Stool analysis is normal in adults. Clinical significance of stool examination. Preparing for stool donation

A general stool analysis is an important element in diagnosing 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 collecting and preparing for delivery of material

How to properly 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. 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 breastfed children it is mushy; if the child is fed formula milk, then normally the material should have a putty-like consistency; in older children and adults it should be shaped.

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

Ointment-like stool is observed in diseases of the pancreas and gall bladder, liquid stool is observed in dyspepsia or excess secretion in the intestines, and foamy stool is noted in fermentative dyspepsia.

Color

Material color depends on age. The normal color of stool in children fed breast milk is golden-yellow, yellow-green; in children fed with formula milk it is yellow-brown. In adults and older children, the normal color is brown.

Reasons for color change:

• Black or tarry stool observed with internal bleeding, usually in the upper gastrointestinal tract, as well as when eating dark berries, or when taking bismuth preparations.
• Dark brown stool occurs with putrefactive dyspepsia, digestive disorders, colitis, constipation, and when consuming large amounts of protein foods.
• Light brown stool – with increased intestinal motility.
• Reddish stool noted 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 with 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 children is sour, in “artificial” babies it is putrid. In older children and adults, soft stool is present.

The main reasons for changes in odor in a general stool analysis in children and adults:

• A putrid odor is observed in colitis, putrefactive dyspepsia, and 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 observed with accelerated excretion of feces from the intestines.

Acidity

What acidity should be in children and adults in a general stool analysis:

• In infants who are fed formula milk, it is slightly acidic (6.8-7.5).
• In children who are fed mother's milk, it is sour (4.8-5.8).
• In children over one year old and adults, acidity should normally be neutral (7.0-7.5).

Changes in stool pH in children and adults influenced by changes in intestinal microflora. When eating carbohydrate foods, due to the onset of fermentation, the acidity of feces may shift to the acidic side. When consuming 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.

Reasons for changes in acidity:

• A slightly alkaline pH (7.8-8.0) is observed when food is poorly processed in the small intestine.
• Alkaline pH (8.0-8.5) – for colitis, constipation, dysfunction of the pancreas and large intestine.
• A sharply alkaline pH (> 8.5) is observed in putrefactive dyspepsia.
• Strongly acidic pH (< 5,5) свидетельствует о диспепсии бродильной.

Slime

In the absence of pathology, there should be no mucus in the feces of children and adults. Small amounts of mucus are allowed in the feces of infants.

Causes of mucus:

• Infectious diseases.
• IBS - irritable bowel syndrome.
• Polyps in the intestines.
• Haemorrhoids
• Malabsorption syndrome.
• Hypolactasia.
• Celiac disease.
• Diverticulitis.
• Cystic fibrosis.

Blood

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

Reasons for the appearance of blood in the analysis:

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

Soluble protein

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

Stercobilin in general analysis

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

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

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

Bilirubin in general analysis

Bilirubin to stercobilin processed by intestinal microflora. Until 9 months, the microflora does not fully process bilirubin, so its presence in the feces of children under 9 months is the norm. In children over 9 months and in adults, there should be no bilirubin 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 putrefaction in the colon. The ammonia content in a general stool analysis according to the norms for children and adults is 20-40 mmol/kg. Reasons for the increase in ammonia: inflammatory process in the small intestine, 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 feces is a product of processing 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.

Reasons for increased muscle fibers in the analysis in children and adults:

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

Connective tissue fibers

Connective tissue fibers– undigested remains of food products of animal origin. If the digestive system is functioning normally, they should not be present in the stool. The causes of the appearance of connective fibers are gastritis, pancreatitis.

Starch

Starch found in plant foods. It is easily digested and is normally absent in tests. Reasons for the appearance of starch: gastritis, pancreatitis, accelerated excretion of intestinal contents.

Plant fiber

Plant fiber It can be digestible or indigestible. Indigestible fiber may be present, but its amount does not have any diagnostic information. Normally, digestible fiber should not be found in the material.

Reasons for detecting digestible plant fiber in coprogram:

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

Neutral fat

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

Some reasons for detecting neutral fats:

• Gallbladder dysfunction.
• Disruption of the pancreas.
• Accelerated evacuation of intestinal contents.
• Syndrome of impaired absorption in the intestine.

Fatty acid

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

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

Soap

Soap- These are the remains of fat processing. During normal functioning of the digestive system, they should be present in small quantities in tests.

Lack of soap in stool– a sign of a number of diseases: accelerated evacuation of intestinal contents, hepatitis, pancreatitis, gallbladder diseases, impaired absorption of food elements in the intestines.

Leukocytes

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

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

Used in the diagnosis and evaluation of treatment results for diseases of the pancreas, intestines and liver. In most cases, stool analysis is carried out 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 stool (enzyme preparations, bismuth preparations, iron, laxatives, etc.). When collecting stool, you should avoid mixing it with urine. Stool analysis includes macroscopic, microscopic, chemical and bacterioscopic study.

At the beginning they carry out macroscopic examination . They study the color, shape, consistency of feces, and pathological impurities.

In obstructive jaundice, stool aholic , light, contain a lot of fat. When there is inflammation in the small intestine, there is a lot of feces, it is watery with the remains of undigested food. During fermentation processes in the intestines, stool becomes foamy with a sour odor. Black stool may be due to bleeding from the upper digestive system ( mel A ena ). But some foods (blueberries, black currants) can also give a black color. True, the stool is of normal consistency, but with bleeding it is mushy. When there is inflammation in the large intestine, there is a lot of mucus in the stool. With tumors in the large intestine or rectum, the stool often contains blood. Blood in the stool occurs with dysentery, ulcerative colitis, hemorrhoids, and rectal fissure.

Microscopic examination

It allows you to identify muscle fibers, drops of fat, starch grains, cellular elements of the blood (leukocytes, red blood cells), protozoan microbes and helminth eggs.

Microscopically, undigested, poorly digested, and scraps of well-digested muscle fibers are distinguished. Normally, with a normal diet, muscle fibers are not detected or single digested fibers are detected. A large number of muscle fibers with longitudinal and transverse striations ( creatororrhea ) is observed with insufficient production of proteolytic enzymes, as well as with accelerated evacuation of food from the intestines.

Normally, small amounts of soap may sometimes be found in feces in the absence of neutral fat. The presence of a large amount of neutral fat in the feces ( steatorrhea ) indicates a lack of lipase or impaired fat emulsification due to insufficient flow of bile into the intestines. An increase in the number of fatty acid crystals indicates malabsorption in the small intestine.

It is best to examine stool for the presence of starch in a specimen stained with Lugol's solution. Large amount of starch ( amilorrhea ) indicates a lack of amylase, which is typical for damage to the pancreas.

The detection of a large number of intestinal epithelial cells (groups, layers) indicates inflammation of the mucous membrane of the large intestine. A large number of leukocytes also occurs with inflammation in the large intestine. Leukocytes coming from the small intestine have time to be destroyed. Unchanged red blood cells are found in stool during bleeding from the large intestine. Macrophages can be found in feces - during infectious inflammatory processes in the intestines.

In addition, crystals of tripel phosphates can be found in feces during putrefactive processes with a sharply alkaline reaction of feces. Charcot-Leyden crystals in combination with eosinophils indicate an allergic process in the intestines and occur with amebiasis, helminthic infestation, and ulcerative colitis.

Eggs of the following helminths are found in feces: trematodes or flukes (liver fluke, Siberian fluke, lancet fluke), cestodes or tapeworms, nematodes or roundworms (roundworms, pinworms, whipworms, eels).

Chemical examination of stool

The task of this stage of the study is to determine the reaction of feces, the determination of “occult blood”, stercobilin, soluble protein, mucus, etc.

