ADDITIONAL RESEARCH METHODS

DIGESTIVE ORGANS,

LIVER AND BILE TRACT

1. Clinical significance of the study of feces.

2. Clinical significance of the study of gastric secretion.

3. Clinical significance of the study of duodenal contents.

4. Biochemical study of blood in diseases of the digestive system, liver and biliary tract.

5. Instrumental methods for studying the digestive organs, liver and biliary tract.

Clinical significance of stool examination

Feces are the contents of the large intestine that are excreted during defecation. In a healthy person, stool contains 75-80% water and 20-25% solid residue. The dense part consists of 1/3 of the remnants of ingested food, 1/3 of the remnants of the separated gastrointestinal tract and 1/3 of microbes, about 90% of which are dead. The study of the composition of feces is an important addition to the diagnosis of diseases of the digestive system and the evaluation of the results of their treatment.

A general clinical analysis of feces in most cases is performed without special preparation of the patient, however, it is recommended 2-3 days before the study to avoid taking medications that change the nature of feces and cause functional disorders of the gastrointestinal tract (iron preparations, bismuth, laxatives, etc.). The most informative is the analysis of freshly isolated feces delivered in a clean, dry glass or plastic container without the admixture of disinfectants. Mixing of feces with urine or vaginal secretions should be avoided. If it is not possible to immediately conduct a coprological study, the feces are stored in a refrigerator (temperature from -3 to -5 0 C).

Fecal analysis includes macroscopic, chemical, microscopic and bacteriological examination.

Macroscopic examination

This study includes determining the quantity, consistency, shape, color, smell of feces, the presence of impurities.

Amount of feces in a healthy person, it averages 120-200 g per day, the frequency of defecation is 1-2 times in 1-2 days. The increase (polyfecal) or decrease (oligofecal) is influenced by the quantity, nature of the food taken, the quality of digestion of food masses in the gastrointestinal tract, the water content, pathological impurities in the feces - mucus, blood, pus. Polyfecalia is characteristic of pancreatitis, chronic enteritis, eating plant foods. Oligofekalia occurs when eating predominantly protein foods, starvation.

Shape and texture of feces depend mainly on the water content. Feces normally have a cylindrical shape and a uniform dense consistency. Such a feces is called decorated. The different shape and consistency of feces may indicate a pathology:

"Sheep feces" - with spastic colitis;

liquid - with enteritis;

"ointment" - with a significant content of fat in the feces;

ribbon-like - with a tumor of the lower sigmoid or rectum.

stool color in a healthy person, it has various shades of brown, depending on the presence of stercobilin in the feces, which is formed under the influence of intestinal bacteria from bilirubin. In addition, the color of feces can be influenced by the nature of food, the intake of drugs, the presence of pathological impurities, for example:

black, liquid, tarry feces (melena) - with bleeding from bleeding from the stomach, duodenum;

black decorated - in the treatment of bismuth, iron preparations;

unaltered blood in the feces - with bleeding from the lower sections of the large intestine, hemorrhoids;

reddish - when eating beets;

“Acholic feces” (clay, grayish-white) - blockage of the common bile duct;

light feces - with milk nutrition;

grayish - with damage to the pancreas;

greenish-yellow - with diarrhea (bilirubin does not have time to recover to biliverdin);

greenish - when using sorrel, spinach;

feces of the "rice water" type - with cholera;

feces of the “pea soup” type - with typhoid fever, etc.

Smell feces are normally unpleasant, but not sharp. It depends on the presence of indole, skatole, formed during the bacterial breakdown of protein foods. The smell intensifies with diarrhea, overeating of protein foods. A particularly sharp fetid odor has feces with putrefactive dyspepsia (digestion of proteins is disturbed). With constipation, the feces are almost odorless. With fermentative dyspepsia (digestion of carbohydrates is disturbed), the feces acquire a sour smell.

Pathological impurities of food origin: pieces of undigested meat (creatorrhoea), a significant amount of fat (steatorrhea) - the surface of "fatty" stools is shiny, the consistency is greasy. The allocation of lumps of undigested food is called lentorrhoea, a large number of starch grains is called amylorrhea.

Chemical research

The reaction of feces is usually neutral or slightly alkaline. A sharply alkaline reaction occurs with the predominance of putrefactive processes, and an acidic reaction occurs with fermentative dyspepsia.

Small, so-called hidden bleeding, does not affect the color of the feces and can only be detected chemically. One of these special tests for occult blood is called the benzidine test (Gregersen test).

Sterkobilin is most often examined in the absence of a brown color characteristic of feces. An increased content of stercobilin occurs with increased hemolysis of erythrocytes, and a reduced (or lack of it) occurs with mechanical and parenchymal jaundice.

Bilirubin in feces is detected in infants, as well as in adults when the intestinal microflora is suppressed (for example, during antibiotic treatment).

microscopic examination

Normally, feces contain small amounts of fiber, muscle fibers, neutral fat, starch grains. In pathology, worm eggs, pathogenic protozoa, fungi, food residues, cellular elements (erythrocytes, leukocytes, mucus, atypical cells) can be detected.

Bacteriological research

Normally, a person always has a microbial flora in the digestive tract, especially a lot of bacteria in the large intestine. Among them, lactic acid fermentation bacilli, E. coli predominate, enterococci, etc. are found. All these bacteria are in a state of eubiosis (a kind of balance). A quantitative or qualitative change in the composition of the normal intestinal microflora in the direction of a sharp increase in pathological and a decrease in normal microflora is called intestinal dysbacteriosis.

