq /24 hr

Lipids ( fatty acid) 0-6 g / 24 hr

Clinical implications
Clinical Implications the previous 4 days)

1. Fecal consistency may be altered in various disease states

  • Diarrhea mixed with mucous and red blood cells is associated with

  • 1. Typhus 2. Typhoid 3. Cholera

  • 4. Amebiasis 5. Large bowel cancer





Clinical implications1
Clinical Implications the previous 4 days)

b. Diarrhea mixed with mucus and white blood cells is associated with

1. Ulcerative colitis 2. Regional enteritis

3. Shigellosis 4. Salmonellosis

5. Intestinal tuberculosis


แผลในโคลอน (ขอบเรียบ)

วัณโรคลงทางเดินอาหาร/ ฝีในท้อง

Clinical implications2
Clinical Implications the previous 4 days)

C. ”Pasty” stool is associated with a high fat content in the stool:

1. A significant increase of fat is usually detected on gross examination

2. With common bile duct obstruction, the fat gives the stool a putty- like appearance.

3. In cystic fibrosis, the increase of neutral fat gives a greasy, “butter stool” appearance.


Stool odor
Stool Odor the previous 4 days)

  • Normal value Varies with pH of stool and diet. Indole and sketole are the substances that produce normal odor formed by intestinal bacteria putrefaction and fermentation.

  • Clinical implication.

  • A foul odor is caused by degradation of undigested protein.

  • A foul odor is produced by excessive carbohydrate ingestion.

  • A sickly sweet odor is produced by volatile fatty acids and undigested lactose

Stool ph
Stool pH the previous 4 days)

Normal value : Neutral to acid or alkaline

Clinical implication

1. Increased pH ( alkaline)

a. protein break down b. Villous adenoma

c.Colitis d.Antibiotic use

2. Decreased pH ( acid)

a. Carbohydrate malabsorption

b. Fat malabsorption

c. Disaccharidase deficiency

สลายโปรตีนมากๆ จะมียูเรียและแอมโมเนียทำให้เป็นด่าง




มีการย่อยไขมัน หมักกรดไขมันได้กรดคีโตนส์


Stool color
Stool color the previous 4 days)

Normal value : Brown

Clinical implication:

1. Yellow to yellow-green: severe diarrhea

2. Green: severe diarrhea เขียวเพราะน้ำดีดูดกลับไม่ทัน ไม่มีเวลาให้แบคทีเรียย่อย bile

Black: resulting from bleeding into the upper gastrointestinal tract (>100 ml blood) การที่มีเลือดออกในทางเดินอาหารส่วนบนเหล็กจะถูกกรดออกซิไดซ์ได้สีดำ

3. Tan or Clay colored : blockage of the common bile duct.

4. Pale greasy acholic (no bile secretion) stool found in pancreatic insufficiency.

การบลอกทำให้ไม่มีน้ำดี สีอึเลยไม่มีสี


Stool color con
Stool color(con) the previous 4 days)

4. Maroon-to-red-to-pink : possible result of bleeding from the lower gastrointestinal tract (eg. Tumors, hemorrhoids, fissures,inflammatory process)

5. Blood streak on the outer surface of usually indicates hemorrhoids or anal abnormalities.

6. Blood in stool can arise from abnormalities higher in the colon. In some case the transit time is rapid blood from stomach or duodenum can appear as bright or dark red or maroon in stool.

เนื้องอก, ริดสีดวง, ร่องตูดแหก, มีการอักเสบ

ริดสีดวง, รูก้นผิดปกติ

Blood in stool
Blood in Stool the previous 4 days)

Normal value : Negative

Clinical Implication :

1. Dark red to tarry black indicates a loss of 0.50 to 0.75 ml of blood from the upper GI tract.

2. Positive for occult blood may be caused by

a. Carcinoma of colon b. Ulcerative colitis

c. Adenoma d. Diaphramatic hernia

e. Gastric carcinoma f. Diverticulitis

g. Ulcers

มะเร็งของโคลอน แผลขอบเรียบที่โคลอน


มะเร็งกระเพาะอาการ ลำไส้พันกันทำให้เน่าตาย

Mucous in stool
Mucous in Stool the previous 4 days)

Normal value : Negative for mucous

Clinical Implication:

