General clinical analysis of feces. General analysis of feces (coprogram) Microscopic analysis of feces

Feces, like urine, are the end product of human life. It is formed in the large intestine as a result of a number of biochemical processes. The composition of bowel movements includes water, undigested food residues, metabolic by-products, bacteria, and so on.

Do not underestimate the study of feces. Sometimes it is this analysis that makes it possible to identify pathology of the digestive tract, diseases of the liver, and pancreas in adults and children. This examination is prescribed not only for the purpose of diagnosing diseases, but also for monitoring the ongoing treatment.

What does the coprogram (fecal analysis) show:

• study of the physical and chemical properties of feces (color, texture);
• material microscopy;
• bacteriological examination (detection of pathogenic microbes and analysis of intestinal microflora);
• detection of helminth eggs;
• detection of occult blood in the feces.

How to prepare for a stool test?

Preliminary preparation for the delivery of material in children and adults normally lasts 3-4 days. It is aimed at cleansing the intestines and preventing food debris, muscle and plant fibers from entering the feces. Subject to special training, laboratory assistants will be able to detect even a small degree of violation of the evacuation and digestion functions of the digestive tract.

The essence of the preparation is to follow a special diet with a certain content of proteins, fats and carbohydrates. Two types of diets are suitable for this purpose: according to Pevzner and according to Schmidt.

Diet according to Pevzner

It involves eating black and white bread, meat (boiled or fried), sauerkraut, rice and buckwheat porridge, fresh apples, potatoes (in any form), butter. The total energy value is about 3000 kcal per day.

Schmidt's diet

She is forgiving. It is recommended to eat 5 times a day, mainly dairy products (milk, butter), a couple of eggs, meat, potatoes, oatmeal (mucus decoction). Daily calorie content should be limited to 2200-2400 kcal.

Feces for occult blood

• Before examining feces for occult bleeding, patients are advised not to eat foods that can cause a false positive reaction to blood. These include: all varieties of green vegetables (cucumber, cabbage), fish, meat, eggs, tomatoes.
• Also, patients should refrain from taking medications containing iron (ferrum-lek, ferrumbo).

In the case when it is necessary to urgently take an analysis or to follow a diet that the state of health does not allow, it is recommended not to drink alcoholic beverages, tea, coffee at least a day before.

It is strictly forbidden before the examination

• do a cleansing and siphon enema;
• take medicines that affect intestinal motility (laxatives or antidiarrheals);
• inject suppositories or other forms of drugs into the anus;
• use medicines that change the color of the material (barium sulfate, bismuth preparations).

How to take a coprogram?

The material should be collected in clean dishes after the morning self-emptying of the intestine. For the study, 10-15 g of feces is enough. In rare cases, the doctor may prescribe a daily study of bowel movements. In this case, the patient needs to collect feces within 24 hours.

If the patient suffers from prolonged constipation and cannot empty himself, it is recommended to massage the colon. If this procedure does not bring results, the patient should be given a cleansing enema. In this case, a solid piece of feces is taken from the wash water.

Analysis collection method:

• in the morning after sleep, the patient is advised to defecate in a pot or vessel
• then, with a special stick or spatula, a small amount of feces is taken into a clean, dry jar and tightly closed with a lid.
• analysis should be sent to the laboratory immediately. The deadline is 8-10 hours. After this time, the material may deteriorate and become unsuitable for examination.
• feces are stored at a temperature of 3-6 0 C.

When examining eggs of worms the material must be completely fresh, that is, delivered to the laboratory in a warm form.

Stool collection during bacteriological examination produced by a laboratory technician. The patient is offered to lie on his right side or in a standing position to lean forward. The laboratory assistant spreads the patient's buttocks and inserts a metal loop with a cotton swab wound around it into the anus. The introduction should be carried out with rotational movements, very carefully so as not to damage the mucous membrane of the anus. The loop is also removed carefully, then placed in a sterile test tube.