A bacteriological study is carried out in order to identify the presence and severity of dysbacteriosis and to establish the nature of the pathological microflora. It is usually carried out with bowel dysfunctions due to antibiotic treatment or with a prolonged recovery period after intestinal infections.

Similar information.

All of us, when healthy, easily give good advice to the sick.

How to decipher the coprogram?

To identify any diseases of the digestive system, first of all, an analysis of feces is performed - a coprogram. A coprogram is an analysis of the chemical, physical and microscopic characteristics of feces, as well as other components and inclusions of various origins.

This study allows you to make the correct diagnosis, control the treatment of diseases of the gastrointestinal tract and timely detect certain pathological processes taking place in the body. With the help of a coprogram, problems such as malabsorption of food, lack of digestive enzymes, inflammation in the intestines, disruption of the stomach, accelerated passage of food, etc. can be diagnosed.

Any special preparation or diet for the collection of this analysis is usually not required. However, a week before the delivery of feces, it is better to stop taking drugs that can affect its color (barium sulfate, bismuth, iron) and lead to increased intestinal motility. It is also not recommended to do an enema, put rectal suppositories and take special laxatives.

Feces must be collected in a sterile container with a tightly closed airtight lid after self-emptying of the intestine. It is advisable to deliver the container to the laboratory that will conduct the study during the day. It is necessary to store the jar with the analysis in the refrigerator.

Shape and texture of stool

The shape of the feces largely depends on its consistency, and the consistency, in turn, is determined by the content of water, fiber and fat in the feces. Normally, feces should have a cylindrical shape and a homogeneous, fairly dense consistency. Water makes up almost 80% of feces, but with constipation, this figure drops to 70-75%, while with diarrhea, on the contrary, it increases to 90%.

If a person consumes a large amount of vegetable fiber, which enhances intestinal motility, his feces may have a mushy form due to insufficient absorption of water. When eating a significant amount of meat, the shape of the stool becomes more dense. Loose stools are characteristic of food poisoning, frothy stools often indicate the presence of fermentative dyspepsia.

With constipation, the feces are usually very dense, which is often the result of low water intake. The ribbon-like shape of the feces indicates the possible presence of a tumor in the rectum or sphincter spasm. Lumpy stools (“sheep feces”) are observed in spastic colitis. If there is an abundant release of fat in the feces, its consistency is called ointment. This picture can be observed in chronic pancreatitis, blockage of the bile duct.

Amount of feces

Usually, a decrease in the amount of fecal excretion by the body occurs due to prolonged constipation, which is caused by chronic colitis, dehydration, intestinal ulcers, etc. With inflammation and diarrhea, fecal excretion, on the contrary, increases.

stool color

The color of the feces of a healthy person should have different shades of brown, which is due to the presence of stercobilin in the feces - the final product of pigment metabolism. The color of the feces is influenced by the food and medicines taken. When eating mainly meat products, a dark brown color of the stool appears, plant foods - light brown. Eating a lot of green vegetables can give your stool a slightly green tint.

With a diet rich in dairy products, the feces become yellow (this is the color of the stool in infants who consume breast milk). Fecal masses of a reddish hue occur when eating beets and red grapes, black color is caused by taking iron, bismuth, activated charcoal, coffee, blackcurrant preparations. From products containing carotene (pumpkin, carrots) there may be an orange stool. Thus, with the exclusion of staining of feces with food or drugs, a change in its color is due to a pathological process in the intestine.

Reddish-brown stool usually indicates bleeding in the lower intestine due to hemorrhoids, anal fissure. Black coloring of feces indicates the presence of bleeding in the upper intestine with a duodenal ulcer or cancer. Green color is typical for such a phenomenon as dysbacteriosis, inflammation of the mucous membrane of the small intestine, or accelerated evacuation of food. A whitish-gray color of the stool often occurs with diseases of the gallbladder and liver.

Smell of feces

The smell of feces is normally unpleasant, but not sharp, and usually depends on the food consumed by a person. It is determined by the presence in it of such aromatic substances as skatole, phenol, indole, etc., formed during the bacterial breakdown of proteins. With the predominance of meat food in the diet, the smell of feces is more pronounced. If a person consumes more vegetable or dairy foods, the smell is less noticeable.

Due to absorption into the intestines of the breakdown product of proteins during constipation, feces are practically odorless. With diarrhea, on the contrary, the smell of the stool is very specific. In people suffering from fermentative dyspepsia (the so-called indigestion, which is associated with a large consumption of sugar, fruits, flour, legumes, kvass), there is a sour smell of feces.

With putrefactive dyspepsia (digestion problems associated with the consumption of large amounts of protein foods that are slowly digested in the intestines), feces acquire a putrid unpleasant odor. Also, a similar smell is characteristic of colitis in combination with constipation. If a person has disorders in the pancreas or there is no flow of bile in the digestive tract, a sharp fetid odor of feces may appear.

fecal reaction

It is believed that normally the reaction of feces should be neutral, slightly acidic or slightly alkaline. Basically, the ph of feces depends on the microflora that inhabits the intestines. If there is an increase in the processes of decay of proteins that are not digested enough in the small intestine and stomach, ammonia is formed, giving the stool an alkaline reaction (pH 8.0-10.0). With an increase in fermentation processes, the iodophilic flora is activated, carbon dioxide and free organic acids are released, which in turn shifts the reaction to a more acidic side (pH 5.0-6.5).