The normal pH value of stool is 6.0-8.0. The predominance of fermentation processes shifts the reaction to the acidic side, and the intensification of rotting processes shifts it to the alkaline side.

To detect “occult blood” they carry out benzidine test – Gregersen reaction. If the blood test is positive, a blue-green color appears within the first 2 minutes. It must be remembered that a positive reaction with benzidine can be observed when eating meat and fish, so 2-3 days before the test they are excluded from the diet.

To detect soluble protein in feces (this happens with inflammation in the intestines), Triboulet-Vishnyakov test .

When stool becomes discolored, it is necessary to determine whether the flow of bile into the intestines has completely stopped. For this purpose they carry out test for stercobilin with a 7% solution of sublimate. In the presence of stercobilin, the feces turn pink.

Stool bacterioscopy

1/3 of the dense part of feces consists of microorganisms. However, microscopically the intestinal flora is not differentiated even in stained preparations. Bacterioscopically, it is possible to differentiate the iodophilic flora (it is non-pathogenic and appears during amylorhea) and the tuberculosis bacillus (in lumps of mucus when stained according to Ziehl-Neelsen). You can study the intestinal microflora using bacteriological research.

Stool microflora is divided into:

Constant(obligate) - it is adapted to certain anatomical locations and participates in metabolic processes.

optional(concomitant, transient) - it does not adapt well to anatomical locations, can be easily replaced, is suppressed in the presence of permanent microflora, but can grow and cause an inflammatory process.

The most common intestinal microflora:

Anaerobes: bifidobacteria, lactobacilli, bacteroides.

Facultative anaerobes: Escherichia coli, enterococci.

Conditionally pathogenic representatives: Klebsiella, Enterobacter, Proteus, Pseudomonas aeruginosa, Staphylococcus, Candida, Clostridia.

Functions of permanent microflora:

1) Neutralizes chemical compounds that come from food or are formed during metabolism.

2) Regulates the gas composition of the intestines.

3) Inactivates intestinal enzymes that are not used in the digestive process.

4) Promotes the preservation of Ig if they are not involved in the work.

5) Synthesizes a number of vitamins and hormones.

6) Regulates the processes of absorption of Ca, Fe ions, inorganic phosphates.

7) Is an antigenic stimulator for general and local immunity.

The permanent microflora is located in mucus, which forms a kind of biological film (turf), within which all metabolic processes take place. Antibiotics, when used for a long time, destroy this film, thus causing the phenomenon dysbiosis with the development of the inflammatory process and signs of diarrhea. In addition, dysbiosis phenomena can also occur in various intestinal diseases, atrophic gastritis with achlorhydria, chronic pancreatitis, and cirrhosis of the liver. The diagnosis of dysbiosis is established on the basis of bacteriological studies of stool.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Stool analysis Each of us has passed at least once in our lives. And many people have to undergo this procedure periodically. If you work in catering establishments or in a kindergarten, then periodic stool testing has already become the norm.

What can be detected by stool analysis?

.site) will talk to you about this in more detail.

It is by analyzing stool that you can determine whether the intestinal microflora is normal.

After the initial examination, the feces are studied using chemical reagents. Such methods make it possible to detect microscopic inclusions of protein, blood or other elements that should not be in a stool analysis.

And the last method of studying stool is microscopy. Under a microscope in a stool analysis, you can find fats, some elements of blood, collagen, muscle, worm eggs and similar inclusions, which normally should not be present in the stool of a healthy person.
Sometimes, just by the appearance of stool, a doctor may suspect that you have some kind of disease. By the way, knowing these signs, you can make your own primary diagnoses.

results

So, if your stool is very faintly colored and rather whitish in color, then this may indicate the presence of cholelithiasis, that is, stones in the gall bladder. Pay special attention to the similar color of the stool if you are sometimes tormented by belching bile, pain or discomfort in the liver area, or nausea.

If the integrity of the gastric mucosa is damaged, or there is a stomach or duodenal ulcer, the feces become black and resemble tar in appearance.
With hemorrhoids, ulcerative colitis or dysentery, there is blood in the stool, which can be seen even without the help of a microscope.

If you suffer from chronic pancreatitis, then your stool usually includes many particles of undigested food, in addition, its smell is unpleasant, reminiscent of rotting. This appearance and smell of feces is due to changes in intestinal microflora.
A disease such as dysbiosis also affects the appearance and consistency of stool. When analyzing stool, the laboratory technician will find watery-looking stool with a specific fetid odor. In addition, there is quite a lot of unprocessed food in the stool of this disease.
If mucus is detected in a stool analysis, this indicates colitis or other inflammatory processes in the intestines. This may also indicate the presence of pathogenic intestinal microflora.

When analyzed, the color of stool may change depending on what food you ate the day before. Therefore, a couple of days before the test, you should not eat foods or take medications or dietary supplements (dietary supplements), which can affect the color of stool. For example, when you consume activated carbon, your stool becomes coal black. This will mislead doctors and prevent them from making the correct diagnosis.

KAL(syn.: excrement, faeces, excrement) - the contents of the distal colon, released during defecation. In a healthy person, K. is a mixture, 1/3 of which is the remains of food taken, 1/3 is the secretions of the digestive organs, 1/3 is microbes, 95% of which are dead.

The study of the composition of K. is an important addition to the diagnosis of diseases of the digestive system and evaluation of treatment results. It consists of macroscopic, microscopic, chemical. and bacterial. research and is drawn up in the form of a coprogram, i.e. a record of the results of a stool examination. The first three methods are easy to perform and are used in the study of blood in all patients with diseases of the digestive system. Bacteriol, the study is carried out only in cases of suspected intestinal infection.

K.'s analysis can be performed without special preparation of the patient (while eating his usual food) or after 3-4 days of using the so-called. a trial diet consisting of a specific set of foods. Trial diets are used to determine the functions and abilities of the digestive system. Schmidt's trial diet - gentle, giving almost no food residues in K. during normal digestion, and Pevzner's trial diet, built on the principle of the maximum allowable food load for a healthy person, have lost their practical significance, only occasionally they are used for special purposes.

Before collecting material, for 2-3 days it is necessary to avoid taking medications that change the character and color of blood or affect the function of the digestive organs (vagal and sympathicotropic substances, laxatives, etc.).

K. obtained during one bowel movement must be collected in a clean, dry glass container; in the case of bacterial, research, the glassware must be sterile: the use of disinfectants is unacceptable. If the purpose of K.’s research is to study the functions and state of the digestive apparatus, in particular to establish the degree of absorption of nutrients, all K. released during defecation in fresh form is collected and sent to the laboratory. Studies that detect protozoa in K. are carried out immediately after defecation, in warm feces; if this is impossible for some reason, K. is fixed with preservative solutions, which allow morphol, signs of vegetative forms and protozoan cysts to be preserved for a long time.

Macroscopic examination of stool

The amount of K excreted per day is normally 100-200 g, depending on the quantity and quality of food taken: with a predominance of protein foods, the weight of K decreases, with predominantly plant foods it increases. K.'s weight also largely depends on the water content: with constipation (see), when water absorption is increased, the weight of the daily amount of K. decreases, and with diarrhea it increases. A significant increase in the daily amount of K. (polyfecal matter) is observed in diseases accompanied by impaired digestion of food (with achylia, lesions of the pancreas, sprue, intestinal amyloidosis, etc.).