Coprogram analysis

Deciphering the analysis of feces in middle-aged and older children and adults

Quantity

• Normally, a person excretes 150-200 g of feces per day for 1-2 times.
• For children, the mass of feces is 80-150 g per day

The volume of bowel movements depends on the amount of food eaten and its qualitative composition. For example, if a person eats meat or dairy products, then the amount of feces decreases. Plant foods, on the contrary, increase its volume. Pathological causes of changes in the amount of feces in the table:

Consistency and shape

Normal is feces of dense consistency, decorated (sausage-shaped). Loose, loose stools are called diarrhea. Usually this condition is accompanied by an increase in bowel movements and polyfecal matter. Diarrhea happens:

• osmotic - happens due to malabsorption of osmotically active substances (potassium, sodium) and proteins - pancreatitis, Crohn's disease, sprue, magnesium sulphate intake;
• secretory - usually caused by inflammatory processes in the intestines (enteritis, colitis);
• motor - occurs with increased peristalsis of the digestive tube (laxatives);
• mixed - due to all of the above factors.

The peculiar ribbon-like shape of feces can be caused by spasms in the rectum and sigmoid colon. If there is a violation of the evacuation of food from the intestines, constipation occurs in a person. Cal in this case becomes hard, dense, like sheep balls. Its hardness is due to excessive absorption of water.

Color

Normal feces are colored brown. This is due to the presence of stercobilin in it - a breakdown product of bilirubin, which is excreted in the bile into the intestine. A change in the color of the material may be due either to various factors:

Smell

The stool normally has a mild specific odor. This is due to the processes of bacterial fermentation that occur in the intestine. In the process of protein breakdown, indole, skatole, phenol and cresol are formed, they form the smell of feces.

Reduces odor stool with a vegetable diet and constipation, and worse with a meat diet and diarrhea.

Pungent fetid odor speaks of putrefactive processes in the intestines. The sour aroma of excrement indicates the presence in them of an increased amount of fatty acids (propionic, butyric).

Visible impurities

Normally, there should be no blood, mucus, remnants of undigested food, stones, helminths, and so on in the stool. Their presence indicates a pathological process in the gastrointestinal tract.

pH

In a healthy person with a normal diet, feces have a neutral or slightly alkaline reaction (pH 6.87-7.64). Change in stool pH:

• acid reaction (pH 5.49-6.79) - occurs when the absorption of fatty acids in the small intestine is impaired;
• sharply acidic reaction (pH less than 5.49) - occurs with excessive activity of the fermentative microflora or lactose intolerance;
• alkaline reaction (pH 7.72-8.53) - takes place during the decay of proteins (heavy consumption of meat);
• sharply alkaline reaction (pH over 8.55) - speaks of.

reaction to occult blood

Hidden blood is called, which is not visible to the human eye (macroscopically) and under a microscope. Normally, the reaction can be positive when eating meat, fish, black pudding, iron preparations, vigorous brushing of teeth, and menstrual blood entering the stool. Pathologies that cause the appearance of blood in the feces:

• gum disease (gingivitis, periodontal disease);
• peptic ulcer of the stomach and duodenum;
• swallowing blood from the upper respiratory tract (nosebleeds);
• bleeding tumors;
• varicose veins of the esophagus and rectum;
• Mallory-Weiss syndrome;
• helminthic invasion;
• intestinal tuberculosis;
• dysentery;
• colitis;
• Stevens-Jones syndrome;
• haemorrhoids;
• intestinal polyposis;
• typhoid fever.

Protein reaction

Normally, the reaction to protein is always negative. It can be positive when:

• inflammatory diseases of the gastrointestinal tract (gastritis, duodenitis, enteritis);
• dysbacteriosis;
• celiac disease.