The food consumed by a person, and more specifically the predominance of protein or plant foods, has a significant effect on the ph of stool. With a mixed diet, feces have a slightly alkaline or neutral reaction. If a person consumes mainly plant foods, the reaction of feces becomes more alkaline. The meat diet gives an acidic reaction. In principle, the determination of fecal ph has no significant diagnostic value, so the values ​​\u200b\u200bmay fluctuate, and this will not be considered pathological.

Connective tissue in the stool

Connective tissue is called undigested particles of meat food that got into the feces. If you look at it under a microscope, you will see whitish-gray patches with a fibrous structure. Sometimes the connective tissue can be mistaken for mucus, but it usually differs in a clearer outline and in its density. Normally, there should be no connective tissue in the feces.

Its presence in the feces indicates a lack or absence of hydrochloric acid or a decrease in the acidity of gastric juice, since it is with the help of gastric juice that the connective tissue in the body is digested. Thus, meat food without hydrochloric acid cannot be subjected to primary processing, which naturally reduces the quality of its digestion and proper assimilation in the digestive tract.

The presence of connective tissue in the feces sometimes indicates a lack of pancreatic function, a lack of its enzymes, which leads to incomplete breakdown of the food consumed and, as a result, the appearance of connective tissue. At the same time, a small amount of connective tissue in the feces is also acceptable in a healthy person with improved digestion, if he has eaten raw or poorly cooked, fried meat.

Muscle fibers

Detection of muscle fibers in the feces occurs when protein foods (mainly fish and meat) are not digested in the digestive tract and enter the feces. Muscle fibers are divided into several types:

Digested (altered)

In appearance, they resemble small lumps of various sizes with rounded edges without pronounced striation.

Insufficiently digested (little modified)

Such fibers are usually cylindrical in shape and have a longitudinal striation, the corners are smoothed.

Undigested (unchanged)

Undigested fibers are characterized by an elongated cylindrical shape with obvious sharp corners and pronounced striation.

Normally, in healthy people, muscle fibers in the feces should not be detected or may be present in small quantities. If there are a large number of muscle fibers in the feces, this is a symptom of creatorrhea. Creatorrhoea appears when there is insufficient release of hydrochloric acid for the digestion of food, and meat food is not properly processed.

It is also characteristic of patients with impaired pancreatic function with a lack of necessary enzymes that are involved in the breakdown of proteins. In a child up to a year old, consuming meat food, an increased number of muscle fibers is often found in the coprogram, which only indicates the immaturity of the digestive system of young children. As the body grows, food begins to be absorbed better.

Fatty acids, soaps and neutral fat in feces

Normally, the feces of a healthy person should not contain neutral fat and its decay products - soaps and fatty acids, because fat from food is usually absorbed by 90-98%. Only a small amount of soap is acceptable.

The presence in the feces of a large amount of neutral fat and its breakdown products is called steatorrhea. The causes of steatorrhea are as follows:

Violation of the pancreas

A decrease in the activity of the main enzyme involved in the process of digestion of fats - lipase, leads to incomplete absorption of dietary fats and, as a result, the presence of neutral fat in the feces.

Malabsorption of fat in the intestine and accelerated evacuation of food

A failure in the process of moving food through the small intestine leads to the fact that products, including fats, simply do not have time to be completely digested.

Sometimes fats in the feces appear due to excessive consumption of fatty foods, the use of some rectal suppositories, castor oil. In children, fats in the feces indicate the immaturity of the enzyme system.

Violation of the flow of bile into the intestines

Insufficient flow of bile into the intestines greatly affects the absorption of fats in the body. Fat cannot dissolve in water and therefore cannot be properly digested by aqueous solutions of enzymes.

Digestible and indigestible plant fiber in feces

Vegetable fiber is found in fruits, vegetables, grains and legumes and belongs to the group of complex carbohydrates (polysaccharides). In the human body, there are no digestive enzymes that can break down fiber, so only a small part of it is digested with the help of beneficial intestinal microflora. The rest is removed from the body unchanged, which is the norm.

Fiber irritates the intestinal wall, causing it to contract and move food and subsequently remove undigested substances from the body. It maintains the balance of microflora in the human intestine, since the beneficial bacteria that live in the intestine feed on coarse dietary fiber.

Fiber is digestible and indigestible. Digestible fiber is a round-shaped cell with a thin, easily collapsing shell. A layer of pectin binds the cells of digestible fiber to each other and first dissolves under the influence of gastric juice, and then in the duodenum.

If the body produces an insufficient amount of hydrochloric acid in the gastric juice, vegetable fiber is found in the feces as a cluster of cells (potatoes, beets, carrots). In this regard, even when eating a large amount of vegetables and fruits, a person may not get useful nutrients from fiber.

Indigestible vegetable fiber is a thick double-circuit shell, which contains lignin, which gives the fiber rigidity and a solid structure. It includes the epidermis of cereal crops, plant hairs, their vessels, the skin of vegetables and fruits. Usually the presence of indigestible fiber in the human body depends on what he eats.