The shape of feces depends on the consistency, which in turn is determined by the content of water, mucus and fat. Normal K. has a cylindrical shape and a uniform dense consistency; it contains approx. 70-75% water. Dense, even hard K., observed with constipation, loses its normal shape and consists of individual lumps (scybalum). With hyperkinetic constipation, the so-called. sheep feces, which are small round lumps of dense consistency, containing approx. 60% water. K. takes on a ribbon or pencil shape with organic stenoses in the lower parts of the sigmoid or in the rectum, with spastic conditions. Liquid K. contains 90-92% water and accompanies inflammatory processes in the intestine; In this case, bowel movements may be heterogeneous; for example, dense lumps of feces may float in liquid or mucus. Feces acquire a more liquid consistency than normal when the intestinal wall secretes abundant inflammatory exudate and mucus, and when the osmotic pressure in the lumen increases under the influence of saline laxatives. K., containing a lot of fat, has a pasty consistency.

The color of K. in a healthy person can vary depending on the food taken. More often, various shades of brown are found, due to the presence in K. of a greater or lesser amount of bilirubin transformation products - stercobilin (see) and mesobilifuscin. Predominantly dairy foods give K. a light brown or yellow color; meat - dark brown; vegetables containing chlorophyll (sorrel, spinach, etc.) - greenish; beets - red; blueberries, black currants, blackberries, coffee, cocoa - from dark brown to black, etc. Some medicinal substances significantly affect the color of K.: carbolene and bismuth color it black, iron preparations - greenish-black, etc. e. The color of K. changes due to patol, processes in the digestive organs: if the flow of bile into the intestines is disrupted, K. acquires a grayish-white, clayey or sandy color (acholic K.), which is associated with the absence of stercobilin and the presence of a large amount of undigested fat; in the case of accelerated peristalsis or when the vital activity of the intestinal flora is suppressed (for example, with dysbacteriosis), K. is colored golden-yellow with unchanged bilirubin, but when exposed to light and air it darkens. K.'s color also changes with bleeding in the glands. tract and depends on the location of the bleeding: when bleeding in the stomach, K. is painted the color of tar (see Melena); The lower the source of bleeding is located along the intestine, the more clearly the red color appears, which is especially pronounced with bleeding in the colon and from hemorrhoids. The presence of blood visible to the naked eye in K. is associated with a violation of the integrity of the mucous membrane of the gastrointestinal tract. tract. When bleeding from the lower parts of the colon, the blood does not mix with blood and retains its scarlet color. It is easier to detect blood if it is mixed with mucus, coloring it. With profuse bleeding, K. may be red even with a high location of the patol process. In all doubtful cases, the question of the presence of blood in K. is resolved by chemical means. reactions (see Benzidine test, Guaiac test).

Some infectious diseases affecting the intestines are accompanied by the release of feces of a characteristic appearance and color: with typhoid fever, they sometimes resemble pea soup; with cholera, there is no feces, and the stool is an inflammatory exudate, similar in appearance to rice water.

The smell of K. depends on the presence in it of decay products of food residues, mainly protein, which serve as a source of formation of aromatic substances - indole, skatole, etc. With an abundant content of proteins in food, the smell of K. intensifies, and with pronounced putrefactive processes in the intestines (putrefactive dyspepsia , decay of tumors) becomes fetid; When fermentation processes prevail in the intestines, fermentation acquires a sour odor from the presence of volatile fatty acids (oil, acetic acid, propionic acid, etc.). Prolonged stay of potassium in the intestines reduces their odor due to the absorption of aromatic substances; K. is almost odorless during fasting. A study of fecal odor is carried out only if it differs sharply from the usual one.

Mucus in normal stool is contained in minimal quantities in the form of a thin shiny coating covering the surface of the feces. More or less noticeable amounts of mucus should be classified as pathological phenomena. The most common reason for its appearance in K. is inflammatory processes; mucus may also be produced by the colon wall in response to irritation caused by stool during constipation. Its consistency ranges from soft, viscous to very dense, sometimes glassy, ​​gelatinous, making up the bulk of feces; sometimes it is distinguished by ribbon-like strands, representing, as it were, a cast of the intestinal lumen (with pseudomembranous colitis). Most often, mucus is found in the form of lumps of larger or smaller size, whitish or yellowish in color, located when the mucus is formed on its surface or between its individual fragments. In liquid and mushy K. it is mixed with it. Mucus is best detected in an aqueous emulsion against a dark background in the form of cloudy, slightly translucent lumps or strands with unclear outlines. In doubtful cases, dyes are used to detect mucus in stool: Ehrlich triacid colors the mucus blue-green, a mixture of 2% solution of brilliant green and neutral red gives it a reddish tint, while the rest of the mucus turns green. . The distribution of mucus in the feces to some extent indicates the place of its origin: mucus located on the surface of the feces is separated from the lower parts of the colon; ribbon-like films - from the sigmoid colon; if the mucus is mixed with K. - from the proximal parts of the colon or small intestine. The smaller the mucus particles and the more firmly they are mixed with mucus, the higher the place of its separation. The presence of mucus released in the small intestine indicates an acceleration of peristalsis.

Pus is found in K. with ulcerations in the lower parts of the colon. In most cases it is mixed with mucus and blood; pus not mixed with mucus is released from the K. when a pararectal abscess is opened into the rectum.

Stones found in feces are gallstones in origin (see Gallstones), pancreatic or intestinal (see Fecal stones). Their composition is determined chemically.

Macroscopically, roundworms and segments of tapeworms can be found in K. (see Helminthiasis). When tumors of the lower parts of the colon disintegrate, tissue fragments are sometimes found that are subject to mandatory cytol, or gistol, examination.

Microscopic examination of stool

Rice. 1-6. Stool microspecimens. Rice. 1. Muscle fibers in feces (native preparation): 1 - fibers with transverse striations; 2 - fibers with longitudinal and striations; 3 - fibers that have lost their striations. Rice. 2. Undigested plant fiber (native preparation): 1 - cereal fiber; 2 - plant vessels; 3 - vegetable fiber. Rice. 3. Starch and iodophilic flora (staining with Lugol’s solution): 1 - potato cells with starch grains in the initial stages of splitting; 2 - potato cells with starch grains in the erythrodextrin stage. Rice. 4. Neutral fat - red-orange droplets (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.

The main background of the microscopic picture of K. is detritus, consisting of particles of food debris, decaying cells of the intestinal epithelium, and bacteria that have lost their structure. The more complete the digestion of food, the more abundant the detritus and the fewer differentiated elements. From the remains of protein foods, muscle fibers can be accurately differentiated. In a healthy person who has eaten approx. 150 g of meat per day, you can detect 1-2 pieces of muscle fibers in the field of view at low magnification (color. Fig. 1). These are small homogeneous lumps of oval or cylindrical shape with rounded edges, colored yellow with stercobilin. When proteins are insufficiently digested, muscle fibers are present in large numbers (creatorrhoea). Weakly digested fibers have a pronounced cylindrical shape with slightly smoothed edges; they show longitudinal and sometimes faint transverse striping. Undigested muscle fibers have a more elongated cylindrical shape with well-preserved right angles and clearly defined transverse striations. This type of muscle fiber is found in patients with pancreatic enzyme deficiency, decreased secretory function of the stomach, as well as with significantly accelerated intestinal motility. In acholic K., muscle fibers are gray in color. Sometimes there are groups of muscle fibers closely adjacent to each other due to the preserved connective tissue layer. In such cases, combined insufficiency of gastric and pancreatic digestion may occur. Connective tissue fibers isolated from muscle fibers are recognized under a microscope due to their sharp refraction of light; When acetic acid is added, the connective tissue swells, losing its fibrous structure.