1. Translucent gelatinous mucous clinging to the surface of formed stool occurs in

a. Spastic constipation b. Mucous colitis

c. Emotionally disturbed patients

d. Excessive straining at stool

2. Bloody mucous clinging to the surface suggests

a. Neoplasm b. Inflammation of the rectal canal

เบ่งแรงๆ เมือกจากการอักเสบ


เก็บอึนานไป ไม่ชอบถ่าย

เนื้องอก ภาวะอักเสบที่ไส้ตรง

Mucous in stool con
Mucous in Stool (con) the previous 4 days)

3. Mucous with pus and blood is associated with

a. Ulcerative colitis b. Bacilliary dysentery

c. Ulcerating cancer of colon d. Acute diverticulitis

e. Intestinal tuberculosis


แผลที่เกิดจากมะเร็งโคลอน ลำไส้พันกันเฉียบพลัน

Fat in stool
Fat in Stool the previous 4 days)

Normal value : fat in stool will account for up to 20 % of total solids. Lipids are measured as fatty acids (0-6.0 g/24hr)

Clinical Implication :

1. Increased fat or fatty acids is associated with the malabsorption syndromes

a. Nontropical sprue b. Crohn’s disease

c. Whipple’s disease d. Cystic fibrosis

e. Enteritis and pancreatic diseases

f. Surgical removal of a section of the intestine



Urobilinogen in stool
Urobilinogen in Stool the previous 4 days)

  • Normal value : 125-400 Ehrlich units / 24 hr

  • 75-350 Ehrlich units/100 g

  • Clinical Implication:

  • Increased values are associated with Hemolytic anemias

  • Decreased values are associated with

  • a. Complete biliary obstruction

  • b. Severe liver disease, infectious hepatitis

  • c. Oral antibiotic therapy that alters intestinal bacteria flora

  • d. Infants are negative up to 6 months of age

Bile in stool
Bile in Stool the previous 4 days)

Normal value : Adults –negative

: Children may be positive

Clinical Implication:

1. Bile may be present in diarrheal stools.

2. Increased bile levels occur in Hemolytic anemia

Trypsin in stool
Trypsin in Stool the previous 4 days)

  • Normal value : Positive in small amounts in 95 % of normal persons.

  • Clinical Implication : Decreased amounts occur in

  • Pancreatic deficiency

  • Malabsorption syndromes

  • Screen for cystic fibrosis

Leukocytes in stool
Leukocytes in Stool the previous 4 days)

Normal value : Negative Clinical Implication

1. Large amounts of leukocytes

a. Chronic ulcerative colitis b. Chronic bacilliary dysentery

c. Localized abscess

d. Fistulas of sigmoid rectum or anus

2. Mononuclear leukocytes appear in Typhoid




ลำไส้กลืนกันบริเวณซฺกมอยด์โคลอน หรือที่ทวาร

Leukocytes in stool con

3. Polymorphonuclear leukocytes appear in the previous 4 days)

a. Shigellosis b. Salmonellosis

c. Yersinia d. Invasive Escherichia coli diarrhea

e. Ulcerative colitis

4. Absence of leukocytes is associated with

a. Cholera b. Non specific diarrhea

c. Viral diarrhea d. Amebic colitis

e. Noninvasive E.coli diarrhea

f. Toxigenic bacteria Staphylococci spp., Clostidium Cholera

g. Parasites-Giardia,

Leukocytes in Stool (con)

Porphyrins in stool
Porphyrins in Stool the previous 4 days)

  • Normal value : Coproporphyrin 400-1200 g / 24hr

  • Urophorphyrin 10-40 g / 24 hr.

  • These values vary from Lab to Lab.

  • Clinical Implication:

  • Increased fecal coproporphyrin is associated with

  • a. Coproporphyria (hereditary) b. Porphyria variegata

  • c. Protoporphyria d. Hemolytic anemia

  • 2. Increased fecal protoporphyrin is associated with

  • a. Porphyria veriegata b. Protoporphyria

  • c. Acquired liver disease

Stool electrolytes
Stool Electrolytes the previous 4 days)

  • Normal values : Sodium 5.8-9.8 mEq / 24 hr

  • Chloride 2.5-3.9 mEq / 24 hr

  • Potassium 15.7-20.7 mEq /24 hr

  • Clinical Implication :

  • Idiopathic proctocolitis Sodium and Chloride Normal Potassium

  • Cholera Sodium and Chloride