In the feces of a healthy person who eats plant foods, normally digestible plant fiber should not be present. Indigestible is always found and can be in different quantities. A large amount of digestible fiber in the feces indicates a decrease in the acidity of gastric juice, problems with the pancreas, and accelerated evacuation of food from the intestines. If a person consumes a lot of fiber, it may not have time to be digested properly and, as a result, be found in the analysis of feces.

Starch in stool

Starch is the complex and most abundant carbohydrate (polysaccharide) in the human diet. It can be found in almost all plant foods consumed by people on a daily basis (rice, corn, millet, potatoes, legumes, rye, oats). The process of starch digestion begins in the human mouth. First, food is mixed with saliva containing the digestive enzyme amylase, then in the stomach until it mixes with gastric juice.

After that, food from the stomach enters the intestines and mixes with pancreatic juice, which contains a more effective amylase than salivary amylase. Digestion of food ends in the small intestine and the end product of the breakdown of starch is glucose, which is absorbed by the body. Normally, there should be no starch in the feces.

With problems with digestion, starch in feces can be in the form of intracellular and extracellular grains. The presence of starch in the stool is called amylorrhea. The detection of a large number of starch grains in the feces is characteristic of disorders of the pancreas and stomach, and is also often found with accelerated intestinal motility during diarrhea.

Iodophilic flora in feces

The intestinal microflora consists of a collection of microorganisms that perform various vital functions. Each person has its own, but among all the microorganisms that inhabit the intestines, the beneficial flora, representatives of which are lacto and bifidobacteria, should prevail. The latter should represent more than 90% of all bacteria living in the intestines, and all immunity rests on them.

If the number of lacto or bifidobacteria decreases, pathogenic flora takes their place. Iodophilic flora in human stool indicates an imbalance of beneficial bacteria in the intestines and should normally be either absent or present in a minimal amount. Iodophilic microorganisms include staphylococci, enterococci, Escherichia coli, yeast fungi, and other bacteria that have the ability to turn dark when interacting with iodine solutions.

Detection of iodophilic flora in the stool is not necessarily a sign of bowel disease. When assessing the presence of bacteria in the analysis, it is necessary to take into account the nature of the patient's diet on the eve of the delivery of the coprogram, since the appearance of iodophilic flora may be the result of fermentative dyspepsia due to excessive intake of carbohydrates from food. The presence of iodophilic bacteria also occurs when the pancreas malfunctions and gastric digestion is disturbed.

Mucus in stool

Mucus is called some iron-like secretions of a light color in the form of strands, lumps or a vitreous mass. In a healthy person, mucus should not be found in the stool, because when it enters the large intestine, it is completely mixed with feces and is not excreted as a separate substance. Normally, a small amount of mucus may be present in the analysis, since the presence of mucus in the stool may appear when certain foods are consumed or a runny nose.

The presence of mucus in the coprogram of a child up to a year old may occur, but there should be no pungent odor, blood, or discoloration of the stool. Mucus should be a little. If mucus is found in large quantities, this may indicate an inflammatory process in the intestines or an intestinal infection.

Leukocytes in feces

Leukocytes are called white blood cells, the purpose of which is the fight against infectious agents. In the presence of an inflammatory process in the human body, leukocytes increase. In a healthy person, leukocytes in the stool are found in a single amount. If there are significantly more of them, this is a signal that there is inflammation in the intestines, the cause of which is most often a gastrointestinal infection, enteritis, colitis, erosive changes in the mucous membrane, etc.

The presence of leukocytes in the feces is considered only in conjunction with the patient's complaints and the study of the overall clinical picture, since their presence alone cannot give an accurate assessment of the state of human health.

erythrocytes in feces

Erythrocytes are red blood cells containing hemoglobin. In a healthy person, they should be absent in the feces. Their presence in the stool may indicate hemorrhoids, anal fissures, polyps, ulcers, bleeding in the digestive tract. There are two sources of red blood cells (that is, blood) in the stool: the upper section (stomach and small intestine) and the lower (large intestine, rectum and anus).

If there is bleeding from the upper digestive tract, the blood is dark or even black. In the lower section, blood usually mixes with feces and is present on surfaces or toilet paper. If bleeding is suspected in the upper intestine, an occult blood test based on the determination of hemoglobin is prescribed.

A positive result of such an analysis can indicate not only serious problems, but also be noted with bleeding gums and eating certain foods. Therefore, before passing this analysis, it is recommended to refrain from eating meat and fish for several days.

epithelium in feces

Epithelium is the cells that line the cavity and surface of the body, the mucous membrane of internal organs, the urogenital tract, the respiratory system, and the lining of the digestive tract. Its main function is to protect the body from mechanical damage and infectious agents. In the analysis of human feces, columnar and squamous epithelium can normally be detected. Cylindrical has the shape of a cylinder - this type of epithelium enters the feces from all parts of the intestine.

The cells of the squamous epithelium are quite dense and strong, their detection in the feces as it is correct has no diagnostic value. They enter the feces from the anus. A small amount of intestinal epithelium can be found in the analysis of feces. This is a consequence of the so-called process of physiological desquamation. If many cells of the cylindrical epithelium are found, as well as mucus, leukocytes and erythrocytes are present in the feces, this indicates an inflammatory process in the intestinal mucosa and requires treatment.

Stercobilin in feces

Stercobilin is a special bile pigment that is formed in the human large intestine during the processing of bilirubin. It is he who gives the feces its usual brown color. Stercobilin in the stool increases with increased bile secretion and hemolytic anemia. A decrease or absence of this pigment indicates the possible presence of pancreatitis, hepatitis or other liver damage, cholelithiasis, cholangitis, or even jaundice in a patient.