From the remnants of carbohydrate foods, cellulose and starch grains can be distinguished by microscopy; in the first case, the native preparation is examined under a microscope; to detect starch, the preparation treated with Lugol's solution is examined. There are digestible (soluble) fiber, which is the pulpy parenchymal cells of potatoes, root vegetables, vegetables and fruits, and indigestible (insoluble), mainly supporting tissue - the shells of cereals, legumes, fruits, etc. Microscopically, indigestible fiber differs from digestible fiber by the presence of thick double-circuit cellulose membranes of individual cells and thick intercellular partitions (color. Fig. 2), and when staining preparations with a solution prepared from 10 g of anhydrous zinc chloride, 2.5 g of potassium iodide, 0.25 g of iodine and 10 ml of distilled water , soluble fiber turns blue, insoluble fiber does not. Each plant is characterized by a special type of cells, their size, shape, and color. The amount of fiber contained in feces depends on the nature of the food, as well as on the length of time feces remain in the large intestine. The amylolytic flora found here in abundance promotes the breakdown of fiber. Therefore, the fiber content with constipation will be less than with normal, and even more so with accelerated peristalsis.

K.'s study for the presence of starch is carried out in a preparation treated with a solution of iodine-potassium iodide (iodine 1 g, potassium iodide 2 g, water 50 ml). In normal K. there is no starch. Unmodified starch turns blue-black, the products of its sequential breakdown - amylodextrin - violet, erythrodextrin - red-brown; the further stage of splitting - achroodextrin - is not stained with iodine (color fig. 3). Incomplete digestion of starch is most often observed in diseases of the small intestine, especially those accompanied by accelerated movement of intestinal contents with insufficient activity of pancreatic enzymes. Starch grains or their fragments can be located freely inside the cells of digestible fiber, being there in different stages of digestion. The abundance of starch in K. (amilorrhea) is usually combined with the presence of rich iodophilic flora and increased fermentation processes.

To detect fat and its breakdown products, use both a native preparation and Sudan III stained with acetic-alcohol solution (96° alcohol - 10 ml, icy acetic acid or 80% - 90 ml, Sudan III - 2 g). With moderate (no more than 100 g per day) fat consumption, neutral fat in K. is almost or completely absent. Residues of fatty foods are found in the form of soaps (alkaline and alkaline earth salts of fatty acids). Since the enzyme lipase, which breaks down fats, is found mainly in the juice of the pancreas, its diseases lead to impaired absorption of fat, and a significant amount of it appears in the pancreas. The deficiency, and even more so the absence of bile entering the intestines, also disrupts the absorption of fat: neutral fat, fatty acids and soaps are found in bile. A large number of them are observed with tumors of the head of the pancreas, with sprue. Neutral fat in native K. preparations has the form of colorless drops that sharply refract light, sometimes round, sometimes with irregular but smooth contours; refractory fats look like lumps. When stained with acetic-alcohol solution of Sudan III in the cold, drops and clumps of neutral fat acquire a bright red-orange color (color Fig. 4). Soaps can be found in the form of lumps and crystals (color Fig. 5), which do not stain in the cold. Fatty acids are found in the form of drops (low-melting fatty acids), lumps and crystals (refractory fatty acids), shaped like thin needles, pointed at both ends; they are often folded into small bunches (color Fig. 6), sometimes arranged radially, surrounding the drops with a rim. After heating the native preparation and its subsequent cooling, the drops of neutral fat do not change, and the lumps of fatty acids, fused into drops, become uneven, lumpy as they cool, and partially turn into characteristic needle-shaped crystals, which are shorter than soap crystals. When the native drug is heated, unlike crystals of fatty acids, they do not fuse. To judge the total amount of fatty elements, a preparation with one or two drops of alcohol-acetic solution Sudan III, covered with a cover glass, is heated to a boil. Soaps are broken down by acetic acid to form fatty acids, which melt into droplets and, just like droplets of neutral fat, are colored by Sudan; by the total number of colored drops one can judge the sum of all fatty products K. To distinguish fatty acids from soaps, you can use a mixture prepared ex tempore of equal parts of 1% neutral red solution and 0.2% brilliant green solution: neutral fat and fatty acids are colored brownish-red by it, soaps - green. Lumps of fat are painted pink using Nile blue sulfate, lumps of fatty acids are colored blue-violet, lumps of soap are not painted. Laboratory methods for determining fatty substances in K. are given in Table 1.

In K. you can find epithelial cells, blood cells, macrophages, tumor cells and mucus. Recording the results of such a microscopic examination is called a coprocytogram.

Flat epithelium, captured by feces as they pass through the anal canal, has no diagnostic value. Cells of the intestinal (cylindrical) epithelium are found (Fig. 2), interspersed with lumps of mucus. Sometimes these are small cells that have well preserved their cylindrical shape and nuclei; often the shape of the cells is significantly changed (triangular, spindle-shaped, etc.) due to their digestion and soaking in soaps. A small number of such cells can be found in normal K. The appearance of them in large groups and layers indicates acute inflammation in the colon and tumor processes.

Leukocytes are usually absent in normal K. In inflammatory bowel conditions, they are found in small quantities in the mucus along with intestinal epithelial cells. The appearance of a significant number of leukocytes, defined as pus, is observed during ulcerative processes in the colon (dysentery, tuberculosis, cancer, etc.). Leukocytes released during ulcerative lesions of the small intestine usually have time to be destroyed. With amoebic dysentery, hookworm, and some types of spastic colitis, a large number of eosinophils are found in the blood, mostly located in the mucus. In the native preparation, they can be distinguished from neutrophils by their large granularity, which sharply refracts light. Staining moist lumps of mucus with a mixture of Azura and eosin (0.6% Azura II solution and 0.2% eosin solution are mixed ex tempore in a ratio of 3: 2) makes it possible to detect eosinophils when examining the drug selectively. In the presence of a large number of eosinophils, Charcot-Leiden crystals (colorless elongated octahedra) are also found in K. The macrophages present in K. are larger than leukocytes and have a round or oval nucleus; in their protoplasm various inclusions are visible (erythrocytes, cell fragments, drops of fat, etc.). In preparations stained with hematol paints, macrophages have intensely blue protoplasm. Macrophages accompany certain inflammatory processes, especially bacillary dysentery. When bleeding from the colon, unchanged red blood cells are found in the bloodstream, glued together into piles of varying sizes. During ulcerative processes, they are present together with leukocytes in the mucus. When bleeding comes from a disintegrating tumor of the rectum or from hemorrhoids, they are not associated with mucus. When blood is released from the proximal intestine, red blood cells are either completely destroyed or take on the character of shadows and are difficult to detect in the bloodstream.

Cells of malignant tumors can enter the colon when the tumor is localized in the rectum. Microscopically, they can only be identified if they occur in groups or in the form of tissue fragments with characteristic cell atypia. Recognition of tumor cells is carried out by cytol methods (see Cytological examination).

Mucus under microscopy is detected in the form of lumps or strands of different sizes, consisting of a structureless substance containing columnar epithelial cells, bacteria, and sometimes blood elements or food debris. These details are visible through a microscope only at high magnification; at low magnification, mucus appears in the form of colorless translucent areas with indistinct blurry outlines, interspersed with the main brown or yellow mass of K. Under the influence of acetic acid, a delicate striation appears in the mucus. With amoebic dysentery, the consistency of feces is different, but they are always viscous, interspersed with transparent mucous lumps containing a relatively small number of significantly altered leukocytes, among which there are many eosinophils, as well as Charcot-Leyden crystals.

Sometimes crystalline formations are found in K.: tripelphosphates, shaped like a coffin lid; oxalates - octahedra in the form of square envelopes that appear after eating a vegetable-rich diet; cholesterol - flat tablets in the shape of a parallelogram with broken corners, often layered on top of each other in steps; Hematoidin is a red-brown rhombic crystal, sometimes found in blood released a few days after bleeding. In K., barium salts can be found (after rentgenol, examination of the gastrointestinal tract) in the form of small grains that fill the entire field of view and complicate microscopic examination. After taking carbolene, black coal particles of irregular shape are detected. Bismuth salts are dark brown, almost black in color and have the shape of long rectangles or rhombuses. Iron salts are amorphous grains or black lumps of varying sizes.