Reaction to stercobilin

Stercobilin is a breakdown product of bilirubin, which gives the feces a brown color. It is excreted in the duodenum with bile. Normally, 100 g of feces contains 75-100 mg of stercobilin. A change in the content of stercobilin in the stool can be with various diseases:

Reaction to bilirubin

Bilirubin can normally be found in the feces of an infant who is breastfed. It gives the feces a greenish color. In an adult, only the breakdown products of bilirubin are excreted with feces. Detection of bilirubin in the stool occurs when:

• diarrhea;
• severe dysbacteriosis against the background of antibiotics.

Microscopic examination of feces

Coprogram in the newborn and infant

Features of the chair after the birth of a child

• In the first couple of days after the birth of the baby, he has a special feces called meconium. Meconium is dark green or olive in color and is a thick, homogeneous mass.
• A week later, mucus, lumps appear in the baby's feces, the stool becomes more frequent and liquid. The color of the feces also changes: dark green is replaced by yellow and yellow-brown.

Analysis of the feces of children of such a young age has a number of features. The intestines of a child at birth are not yet sufficiently developed and are not adapted to receive ordinary adult food. Therefore, a very important factor in the development of an infant is its proper feeding.

In the first days of life, a baby with mother's milk receives all the necessary microelements, nutrients and vitamins. Also, during feeding, the intestines of the baby are seeded with lacido- and bifidobacteria, which are necessary for the production of feces.

If the pediatrician prescribes the baby to take a stool test, the mother needs to follow a certain diet for 2-3 days, since what the mother eats necessarily enters the child's body with milk.

Mom's diet features (see):

• exclude all possible allergens (eggs, citrus fruits, chocolate);
• do not drink alcohol, do not smoke;
• it is preferable to eat slimy cereals (oatmeal, rice), vegetable soups, steam cutlets;
• do not abuse fatty foods, easily digestible carbohydrates.

However, not always the mother can provide the baby with enough milk. Recently, infants have been supplemented with mixtures from the first months or immediately transferred to artificial feeding.

Main differences

The coprogram for natural and artificial feeding of children may differ. No matter how balanced the mixture is, it will never replace breast milk in its quality. This is also reflected in the work of the digestive system of the baby, the product of which is feces.

Food, passing through the gastrointestinal tract, undergoes successive transformations, is gradually absorbed. Feces are the result of the digestive system. In the study of feces, the condition of the digestive system organs and various digestion defects are evaluated. Therefore, scatology is an indispensable component in the diagnosis of diseases of the gastrointestinal tract and helminthiases.

There are different types of fecal examinations. Which of them will be made is determined by the purpose of the study. This may be the diagnosis of gastrointestinal pathology, helminthiasis, changes in microflora. Clinical analysis of feces is sometimes carried out selectively, only according to the parameters necessary in a particular case.

General analysis

The study of excrement can be divided into a general analysis of feces and examination under a microscope (called a coprogram). In general, the quantity, smell, color, consistency, impurities are examined, microscopic analysis reveals undigested muscle and vegetable fibers, salts, acids and other inclusions. Now often a coprogram is called a general analysis. Thus, CPG is a study of the physical, chemical properties of feces and pathological components in them.

Fecal tests for the detection of protozoa are performed when amoebiasis or trichomoniasis is suspected. Trichomonas in the stool is difficult to see. When taking material for this purpose, you can not use enemas, laxatives, treat the container for feces with disinfectant liquids. The interpretation will be correct only with an immediate examination of a maximum of 15 minutes after the collection of the material. The search for cysts does not require such urgency, they are stable in the external environment. For reliable detection of shigella, a fragment of feces with blood or mucus is taken and placed in a container with a special preservative.

Clinical picture

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The fecal analysis of the tank shows the presence of pathogens of intestinal infections in the body and the ratio of different types of bacteria.

Sowing on nutrient media will make it possible to objectify the quantitative and qualitative changes in the intestinal microflora.