Presence of bilirubin in feces

A healthy person should normally not have bilirubin in the feces. However, there is an exception for children who are breastfed. Bilirubin may be present in their feces up to 9 months of age. The presence of bilirubin in the feces of an adult indicates a violation of the restoration of bilirubin in the intestine when exposed to microbes.

It can be detected with accelerated evacuation of intestinal contents, neglected dysbacteriosis (increased growth of pathogenic microorganisms in the colon), often as a result of prolonged use of antibiotics. If both stercobilin and bilirubin are detected in the analysis of feces, this indicates the displacement of the normal intestinal flora by the pathogenic flora and requires adjustment with drugs with beneficial bacteria.

Soluble protein in feces

Soluble protein in feces is called calprotectin. Normally, it should not be detected in the analysis of feces. The appearance of calprotectin in human feces often indicates diseases of the gastrointestinal tract, such as ulcerative colitis, Crohn's disease, gastritis, pancreatitis, putrefactive dyspepsia, and massive intestinal bleeding. Also, the presence of soluble protein in the feces can indicate obesity, allergies to dairy products, celiac disease.

Worm eggs and protozoa in stool

The presence in the feces of eggs of worms and protozoa (giardia, dysenteric amoeba, etc.) indicates helminthic invasion and invasion by protozoa and requires mandatory treatment.

Yeast fungi in stool

Often, the cause of the appearance of fungi in the intestines can be prolonged use of antibiotics, a history of diabetes mellitus, as well as a weakening of human immunity. Yeast fungi are found as spores, yeast cells, mycelium and pseudomycelium.

Calcium oxalate crystals in stool

The presence of calcium oxalates in the analysis of feces indicates achlorhydria (the absence of free hydrochloric acid in human gastric juice).

Tripelphosphate crystals in feces

If crystals of trippelphosphates are found in fresh human feces, this indicates an increase in the process of protein decay in the large intestine.

Feces should be examined no later than 8-12 hours after defecation. The material is collected in a clean, dry dish. If, when collecting material for examining feces for the presence of worm eggs, blood, stercobilin, it is advisable to use waxed cups, then to determine the degree of digestion of food, when you need to collect all the feces allocated for defecation, the dishes should be glass and capacious.
For testing for the presence of protozoa, feces must be immediately delivered to the laboratory.
Before a scatological examination, in some cases it is necessary to resort to appropriate preparation of the patient. If the purpose of the study is to detect occult blood, then it is necessary to exclude from the diet for 3 days foods that can affect reactions aimed at detecting blood. Such products are meat, fish, all kinds of green vegetables, tomatoes.

For research in order to find worm eggs, there is no need for the entire daily amount of feces, but a small portion of 40-50 g collected in a clean, dry dish is sufficient.
A small piece (the size of a pea) of feces is placed on a glass slide with a pre-applied drop of 50% glycerol solution and mixed with a glass rod. Then microscopically under a coverslip with an 8X objective, and sometimes 40X. The study of such a native drug is successful with a high content of eggs in the feces. With a small number of them, concentration methods must be used.
The most simple and common is the Fülleborn method. A small lump of feces the size of a pea is stirred with 20 times the volume of sodium chloride solution in a thick-walled glass cup. They stand up to 1 "/2 hours. The surface film is removed with a wire loop calcined in the flame of an alcohol lamp. In this way, several preparations are prepared and microscoped. A saturated solution of sodium chloride is used as a reagent. The specific gravity of a saturated solution of salt is not high enough to all the eggs surfaced, so a number of other solutions with a high specific gravity were proposed.The most successful was the saturated sodium nitrate solution proposed by E. V. Kalantaryan, in which helminth eggs float for 10 minutes. according to the following indications.
Ascaris (Ascaris lumbricoides). A characteristic feature of the egg is a bumpy brown protein shell, located on top of a smooth inner shell. Sometimes the protein shell is absent and the surface of the egg is smooth.
Pinworm (Enterobius verniicularis). The egg is oval in shape, asymmetrically (one side is flattened), colorless, transparent, the shell is thin, double-contour.
Vlasoglav (Trichocephalus trichiurus). The egg has a characteristic barrel shape, thick walls are painted brown, colorless plugs are located on the poles. The contents of the egg are fine-grained.
Hookworm (Ancylostoma duodenale). The eggs are oval, colorless, surrounded by a thin transparent shell, under which 2-8 crushing balls are visible.
Unarmed tapeworm (Tachiarynchus saginatus). In the feces, not eggs are usually found, which are quickly destroyed, but embryos - oncospheres, which have an oval shape and a thick shell with radial striation, inside - an embryo with 3 pairs of hooks.