Microscopic examination reveals protozoa in K.: rhizomes (amoebas), ciliated ciliates (Balantidium coli), flagellates (Lamblia intestinalis and Trichomonas intestinalis), etc.

To find mobile vegetative forms of protozoa, feces are diluted with physiological solution on a slightly warmed glass slide and covered with a coverslip. To detect protozoan cysts, a lump of K. is ground with one or two drops of iodine-potassium iodide solution. Both smears are examined first with low and then with high magnification. Good results are obtained from the study of native preparations using the phase-contrast method and anoptral microscopy. If it is not possible to differentiate the type of protozoa in a native preparation, they resort to the preparation of dry colored preparations. For this purpose, K. is fixed with Schaudinn's solution and stained with iron hematoxylin according to Heidenhain (see Protozoa). Detection of worms and their eggs - see Helminthological research methods.

Bacterioscopic examination of stool

Bacterioscopic examination of stool is of relatively little importance, since in this case most of the detected microorganisms are not differentiated. Differential stains make it possible to distinguish gram-negative flora, which include Escherichia coli and the entire group of typhoid, paratyphoid and dysentery microbes; gram-positive flora - mainly strepto- and staphylococci; non-pathogenic iodophilic flora, which appears due to incomplete absorption of carbohydrates; tuberculosis bacillus, easily identified by Ziehl-Neelsen staining. In the latter case, to prepare a smear, mucopurulent lumps should be selected from K.; decolorization is carried out with 3% hydrochloric acid alcohol. Due to the widespread use of antibiotic therapy, especially drugs with a broad spectrum of action, cases of damage to the mucous membranes, in particular gastrointestinal tract, have become more frequent. tract, yeast-like fungi of the genus Candida (see Candidiasis). These fungi are found in normal cells and can be isolated from them. With candidiasis, the number of fungi in K. increases so much that they are detected by simple microscopy: a small lump of K. is mixed on a glass slide with one or two drops of 20-30% caustic alkali solution and, covered with a coverslip, microscopically examined with high magnification dry systems. The preparation may contain budding fungal cells and short segmented branched mycelium, on which spores are located. Much more important than bacterioscopy is bacterial research, which is undertaken to identify pathogenic microorganisms in it (see Bacteriological techniques). It makes it possible to determine the morphological, cultural and biochemical characteristics of the microbes being studied and identify them using a specific agglutination reaction (see Identification of microbes).

Chemical examination of stool

A chemical study of feces involves, first of all, determining the reaction of the medium in the stool. For this purpose, strips of blue and red litmus paper moistened with distilled water are applied to a lump of fresh stool, and after a few minutes the change in their color is recorded. Normally, K.'s reaction to litmus is neutral or slightly alkaline, depending on Ch. arr. from the vital activity of the intestinal microbial flora: when fermentation processes predominate, the reaction becomes acidic, and when putrefactive processes prevail, it becomes alkaline. The pH of K. extract, diluted 10 times, is normally approx. 6.8-7.0; during putrefactive processes the pH is 7.4, during fermentation it reaches 5.2-5.6. In the latter case, when titrating the aqueous extract with alkali, its acidity corresponds to the content of 50-100 ml of 0.1 N. solution of HCl per 100 g of K. Protein foods enhance the vital activity of proteolytic (putrefactive) flora and therefore shift the K. reaction to the alkaline side, carbohydrate foods - to the acidic side. K. acquires an acidic reaction even with a significant content of fatty acids. To determine the intensity of fermentation processes, the amount of organic matter in the mixture is determined, and to register decay, the amount of ammonia contained in it is determined.

Determination of organic substances should be made in fresh feces. To do this, weigh out 10 g of mixed K., place it in a porcelain mortar; measure 100 ml of water in a cylinder and gradually pour 80-90 ml from it into a mortar with K., rubbing thoroughly; add 2 ml of ferrous sesquichloride solution and 20-30 drops of phenolphthalein; 2 g of calcium oxide hydrate is ground with the remaining water in the cylinder and poured into a mortar. A well-mixed mixture should be red in color, otherwise add a little more calcium oxide hydrate. In 10 minutes. The liquid is drained from the sediment onto a folded filter. Measured in chemical a glass of 25 ml of transparent red filtrate and neutralize it with 0.1 N. HC I solution until slightly pink (in case of discoloration from excess HCl, the pink color can be restored by adding a few drops of 0.1 N NaOH solution). The amount of added HCl is not taken into account in the calculation. Next, add 15 drops of dimethylamido-azobenzene solution and titrate with 0.1 N. HCl solution until the indicator color changes (from yellow to pinkish-orange). Calculation: the number of milliliters of HCl used for titration corresponds to the content of organic compounds in 25 ml of filtrate. The result of the analysis is usually expressed in milliliters of HCl, which was used to neutralize 100 ml of filtrate (which corresponds to 10 g of K). To do this, the number of milliliters expended from the burette is multiplied by 4.

Ammonia in K. is the end product of the putrefactive breakdown of food and endogenous (digestive juices, mucus, inflammatory exudate) proteins. Its quantity to a certain extent reflects the intensity of putrefaction processes in the large intestine. Formol titration using the Guaffon method determines the total free and bound ammonia, as well as amino acids. This study is carried out together with the determination of organic substances and is, as it were, its continuation.

From the filtrate remaining from the determination of organic compounds, measure out 25 ml and neutralize it, as in the previous analysis, to a pale pink color. Add 5 ml of neutralized formalin, a few drops of phenolphthalein and titrate with 0.1 N. NaOH solution until the pink color does not disappear. The ammonia content in K. is expressed in milliliters 0.1 N. solution of NaOH needed to neutralize 100 ml of filtrate (from 10 g of K), for which the number of milliliters poured from the burette is multiplied by 4.

Normal ammonia content is 2-4 ml. An increase to 10 ml or more indicates an increase in the processes of putrefactive breakdown of proteins in the intestines. As fermentation intensifies, the amount of volatile fatty acids increases: oil, propionic, and acetic. An increase in their number can be more pronounced than an increase in the total amount of organic substances. Therefore, some authors recommend determining their content in K to characterize the intensity of fermentation processes.

100 ml of a 10% homogeneous suspension of K is poured into a 350 ml round-bottomed flask with a long neck, to which are added several pieces of paraffin, several grains of pumice and 0.5 ml of strong sulfuric acid. Using a curved glass tube threaded through a rubber stopper, the flask is connected to a vertically located refrigerator, under which a graduated vessel is placed. The contents of the flask are distilled to obtain 66 ml of distillate. By adding a few drops of phenolphthalein alcohol solution to the distillate, it is titrated with 0.1 N. NaOH solution. The amount of volatile fatty acids is expressed by the volume of alkali used for titration.

Normally it is 7-8 ml, with increased fermentation 15-18 ml, with constipation 2-3 ml.

Determination of the dry residue makes it possible to estimate the water content in the colon, which in turn gives an indirect judgment about the time the fluid remains in the large intestine.