A tank analysis of feces should be carried out no later than three hours after taking the morning portion of feces. It is advisable to store the sample in the cold (). A fecal analysis should not be performed during antibiotic therapy, optimally two weeks after its completion. It is important to exclude the ingress of urine and vaginal discharge, especially during menstruation. The volume of the sample should be at least 10 ml, the sampling should be done from different parts of the feces, be sure to capture areas with mucus and blood.

Fecal analysis scraping in the perianal area is performed to detect pinworm eggs. The material must be examined no later than three hours after taking.

So what the analysis shows:

• protozoa and microbes that cause intestinal infections;
• the presence of helminths and their eggs;
• the state of the microflora;
• digestion defects;
• effectiveness of treatment (with dynamic observation);
• in children - signs of cystic fibrosis and lactose deficiency.

Research rules

To get reliable data, you need to know how to properly collect feces and when a stool analysis should be decoded.

An example of a correctly taken sample:

1. Prior to the examination for several days, there should be a diet that excludes flatulence, staining of the stool, its delay or diarrhea.
2. Scatological analysis of feces should be taken during natural defecation. Enemas, laxatives, including rectal suppositories, microclysters Microlax cannot be used, since a distortion of the true picture of the study is possible.
3. A general analysis of feces is reliable if, within three days before collecting the material, the patient did not take drugs that could change the color or nature of feces (barium, iron, bismuth).
4. Scatological analysis of feces should be carried out no later than five hours after sampling.
5. The optimal volume for research is about two teaspoons (about 30 grams of feces).
6. To identify helminthiasis, it is best to take samples from different areas of the feces.
7. Collection of material should be carried out in a sterile container.

Deciphering the results of the study

It is very important to correctly decipher the analysis of feces. To do this, you need to know the research algorithm and normal indicators.

Deciphering the patient includes three main points: macroscopy (examination), biochemistry, microscopy (actual coprogram).

Inspection

Clinical analysis of feces begins with its visual assessment. The norm implies a dense texture and dark color of excrement, the absence of mucus, blood, fetid odor, undigested food particles and other pathological impurities.

Biochemistry

A chemical analysis of feces is carried out.

A normal fecal analysis implies the following negative biochemical reactions to the following elements:

• hidden blood;
• bilirubin;
• iodophilic flora;
• starch;
• protein;
• fatty acid.

The reaction to stercobilin should be positive (75-350 mg per day). It provides color and reflects the work of the liver and large intestine, its amount increases with hemolytic anemia, decreases with violations of the outflow of bile.

Ammonia is normally 20–40 mmol/kg.

It is important to determine the acid-base state of excrement using litmus paper, the pH of feces should be close to neutral values ​​(6-8). Changes in the acidity of the intestinal contents are possible with violations of the microflora or diet.

Microscopy

It is also necessary to analyze the feces under a microscope. The coprogram carries information about the presence of pathological components in the excrement, allows you to assess the quality of food digestion. Examination of feces in children will help in the diagnosis of infections and inflammations of the gastrointestinal tract, cystic fibrosis, enzymatic and dysbacterial disorders, and helminthic invasions.

Normally, the absence of the following substances is implied:

• undigested fat and its derivatives;
• muscle fibers;
• connective tissue;
• crystals from the remains of destroyed blood cells.

Yeast and other fungi in the analysis of feces are also normally absent.

Also, stool microscopy is used for an objective assessment of the dynamics of the patient's condition.

What diseases can a stool test help diagnose?

What do certain deviations from the norm, which were found during a laboratory study of excrement, indicate? Options for changing normal fecal values ​​exist for various diseases.

Macroscopic abnormalities

Discoloration speaks of cholelithiasis, since stones disrupt the outflow of bile, stercobilin does not enter the intestine, feces lose their dark color. This phenomenon is observed in pancreatic cancer, hepatitis, cirrhosis of the liver.

Black color, the consistency of tar is a sign of peptic ulcer, a tumor complicated by gastric bleeding.

The reddish color of the feces gives bleeding in the lower intestines.