Armed tapeworm (Tachia solium). Oncospheres are indistinguishable from oncospheres of an unarmed tapeworm, more often rounded.
Dwarf tapeworm (Humenolepis nana). The egg is round or elliptical in shape, strongly refracts light. It has two thin shells, of which the inner one covers the oncosphere. There are 6 hooks in the oncosphere.
Wide tapeworm (Diphyllobothrium latum). Eggs are oval, yellow or brown. On one pole there is an operculum, on the opposite - a tubercle. Inside the egg is coarse-grained content.
Detection and differentiation in the feces of protozoa is one of the most difficult sections of the study, which requires a certain amount of experience and thoroughness in work.
Most unicellular organisms are found in feces in 2 forms: vegetative-active, live, and in the form of immobile cysts resistant to the external environment.
Vegetative forms can be found mainly in liquid feces, in the formed they are found only in the encysted state. Therefore, if the stool is not formed and a fecal analysis is prescribed to identify vegetative forms, then the feces should be immediately delivered to the laboratory and examined, since in the cooled feces the protozoa lose their mobility, die and are quickly destroyed dead under the action of proteolytic enzymes.
A chemical study in the general analysis of feces is reduced to determining the pH using a litmus test, to reactions to the detection of latent blood and a test for stercobilin.

Qualitative test for stercobilin

To detect occult blood in the feces, a benzidine test (Gregersen) and a test with guaiac resin (Weber) are used.
The benzidine test is made on a glass slide. The glass is placed in a Petri dish placed on white filter paper, a little fecal emulsion is applied to the glass and 2 drops of a solution of benzidine in acetic acid and 2 drops of hydrogen peroxide are dripped onto it and the time of appearance of a blue-green color is noted. If the color appears instantly, then the sample is considered sharply positive (+ + +); the appearance of color between the 3rd and 15th s is regarded as a positive test (+ +); if the color appears between the 15th and 60th seconds, then the sample is considered weakly positive (+). A faint green coloration that appears between the 1st and 2nd minute is regarded as traces. The color developed after 2 minutes is not taken into account, since 1 blood participates in this reaction as its accelerator (catalyst). If the benzidine test is positive, then Weber's test, which is much less sensitive, must be done. With a negative benzidine test, the latter does not make sense, and with a positive one, it makes it more likely to confirm the presence of hidden bleeding.
The Weber test is also performed on a glass slide with a piece of white filter paper. 2 drops of acetic acid, 2 drops of alcohol tincture of guaiac resin and 2 drops of hydrogen peroxide are applied to the fecal emulsion. The appearance of a blue-green color indicates a positive reaction.
Filter paper is used to better detect color changes.

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Odor rating
A sharp unpleasant odor of feces appears due to the occurrence in the digestive tract of pathological reactions of decay or fermentation. This is found in chronic pancreatitis, dysbacteriosis.

Examination of feces for occult blood
If it is necessary to conduct a study of feces for occult blood, the patient must strictly adhere to a diet for 3 days with the exception of meat and fish products. If blood is present in a significant amount, then its presence is determined even visually. A small admixture of blood is established by means of a special benzidine test, as well as a pyramidon or Weber reaction. The collection of material for research from the patient is carried out in the same way as in the general analysis. Occult blood is present in the feces in diseases such as peptic ulcer of the stomach or duodenum with little bleeding, polyposis of the stomach or intestines, neoplasms of any part of the gastrointestinal tract and helminthiasis.
The benzidine fecal occult blood test is better known as the Gregersen test. This analysis allows you to detect even the minimum amount of blood in the feces - up to several milliliters.

Examination of feces for enterobiasis
This analysis reveals pinworm eggs. The material for it is often obtained by scraping helminth eggs with a cotton swab soaked in a 50% glycerol solution from the perianal folds.

Examination of feces for protozoa
Of the simplest in the feces, dysenteric amoeba and Trichomonas are detected. In preparation for the sampling of material for research, the patient should refrain from administering drugs, especially with the help of enemas. The feces container should not contain the slightest traces of disinfectants. Material is taken for examination from mucous, bloody areas of feces. Their microscopy is carried out immediately within 15-20 minutes.

Examination of feces for Giardia cysts
Giardia cysts have the ability to remain in the material for research from the patient without changes for a long time. In this regard, feces do not have to be sent to the laboratory urgently.

Examination of feces for bile pigments
This analysis allows you to establish the quantitative content of stercobilin in the feces.
The sampling and sending of material for research from the patient is carried out in the same way as for a general analysis of feces.

Examination of feces for dysentery, typhoid and paratyphoid group of microorganisms and stake and pathogenic bacillus
For this analysis, a special case with a preservative is used, in which the material for research is placed. In this case, it is preferable to send mucous and bloody fragments of feces. The study is carried out by bacteriological method.

Examination of feces for tubercle bacilli
For maximum information content of the results of laboratory tests, mucous and bloody stools are collected in a sterile container.

Examination of feces for dysbacteriosis
A small portion of feces is placed in a conventional sterile container without preservative and is urgently sent for laboratory research.

Examination of feces for stercobilin and stercobilinogen
This analysis is carried out in order to diagnose cholelithiasis and hepatitis, in which the content of pigments in feces is significantly reduced.

Examination of feces for bilirubin
In a healthy person, this reaction is negative. The presence of bilirubin in the feces is determined in dysbacteriosis and acute gastroenteritis.

Examination of material from a patient for cholera vibrio
In this case, the material for bacteriological analysis in order to detect vibrio cholerae is not only the patient's feces, but also his vomit. The container for collecting material should be glass or enameled. The use of tinware is excluded in order to avoid oxidation of the test material and distortion of the analysis results. After taking the material for research from the patient, the container should be packed in a special metal container. Due to the special danger of the spread of infection, analysis for the detection of cholera vibrio is carried out only in special laboratories of sanitary and epidemiological stations.