A piece of K. is weighed in a crystallizer, the weight of which is determined in advance, and smeared in a thin layer along its bottom. The crystallizer is placed in a boiling water bath and the mixture is dried to a constant weight for 48 hours, then dried in a desiccator over sulfuric acid and weighed. The weight of dried K. (P1), multiplied by 100 and divided by the weight of fresh K. (P), will be equal to the dry residue, expressed as a percentage:

Protein and its breakdown products in protein can be determined using the Kjeldahl method (see Kjeldahl method). In the absence of inflammatory processes in the intestines, the nitrogen released from K. can give an approximate judgment about the degree of absorption of dietary protein. A healthy person excretes no more than 10% of nitrogen taken from food with nitrogen (1-1.5 g with mixed food). With the normal speed of passage of food chyme through the intestines, protein products undergo almost complete breakdown, and therefore the soluble protein found in K. should in such cases be classified as secretions of the intestinal wall (inflammatory exudate, cellular decay), which has diagnostic value.

Determination of soluble protein is carried out using the Triboulet-Vishnyakov method (see Triboulet-Vishnyakov method). A positive test is conclusive. If feces remain in the colon for sufficient time for bacterial decomposition of the protein, the reaction may be negative even in the presence of an inflammatory process. The most reliable data on protein absorption can be obtained by loading with albumin labeled with 131 I, followed by studying the radioactivity of K.; healthy people lose less than 5% of the received radioactivity with K. For a more detailed study of the transformations of fat, they resort to the quantitative determination of fatty products (neutral fat, fatty acids, soaps, lipoids) in K. A healthy person with normal fat intake absorbs 95-96% of it; Of the residues released from K., only 0.3-0.4% (of the accepted fat) is neutral fat, the rest is soap.

Determination of the total amount of fatty products. 5 g of fresh K. boil for 20 minutes. with 10 ml of 33% KOH solution and 40 liters of ethyl alcohol containing 0.4% amyl alcohol. After cooling its contents, pour 17 ml of 25% HCl solution into the flask. The mixture is completely cooled again and 50 ml of petroleum ether with a boiling temperature of 60-80° is added to it. After shaking, the liquid is allowed to separate, 25 ml of petroleum ether is aspirated and transferred to a small Erlenmeyer flask containing a piece of filter paper. The contents of the flask are evaporated in a water bath, then J0 ml of ethyl alcohol is poured into it and titrated with 0.1 N from a microburette. NaOH solution using thymol blue indicator or phenolphthalein. The amount of fat is expressed in grams of stearic acid per 100 g K. The calculation is made using the formula:

(A * 284 * 1.04 * 2 100)/10000Q = 5.907A/Q,

where A is the number of milliliters of alkali used for titration, Q is the weight of K taken for analysis; 284/10000 - quantity of stearic acid, resp. 1 ml 0.1 n. NaOH; 1.04*2 - coefficient. Converting fatty acids to neutral fat.

Separate determination of fatty acids and neutral fat. 5 g of fresh K. is boiled with 22 ml of 2.5% HCl solution containing 250 g of NaCl per 1 liter in a cylindrical flask 30 cm long and dia. 4 cm with a ground reflux condenser 50 cm long. After cooling, add 40 ml of ethyl alcohol and 50 ml of petroleum ether. After the layers are separated, 25 ml of the petroleum ether layer is transferred to a 100 ml round bottom flask and evaporated with a piece of filter paper in a water bath. Add 2 ml of ethyl alcohol to the dry residue. Free fatty acids, which were present in K. primarily and formed during the hydrolysis of soaps, are determined by titration of 0.1 N. KOH solution prepared in isobutyl alcohol with a boiling point of 105-108°. Neutral fat in the same sample is saponified after adding 10 ml of 0.1 N. KOH solution and boil for 15 minutes. with reflux condenser. After this, 10 ml of ethyl alcohol is added to the flask and the excess alkali is titrated with 0.1 N. HCl solution using thymol blue indicator and phenolphthalein. Fatty fats are calculated using the above formula, and neutral fats are calculated using the formula:

(B-C)* 297 * 1.01 *2 * 100 / 10000Q = 5.999(B-C)/Q

neutral fat in grams per 100 g K., where B is the amount of 0.1 n. HCl solution used for titration of isobutyl alcohol solution KOH in a blind experiment; C - quantity ml 0.1 N. solution of HCl, used for titration of excess alkali when determining neutral fat; 297/10000 amount of stearic acid, resp. 1 ml 0.1 n. KOH; 1.01*2 - coefficient. Converting fatty acids to neutral fat.

Separate determination of neutral fat and fatty acids is important for differential diagnosis in malabsorption syndrome. The nature of steatorrhea (impaired breakdown or absorption of fats) can be determined by determining the radioactivity of K. after loading first with 131 I-trioleate-glycerol, and then with 131 I-oleic acid.

Normally, bilirubin (see) entering the duodenum with bile is completely reduced by the action of colon flora to stercobilin and colorless stercobilinogen, which is oxidized in light and air into yellow-brown stercobilin. Therefore, when standing, K. darkens. However, even after complete extraction of stercobilinogen and stercobilin (stercobilinoids), K. remains colored brown due to the presence of another pigment - mesobilifuscin, the chemistry of which has been little studied. The determination of stercobilinoids has diagnostic value, since with a reduced secretion of bile into the intestine, their content in the blood decreases until they completely disappear when the bile ducts are blocked. Processes associated with increased breakdown of erythrocytes, increasing the production of bilirubin, lead to an increase in the content of stercobilinoids in K. Since the conversion of bilirubin into its derivatives begins only in the cecum, then with the acceleration of peristalsis, starting in this or in overlying areas, part of the bilirubin can be retained in K. unchanged.

Unchanged bilirubin can be released when antibiotics are used that suppress the activity of intestinal flora.

Schmidt's test. A piece of K. the size of a hazelnut is ground in a porcelain mortar with a few milliliters of 7% sublimate solution, poured into a porcelain cup or wide test tube and left for a day at room temperature. In the presence of stercobilin, K. acquires a pink or red color.

Reaction with zinc acetate. A piece of K. is ground with 10 times the volume of water, an equal amount of 10% alcohol solution of zinc acetate and a few drops of iodine tincture are added, then filtered. The filtrate gives green fluorescence.

Test for stercobilinogen. A piece of K. the size of a bean is ground with a small amount of 10% soda solution and extracted with 10 ml of petroleum ether to remove indole and skatole. Petroleum ether is drained, the remaining aqueous emulsion is acidified with ice-cold acetic acid and extracted twice with 10 ml of ether. Ehrlich's reagent (2% paradimethylamidobenzaldehyde solution in 20% HCl solution) is added dropwise to the ethereal extract. In the presence of stercobilinogen, a bright red color is obtained.

The test for bilirubin with mercuric chloride is the same as for determining stercobilin. Bilirubin, transforming under the influence of mercuric chloride into biliverdin, gives K. a green color. The reaction is suitable for large quantities of bilirubin. Low bilirubin content is determined using Fouche's reagent (25 g of trichloroacetic acid is dissolved in 100 ml of distilled water and 10 ml of 10% ferrous sesquichloride solution is added): a piece of K is ground with 20 times the amount of water and Fouche's reagent is added dropwise (but not more than the volume of fecal emulsion). In the presence of bilirubin, a blue or green color appears.

Quantitative determination of stercobilinoids according to Terven is the most accurate of the existing methods. For each determination, a fresh standard solution is prepared, which serves for comparison in colorimetry.