The fetid odor is due to putrefaction or fermentation in the gastrointestinal tract. Its appearance is possible with chronic pancreatitis, dysbacteriosis, cancer.

Elements of undigested food can be found in excrement. This indicates a deficiency of gastric juice, bile, enzymes, or an acceleration of peristalsis, when food simply does not have time to digest.

Fresh blood is possible with anal fissures, hemorrhoids, ulcerative colitis

Mucus plays a protective role. Its detection indicates the presence of inflammation of the intestinal walls. , dysentery, colitis are characterized by a large amount of mucus in the excrement. Also, mucus is found in cystic fibrosis, celiac disease, malabsorption syndromes, irritable bowel, hemorrhoids, polyps.

Changes in biochemistry

If there is a change in the acid-base properties of the studied feces, this indicates a violation of the digestion of food. The alkaline environment of excrement is a consequence of putrefactive processes in violation of the breakdown of proteins, acidic - during fermentation, which is observed with excessive consumption or impaired absorption of carbohydrates.

An occult blood test is used to detect gastric and intestinal bleeding with peptic ulcer, polyps, cancer of various parts of the gastrointestinal tract, and the presence of helminths. In order to avoid erroneous results, three days before the proposed collection of material, products containing iron should be excluded from the diet; traumatic procedures such as EGD and colonoscopy should not be performed. In case of periodontal disease, it is better not to brush your teeth on the day of the test, so that there is no admixture of blood from diseased gums.

Bilirubin can be found in acute poisoning, gastroenteritis.

Protein is found in pancreatitis, atrophic gastritis.

If starch appears, it is necessary to exclude pancreatitis, malabsorption, pathology of the small intestine.

Iodophilic flora appears with dysbacteriosis, pathology of the pancreas, stomach, fermentative dyspepsia. Especially often found during fermentation, acid reaction of intestinal contents and acceleration of its evacuation.

Ammonia increases during putrefactive processes, against the background of inflammation and impaired digestion of proteins.

Deviations of microscopic analysis

Many muscle fibers in excrement are observed in pancreatitis and atrophic gastritis. They can be found in young children, with diarrhea, poor chewing of hard meat.

Connective fibers can be found in gastritis with low acidity, pancreatitis, when eating poorly cooked meat.

If neutral fat, elements of fatty acids and their salts are found, this indicates insufficient production of bile and pancreatic enzymes. Possible reasons:

• pancreatitis;
• pancreatic tumor;
• stones in the bile ducts;
• increased peristalsis, when fats do not have time to digest;
• malabsorption in the intestine;
• eating too fatty foods;
• use of rectal suppositories.

In children, the presence of fat may be associated with an incompletely developed digestive function.

When the acidity of excrement changes to the alkaline side, soaps (salts of undigested fatty acids) are found. In large numbers, their detection in adults is possible with the acceleration of peristalsis, pathology of the biliary tract.

Soluble plant fibers indicate a reduced production of gastric juice and other enzymes.

The appearance of yeast-like fungi indicates dysbacteriosis against the background of immunodeficiency or antibiotic therapy.

In the analysis of feces, a high rate of leukocytes is noted with inflammation in the digestive tract, rectal fissures, and oncology.

Fecal microscopy allows a more detailed study of the nature of pathological impurities in the stool. Detection of elements of food origin gives an idea of ​​the degree of digestibility of food (Figure "Native stool preparation").

One of the most important steps in the analysis of feces is its microscopic evaluation and determination of the presence and / or level of certain substances: stercobilin, bilirubin, occult blood and soluble protein.