General analysis of feces is an important element in the diagnosis of diseases of the digestive system. With its help, you can assess the state of the intestinal microflora, enzymatic activity, diagnose inflammatory processes, and more.

Rules for the collection and preparation for the delivery of material

How to prepare for a stool test:

Rules for collecting material for analysis:

Macroscopic and microscopic properties of feces

Quantity

In children up to a month, the norm- 10-20 grams per day, from 1 month to 6 months - 30-50 grams per day. In some cases, there is an increased or decreased amount of feces in children and adults.

The main reason for this is constipation. The reasons for the increased amount: increased intestinal motility, pancreatitis, pathology of food processing in the small intestine, enteritis, cholecystitis, cholelithiasis.

Consistency

Normal stool consistency in children who are breastfed - mushy, if the child is fed with milk mixtures, then normally the material should be of a putty-like consistency, in older children and adults - decorated.

Changes in stool consistency occur for various reasons. Very dense material occurs with stenosis and spasm of the colon, with constipation, mushy - with hypersecretion in the intestine, colitis, dyspepsia, increased intestinal motility.

Ointment-like feces are noted in diseases of the pancreas and gallbladder, liquid - with dyspepsia or excessive secretion in the intestine, with fermentative dyspepsia, foamy feces are noted.

Color

Material color depends on age. The norm for the color of feces in children who are breastfed is golden yellow, yellow-green, in children who are fed with milk mixtures - yellow-brown. In adults and older children, the normal color is brown.

Causes of color change:

• Black or tarry stool noted with internal bleeding, usually in the upper gastrointestinal tract, as well as when eating dark berries, or when taking bismuth preparations.
• Dark brown stool happens with putrefactive dyspepsia, disorders of food digestion, colitis, constipation, when eating a large amount of protein food.
• Light brown stool - with increased intestinal motility.
• Reddish stool observed in ulcerative colitis.
• Green feces indicates an increased content of bilirubin or biliverdin.
• Greenish black stool happens after taking iron supplements.
• Light yellow stool observed in pancreatic dysfunction.
• Grayish-white - with hepatitis, pancreatitis, choledocholithiasis.

Smell

The main components of the smell are hydrogen sulfide, methane, skatole, indole, phenol. The normal smell in breastfed babies is sour, in “artificial” babies it is putrid. In older children and adults - unsharp feces.

The main reasons for the change in odor in the general analysis of feces in children and adults:

• A putrid smell is noted with colitis, putrefactive dyspepsia, gastritis.
• The sour smell of feces indicates fermentative dyspepsia.
• Fetid - with pancreatitis, cholecystitis with choledocholithiasis, hypersecretion of the large intestine.
• The smell of butyric acid is noted with accelerated excretion of feces from the intestines.

Acidity

What should be the acidity in children and adults in the general analysis of feces:

• In infants who eat formula milk, it is slightly acidic (6.8-7.5).
• In children who are breastfed, it is sour (4.8-5.8).
• In children older than a year and adults, the acidity should normally be neutral (7.0-7.5).

Changes in stool pH in children and adults affected by changes in the intestinal microflora. When eating carbohydrate foods, due to the onset of fermentation, the acidity of feces can shift to the acid side. When eating protein foods in large quantities, or with diseases that affect the digestion of proteins, putrefactive processes sometimes begin in the intestines, shifting the pH to the alkaline side.

Causes of acidity change:

• Slightly alkaline pH (7.8-8.0) is observed with poor processing of food in the small intestine.
• Alkaline pH (8.0-8.5) - for colitis, constipation, dysfunction of the pancreas, large intestine.
• Sharply alkaline pH (> 8.5) is noted with putrefactive dyspepsia.
• Acid pH (< 5,5) свидетельствует о диспепсии бродильной.

Slime

In the absence of pathology, mucus in the feces in children and adults should not be. Small amounts of mucus are allowed in the feces of infants.

Causes of mucus:

• Infectious diseases.
• IBS is irritable bowel syndrome.
• Polyps in the intestine.
• Haemorrhoids
• Malabsorption syndrome.
• Hypolactasia.
• celiac disease
• Diverticulitis.
• Cystic fibrosis.

Blood

In the absence of pathology, there is no blood in the feces in children and adults.

Reasons for the appearance of blood in the analysis:

• Haemorrhoids.
• Anal fissures.
• Inflammation of the rectal mucosa.
• Ulcers.
• Expansion of the veins of the esophagus.
• Nonspecific ulcerative colitis.
• Neoplasms in the gastrointestinal tract.

Soluble protein

In the feces, in the absence of diseases, the protein is not detected. The reasons for its appearance: inflammatory diseases of the digestive system, hypersecretion of the large intestine, putrefactive dyspepsia, internal bleeding.

Stercobilin in general analysis

Sterkobilin- a pigment that stains feces in a specific color, it is formed from bilirubin in the large intestine. The rate of formation of stercobilin is 75-350 mg / day.

Increased content of stercobilin and in the feces due to increased bile secretion, and is also noted in hemolytic anemia.

The reasons for the decrease in stercobilin are obstructive jaundice, cholangitis, cholelithiasis, hepatitis, pancreatitis.

Bilirubin in general analysis

Bilirubin to Stercobilin processed by the intestinal microflora. Up to 9 months, the microflora does not fully process bilirubin, so its presence in the feces in children under 9 months is the norm. In children older than 9 months and in adults, bilirubin should not be present during normal functioning of the digestive system.