To 94 ml of distilled water add 5 ml of carbonated soda solution saturated in the cold and 1 ml of 0.05% phenolphthalein alcohol solution. The color of the resulting solution corresponds to the content of 0.4 mg% stercobilinogen in the described reaction. From the mixed and weighed daily amount of K., weigh out 5 g and grind in a mortar with 50 ml of distilled water, added gradually. Continuing to stir, add 50 ml of 16% Mohr's salt solution and 50 ml of 12% NaOH solution. A 100 ml cylinder with a ground-in stopper is immediately filled to the top with the mixture so that there is no air left under the stopper, and it is placed in a dark place for a day. The next day, the liquid is filtered into a brown glass bottle. Accurately measured 2 ml of the filtrate are transferred to a separating funnel, 2 ml of ice-cold acetic acid and 20 ml of ether are added; The funnel is shaken vigorously up to 100 times. Allow the liquids to separate. Aspirate 10 ml of the ethereal extract and transfer it to another separatory funnel, add paradimethylamidobenzaldehyde (at the tip of a knife) and 10 drops of HCl with sp. weighing 1.19. Shake for 1.5 minutes, quickly add 3 ml of distilled water and 3 ml of pre-measured aqueous solution of sodium acetate saturated in the cold and shake again. The lower, colored layer of liquid, after separation, is released into a small graduated cylinder. To the ethereal extract remaining in the separating funnel, add 5 drops of HC I again, shake for 0.5 minutes, add 1.5 ml of water, 1.5 ml of sodium acetate solution and shake again. After allowing the liquids to separate, the lower layer is again lowered into the same cylinder. Depending on the color intensity, the liquid is added with water to the 10, 25 or 50 ml mark and colorimetry is performed against a standard liquid. When calculating, dilution must be taken into account. If the final volume is 10 ml, then the dilution is made 300 times, if 25 ml, then 750 times, etc. The resulting figure (in mg%) is recalculated to the daily amount of K.

Detection of blood in the bloodstream is of great importance for the diagnosis of ulcerations and malignant neoplasms of the digestive tract. With minor bleeding, the color of K. does not change; in such cases they talk about hidden blood, determined chemically. way. Blood is determined by a catalytic or spectrometric method. For catalytic determination, the participation of a reducing agent that changes its color during oxidation and an oxidizing agent that easily releases oxygen in the presence of a catalyst is necessary, which in this case is hemoglobin (or hematin) in the blood. The role of a catalyst in this reaction can be played by substances taken with food: blood and myoglobin of meat, chlorophyll of green vegetables, tomato juice, etc. Therefore, patients should not be given meat and fish products, green vegetables for 3 days before taking the sample. . In addition, other sources of bleeding should also be excluded - from the oral cavity, nasopharynx, etc. The greatest use of chemicals. samples were obtained benzidine test (see), guaiac test (see) and pyramidon test.

In a spectroscopic study according to Snapper, several grams of K are ground in a mortar with acetone, filtered, the precipitate is washed again with acetone, squeezed out and transferred to a clean mortar, where it is ground with a small amount of a mixture consisting of 1 part 50% NaOH solution, 1 parts of pyridine and 2.5 parts of alcohol, and filter. 4-5 drops of ammonium sulphide are added to a few milliliters of the filtrate and spectroscopy is performed. In the presence of blood, a hemochromogen absorption band is detected at 560 nm.

Bile acids are usually absorbed in the upper intestine; their appearance in K. is a sign of the disease. To detect them, pour a few drops of K.’s aqueous extract into a porcelain crucible, add 2-3 drops of diluted H 2 SO 4 (1 teaspoon and 5 parts of water) and a grain of granulated sugar (sucrose); carefully heat the crucible on the flame. In the presence of gallstones, a purple color appears.

Under normal conditions, digestive enzymes are destroyed by 99% in the large intestine and are found in K. only in small quantities; their content increases with a significant increase in peristalsis. If enzymes are not detected even after giving laxatives, we can assume a decrease in their secretion. The determination of enterokinase and alkaline phosphatase in K. is of diagnostic importance. The first is a specific intestinal enzyme that is also produced in other organs, but in much smaller quantities than in the small intestine. An increase in the content of both enzymes in K., sometimes significant, is found both in acute inflammatory lesions of the intestine and in chronic processes. Determining them can be useful for assessing the condition of the intestines during recovery from diseases of the digestive tract.

Scatological syndromes

The nature of K. depends mainly on four factors: 1) enzymatic breakdown of foods at different levels of the digestive tract; 2) absorption of food digestion products in the small intestine; 3) the state of colon motility, its excretory and absorption functions; 4) vital activity of intestinal flora. Combinations of these factors give different pictures, sometimes detected macroscopically, sometimes captured only through laboratory studies. It is possible to identify a number of combinations of symptoms characteristic of certain lesions of the digestive system. These combinations are called “scatological syndromes.” The most typical of them are given in Table 2.

Features of feces in children

Rice. 7 - 12. Feces in children. Rice. 7. Meconium. Rice. 8. Ointment-like homogeneous feces of a breastfed child. Rice. 9 and 10. Feces for nutritional dyspepsia. Rice. 11. “Hungry” stool. Rice. 12. Feces for dysentery.

The nature of K. in children, its color, smell, consistency, as well as chemical, microscopic and bacterial composition depend on the age of the child, the nature of feeding, function, condition of his intestines, liver, etc.

The feces of a newborn in the first 1-3 days are called “meconium” and are formed in the intestines of the fetus. Meconium (color fig. 7) is a greenish, homogeneous, odorless mass with small spherical yellowish inclusions and consists of secretions from various parts of the digestive tract, remnants of the intestinal epithelium, swallowed amniotic fluid, and mucus. Upon microscopy, crystals of bilirubin, cholesterol, fatty acids, drops of fat, lime soaps, etc. are found in it (Fig. 3). Biochemical, the composition of meconium is represented by proteins, mucoproteins, the content of lipids is quite high (neutral fats, divalent calcium soaps, ionized fatty acids and related fats).

After the birth of a child, K. is sterile, but already during the first day of life a large number of bacteria appear in the meconium.

If the child was artificially fed from the first days, the flora of K. is more diverse. By the 4th-5th day, meconium is gradually replaced by normal infancy; the establishment of normal stool may be preceded by watery stools rich in mucus.

A breastfed baby has stool 1-4 times a day; K. has the consistency of a soft ointment, orange-yellow color, homogeneous, sour odor, slightly acidic or alkaline reaction (color. Fig. 8). The color of K. depends on unchanged bilirubin; When standing in air, due to the oxidation of bilirubin into biliverdin, K. becomes green. When mixed feeding with formulas similar in composition to human milk, stool occurs 2-3 times a day, mushy, whitish-yellowish in color, slightly acidic; stool of a child who is bottle-fed with milk formula - 3-4 times a day, thicker consistency, whitish color, alkaline reaction, with a sharper odor. If carbohydrates are added to an infant's food, the carbs become less dense, yellowish-brown in color, and acquire an acidic reaction. The richer the food is in protein, the denser the protein and the paler its color. Older children who eat a variety of foods tend to have thicker stools. In children over one year of age, stools are usually formed, 1-2 times a day in the amount of 50-70 g, with a moderate fecal odor.

Coprol, research, a cut is carried out in all cases went.-kish. diseases in children, reveals some features. In the first days of a child's life, a large number of bacteria appear in the feces. When breastfeeding, Bact predominates in the K. of a child during the newborn period. bifidum. Aerobic flora is represented mainly by Escherichia coli, to a lesser extent by Enterococcus, Proteus vulgaris, and para-Ecolibacillus is much less common. The microflora of mixed-fed children is much richer in quantity; in most cases, E. coli also predominates. The richest in quantitative terms is the microflora of children with artificial feeding. Paraintestinal coli, Proteus, and Enterococcus make up a significant part of the aerobic flora. The intestinal flora of healthy children aged 1 to 3 years is characterized by great homogeneity with a predominance of active Escherichia coli. Older children who receive a wide variety of foods are characterized by sharper fluctuations in both the qualitative and quantitative composition of the intestinal microflora. In healthy children, the intestinal microflora is a pure culture of gram-positive bacilli, and only in cases of illness does an admixture of gram-negative microbes appear.