Microscopic analysis of feces

When examining feces under a microscope, the presence of the following elements can be determined:

• undigested muscle fibers, which may be present normally in small amounts or when eating a large amount of meat or fish; an increase in their number is a sign of insufficient protein digestion (pancreatic disease, a pronounced decrease in the acidity of gastric juice, insufficient bile, increased intestinal motility)
• connective tissue fibers are found in violation of the digestion of food in the stomach, as well as with reduced pancreatic function
• neutral fat in faeces - a possible sign of pancreatic insufficiency or deterioration in the processes of digestion of food in the small intestine
• fatty acids and soaps in feces are found in case of deterioration of the pancreas, a decrease in the amount of bile entering the intestines and pronounced fermentation of food in the intestines (fermentative dyspepsia)
• the presence of starch in the feces also indicates a decrease in thyroid function or an increase in intestinal motility
• iodophilic flora is a group of microorganisms that stain with iodine; can be a sign of almost any disorder of the gastrointestinal tract

The appearance in the feces of any of the above elements should be the reason for an in-depth study of the digestive system.

Determination of stercobilin and bilirubin in feces

Bilirubin is a biologically active substance, one of the main components of bile. In the process of metabolism, it undergoes a number of changes, getting in one form or another into the blood, urine, feces. One of the products of its metabolism is stercobilin. Normally, only bilirubin is present in the faeces of all metabolic products (in an amount of 75 to 350 mg per day).

An increase in the level of stercobilin can be observed in such cases:

• hemolytic anemia, accompanied by intravascular breakdown of red blood cells)
• increased production and/or secretion of bile

With an increase in the level of stercobilin, the stool becomes darker than normal, and is called hypercholic.

Acholic feces have a light color, due to a reduced content of stercobilin. The reasons for this condition may be:

• obstructive jaundice due to obstruction to the outflow of bile
• cholangitis (inflammatory process in the bile ducts)
• a number of liver diseases

The appearance of bilirubin in the feces most often occurs in the following cases:

• increased motor function of the intestine (including diarrhea)
• suppression of normal intestinal microflora (for example, with prolonged use of antibiotics)

For the qualitative determination of bilirubin, the so-called Schmidt test is performed. Its result is determined by the color that the test sample acquires when a certain reagent is added. Green color is a reliable sign of the presence of bilirubin in the feces.

In small quantities in the feces of a healthy person, another of the metabolic products of bilirubin, urobilin, is also determined. Sometimes the ratio of its amount and the amount of stercobilin is calculated: the so-called Adler coefficient. Normally, it is in the range of 1:10 - 1:30. An increase in this coefficient is a sign of damage to the liver tissue, and a decrease is a sign of intravascular breakdown of red blood cells (hemolysis).

Determination of occult blood and soluble protein

Evaluation of the presence of occult blood in the feces (Gregersen's test) plays an essential role in the diagnosis of diseases of the digestive tract. It is important that the patient is sent for this analysis, then within three days before that, meat and fish should be completely excluded from the diet.

A positive Gregersen test unequivocally indicates the presence of latent (that is, invisible during visual assessment) blood in the feces and can serve as a sign of:

• bleeding from the organs of the gastrointestinal tract (esophagus, stomach, intestines)
• bleeding from the respiratory tract (in case of swallowing blood)
• tumors of the digestive tract

The so-called Triboulet-Vishnyakov test or soluble protein test becomes positive under such conditions:

• bleeding in the digestive system
• excessive function of the glands of the large intestine
• putrefactive processes in the intestines

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 formulas, 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 should 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.

PROTEIN

Clinical aspects

There is no protein in the feces of a healthy person. A positive reaction to the protein indicates the presence of inflammatory exudate, mucus, undigested food protein, bleeding.

Protein in feces is found when:

Damage to the stomach (gastritis, ulcer, cancer);

Damage to the duodenum (duodenitis, cancer of the Vater nipple, ulcer);

Damage to the small intestine (enteritis, celiac disease);

Damage to the colon (fermentative, putrefactive, ulcerative colitis, polyposis, cancer, dysbacteriosis, increased secretory function of the colon);

Damage to the rectum (hemorrhoids, fissure, cancer, proctitis).