Reasons for the appearance of bilirubin: antibiotic therapy, increased intestinal motility.

Ammonia

By the amount of ammonia in the analysis, one can judge the intensity of protein decay in the toast intestine. The content of ammonia in the general analysis of feces according to the norms in children and adults is 20-40 mmol / kg. Reasons for the increase in ammonia: inflammation in the toast, hypersecretion.

Detritus

Detritus- small structureless particles consisting of bacteria, processed food and epithelial cells. A large amount of detritus indicates good digestion of food.

Muscle fibers

Muscle fibers in stool is a product of the processing of animal protein. Normally, there should be no muscle fibers in the feces of infants; in adults and older children, a small amount is allowed, but they must be well digested.

The reasons for the increase in muscle fibers in the analysis in children and adults:

• Dyspepsia.
• Gastritis.
• Achilia.
• Increased intestinal peristalsis.
• Pancreatitis.

Connective tissue fibers

Connective tissue fibers- undigested food residues of animal origin. With the normal functioning of the digestive system, they should not be in the feces. The causes of the appearance of connective fibers are gastritis, pancreatitis.

Starch

Starch found in plant foods. It is well digested and is normally absent in the analyzes. The causes of the appearance of starch: gastritis, pancreatitis, accelerated withdrawal of intestinal contents.

vegetable fiber

vegetable fiber is digestible and indigestible. Indigestible fiber may be contained, its amount has no diagnostic value. Normally, digestible fiber should not be found in the material.

Reasons for the detection of digestible vegetable fiber in the coprogram:

• Pancreatitis.
• Gastritis.
• Ulcerative colitis.
• Accelerated removal of intestinal contents.
• Putrid dyspepsia.

Neutral fat

A small amount of neutral fats can only be found in infants, since their enzyme system is still not sufficiently developed. The presence of neutral fat in stool tests in adults and older children is a sign of some kind of disease.

Some reasons for finding neutral fats:

• Gallbladder dysfunction.
• Violation of the pancreas.
• Accelerated evacuation of intestinal contents.
• Intestinal malabsorption syndrome.

Fatty acid

With normal functioning of the intestines, fatty acids are completely absorbed. A small amount of fatty acids in the faeces of infants is allowed.

The appearance of fatty acids in the feces can be caused by the following diseases: fermentative dyspepsia, pancreatitis, hepatitis, cholecystitis.

Soaps

Soaps are leftovers from the processing of fats. With the normal functioning of the digestive system, they should be in the analysis in a small amount.

No soaps in stool- a sign of a number of diseases: accelerated evacuation from its intestinal contents, hepatitis, pancreatitis, gallbladder disease, malabsorption of food elements in the intestine.

Leukocytes

Leukocytes- blood cells, the presence of single leukocytes is normally allowed only in infants. Sometimes leukocytes are found if the analysis was incorrectly collected (leukocytes from the urethra).

The main reasons for the presence of leukocytes in feces: colitis, enteritis, rectal fissures.

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

The stool of a healthy person consists of about 1/3 food debris, 1/3 organ secretions and 1/3 microbes, 95% of which are dead. The study of feces is an important part of the examination of a patient with. It can be general clinical or pursue a specific goal - the detection of hidden blood, eggs of worms, etc. The first includes macro-, microscopic and chemical research. Microbiological examination of feces is performed if an infectious intestinal disease is suspected. Feces are collected in a dry, clean dish and examined fresh, no more than 8-12 hours after isolation, while keeping in the cold. The simplest are sought in completely fresh, still warm feces.

For microbiological examination, feces must be collected in a sterile tube. When examining feces 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 digestion of food, the patient receives a common table (No. 15) with the obligatory presence of meat in it. In some cases, for a more accurate study of the assimilation of food and metabolism, a trial diet is resorted to. Before collecting feces for 2-3 days, the patient is not given drugs that change the nature or color of feces.

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 assimilation. With lesions of the pancreas, intestinal amyloidosis, when the absorption of food is impaired, the weight of feces can reach up to 1 kg.

The shape of the 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 feces depends on the presence of stercobilin in it (see).

In case of violation of bile secretion, the feces acquire a light gray or sandy color. With heavy bleeding in the stomach or duodenum, black feces (see Melena). The color of the feces is also changed by some medicines and plant food pigments.

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

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

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

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

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

Microscopic examination (Fig. 1-8) is carried out in four wet preparations: a lump of feces the size of a match head is rubbed on a glass slide with tap water (first preparation), Lugol's solution (second preparation), Sudan III solution (third preparation) and glycerin (fourth preparation). In the first preparation, most of the formed elements of feces are differentiated: indigestible plant fiber in the form of cells of various sizes and shapes with a thick shell or their groups, digestible fiber with a thinner shell, yellow muscle fibers, cylindrical in shape with longitudinal or transverse striation (undigested) or without striations (semi-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 that turn blue or purple with this reagent, and iodophilic flora. In the preparation with Sudan III, bright, orange-red drops of neutral fat are found. A preparation with glycerin serves to detect helminth eggs.

Chemical research in general clinical analysis is reduced to simple qualitative samples. Using litmus paper, determine the reaction of the medium. Normally, it is neutral or slightly alkaline. With a light color of feces, a test is made for: a lump of feces the size of a hazelnut is triturated with several milliliters of a 7% sublimate solution and left for a day. In the presence of stercobilin, a pink color appears.

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