The diagnostic value of the presence of leukocytes and erythrocytes in the K. of children is not as great as in adults. Leukocytes in K. can be found even in healthy children in the first days and sometimes even weeks of life. In addition to leukocytes, a small number of red blood cells and eosinophils may be present due to the increased permeability of the intestinal vascular walls. The detection of red blood cells in large quantities may indicate an erosive and ulcerative process in the intestines, more often dysentery. An increased content of leukocytes (up to 20-30 per field of view) is observed with dyspepsia and severe manifestations of exudative diathesis. Protein in K. in children cannot serve as clear evidence of the inflammatory process in the intestines: sometimes the Triboulet reaction is positive even in healthy children.

To determine the digestive function of the intestine, microscopic examination of stool is important. The abundance of undigested muscle fibers, drops of neutral fat and a significant amount of undigested starch in K. gives reason to suspect a violation of the exocrine function of the pancreas. To identify this pathology, trypsin is also determined in K. The detection of amylase and lipase in K. has no practical significance. With dysentery in children, there is no increase in K. enterokinase, as happens in adults. Normally, children under 2 years of age with K. secrete significantly greater amounts of enterokinase and phosphatase than adults.

In all cases of diarrhea in children, a bacterial examination is carried out, K., which, in conjunction with the wedge, the picture of the disease, is of great importance; re-seeding is necessary. K.'s crops for the isolation of the causative agent of dysentery, paratyphoid fever and pathogenic Escherichia coli are carried out before the use of antibiotics.

K. in various diseases is characterized by the peculiarities of its consistency, color, and smell. With overfeeding, errors in nutrition and feeding that is not appropriate for age, the so-called. dyspeptic stool (tsvetn. fig. 9 and 10), characterized by frequent (up to 10 times a day) and copious bowel movements of a pasty, sometimes foamy consistency; the amount of mucus is increased; the stool has a characteristic appearance - white sticks, consisting of compounds of salts with fatty acids and mucus with unchanged bile. The smell of feces is sour; with artificial feeding, a putrid smell is added.

When a breastfed baby is starving, the so-called. hungry stool: scanty stools, dark in color; stool may be rapid, liquid and alkaline (color. Fig. 11). With excessive milk feeding, stools are usually shaped, grayish or yellowish in color, dryish, foul-smelling, acidic - greasy-soapy stools. With enterocolitis, colitis, stools can be very frequent (10-30 times a day), foamy, contain more or less admixture of mucus and blood, elements of undigested food, muscle fibers, neutral fat. When the colon is affected, bowel movements are more scanty than with enteritis; Putrefactive dyspepsia usually develops, which is characterized by feces with a sharp putrefactive, rotten odor and containing mucus (unlike K. with enteritis, the mucus is not mixed with feces). With dysentery, the frequency of stools is from 2 to 30 times a day. Feces can be liquid, mushy, yellow or green, watery with an admixture of mucus and blood (color fig. 12).

With celiac disease (see) K. is light yellow or grayish in color, shiny, mushy, foamy, smelly and voluminous; defecation 3-6 times a day. In children with cystic fibrosis, bowel movements are frequent, voluminous, plentiful, light in color, sometimes discolored, sticky, shiny, contain a lot of neutral fat, and smelly. With hyperkinetic constipation, K. is extremely hard and takes the form of a sheep. Changes in K. in older children with diseases of the gastrointestinal tract. tract are similar to those in adults.

Table 1. MAIN METHODS AND RESULTS OF PROCESSING FECAL PREPARATIONS FOR DETECTION OF FATTY SUBSTANCES

Type of detected fat	Results of drug processing			Results of processing drugs with dyes
	when heated without acetic acid	when heated with acetic acid	acetic acid without heating	Sudan III solution	Nile blue sulfate	a mixture of neutral red 4-brilliant green
Neutral fat
	Droplet formation			Red staining	Pink coloring
	Droplet formation		No drops	Red-orange coloration	Pink coloring	Brownish-red coloration
Fatty acid
crystals	Droplet formation		No drops	No coloring		Brownish-red coloration
	Droplet formation		No drops	Red-orange coloration	Blue-violet coloration	Brownish-red coloration
	Droplet formation			Red-orange coloration	No coloring	Brownish-red coloration
crystalline	No drops	Droplet formation	Partial droplet formation	Red-orange coloration	No coloring	Green coloring
	No drops	Droplet formation	Partial droplet formation	Red-orange coloration	No coloring	Green coloring

Table 2. PHYSICAL AND CHEMICAL PROPERTIES OF ADULT FECES NORMAL AND UNDER THE INFLUENCE OF VARIOUS PATHOLOGICAL FACTORS

Designations: + the sign is weakly expressed; ++ sign is expressed moderately; +++ sign is pronounced; - the sign is absent; ± the sign is not clearly expressed

Factors influencing the character of stool

Quantity

Consistency and shape

Stercobilin

Bilirubin

Muscular

Connective

Neutral fat

Digestible fiber

Iodophilic flora

There is no pathological factor (normal stool)

Densely decorated

Brown

Fecal unsharp

Slightly alkaline or neutral

Single

Insufficient digestion in the stomach

decorated

Dark brown

Putrefactive

Alkaline

Pancreatic insufficiency

ointment-like

Grayish yellow

Fetid

Silky, sour

Insufficiency of bile secretion and changes in the biochemical composition of bile

More than 200 g

Hard or ointment-like

Grayish white

Fetid

Inadequacy of digestion and absorption in the small intestine

More than 200 g

Fecal unsharp

Slightly alkaline

Dysbacteriosis:

fermentative dyspepsia

More than 200 g

Mushy, foamy

Strongly acidic

putrefactive dyspepsia

More than 200 g

Dark brown

Putrefactive

Alkaline or strongly alkaline

Inflammatory processes in the colon:

distal colitis with constipation

Less than 200 g

Solid (sheep feces)

Dark brown

Putrefactive

Alkaline

diarrhea after coprostasis

More than 200 g

Dark brown

Fetid

Alkaline

Dyskinesia:

accelerated evacuation of the small intestine

More than 200 g

Fecal unsharp

Slightly alkaline

accelerated colonic evacuation

More than 200 g

Mushy

Light brown

Butyric acid

Neutral or slightly acidic

delayed colonic evacuation

Less than 200 g

Brown

Fecal unsharp

Alkaline

Bibliography: Abezgauz A. M. Rare diseases in childhood, p. 83, L., 1975; Atserova I. S. et al. Microbial intestinal flora in healthy newborns and premature babies, Proceedings of Moscow. region scientific research, wedge, institute, vol. 2, p. 83, 1974; Lobanyuk T. E. Study of the dynamics of colonization of the intestines of children by microflora resistant to antibiotics, Antibiotics, vol. 18, No. 8, p. 756, 1973, bibliogr.; Mikhailova N.D. A manual on scatological research, M., 1962, bibliogr.; Handbook of Clinical Laboratory Research Methods, ed. E. A. Kost, p. 270, M., 1975; Tashev T. et al. Diseases of the stomach, intestines and peritoneum, trans. from Bulgarian, Sofia, 1964; T im e s k o v I. S. Coprological analysis, L., 1975; Carol W. Das menschliche Mekonium, morphologische, chemische, elektrometrische und mikro-biologische Untersuchungen im fetalen Darminhalt, Lpz., 1971; With a v a g o with M. L. Guide de coprologie infantile, P., 1966, bibliogr.; Gherman I. Coprologie clinici, Bucure§ti, 1974, bibliogr.; Teich-m a n n W. Untersuchungen von Harn und Konkrementen, B., 1967, Bibliogr.

N. D. Mikhailova; Yu. F. Kutafin (ped.).

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 - cereal fiber; 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. The reaction of the medium is determined using litmus paper. 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).