Test principle

The test is based on the principle of "Protein Indicator Error". The reactive sensory zone contains an acid buffer and a special indicator (bromophenol blue) that changes color from yellow through green to blue in the presence of proteins.

Sensitivity and spa digitality

The test is highly sensitive to protein and responds to its presence in feces at concentrations as low as 0.10-0.15 mg/ml fecal emulsion.

If the reaction of the feces is alkaline or sharply alkaline (pH 8.0-10.0), in order to avoid a false positive reaction, it is necessary to acidify the stool emulsion with a few drops of 30% CH3COOH to pH 7.0-7.5.

Test score

The change in the color of the reagent sensory field occurs immediately after the application of the test material and is compared with the color of the colored zones on the container after 60 seconds.

Reagent field coloring:

light green - the reaction to the protein is weakly positive;

green - positive;

dark green or green-blue - sharply positive.

BLOOD

Clinical aspects

A positive reaction to blood (hemoglobin) indicates bleeding from any part of the digestive tract (gums, varicose veins of the esophagus and rectum, affected by an inflammatory process or a malignant neoplasm of the gastric and intestinal mucosa). Blood in the feces appears with hemorrhagic diathesis, ulcers, polyposis, hemorrhoids. With the help of diagnostic strips, the so-called "occult blood" is detected, which is not determined by macroscopic examination.

Test principle

The reagent zone is impregnated with cumyl hydroperoxide, citrate buffer and reagents that enhance the color reaction. Cumyl hydroperoxide provides a positive reaction with hemoglobin and myoglobin. The test is based on the pseudoperoxidase effect of hemoglobin, which catalyzes the oxidation of a chromogen by a stabilized organic hydroperoxide.

Sensitivity and specificity

The test is specific, giving a positive result in the presence of hemoglobin and myoglobin, has a very high sensitivity to hemoglobin. The reaction drops out positively in the presence of 4000-5000 erythrocytes in 1 ml of fecal emulsion. The reaction can be positive in the presence of bacterial and fungal peroxidases.

Test score

Particular attention should be paid to the rate of color development. A positive fast green or dark green color that occurs in the first seconds indicates the presence of erythrocytes or hemoglobin. The appearance of a positive color after 30 seconds or more is observed in the presence of a large number of muscle fibers (undigested protein food), which is usually confirmed by microscopic examination of feces. The combination of a positive reaction to protein with a rapid positive reaction to blood (hemoglobin) confirms the presence of damage to the mucosal gastrointestinal system.

UROBILINOGEN (STERCOBILINOGEN)

Clinical aspects

Stercobilinogen and urobilinogen are end products of hemoglobin catabolism in the intestine. Analytically distinguishing between urobilinogen and stercobilinogen is very difficult, so the term "urobilinogen" combines both of these substances. Urobilinogen is largely absorbed in the small intestine. Stercobilinogen is formed from bilirubin in the large intestine as a result of the vital activity of the normal bacterial flora (Figure No. 5). The feces of a healthy person contain stercobilinogen and stercobilin, 40-280 mg of them are excreted per day with feces. Stercobilinogen is colorless. Stercobilin stains feces brown.

There are no stercobilin and stercobilinogen in the feces during obstruction of the biliary tract. The stool becomes colorless.

The content of stercobilin in feces decreases with parenchymal hepatitis, cholangitis; during the period of intrahepatic stagnation, the feces are also colorless. In acute pancreatitis, stercobilinogen (light gray stool) is excreted in the feces.

The content of stercobilin in feces increases with hemolytic anemia.

Test principle

Determining the level of stercobilinogen is based on the principle of the Ehrlich azo coupling reaction of a stabilized diazonium salt with stercobilinogen in an acidic medium. The colorless reaction zone becomes pink or red in the presence of stercobilinogen.

Sensitivity and specificity

The test is specific for urobilinogen and stercobilinogen. A positive reaction is noted at a concentration of stercobilinogen of 3-4 μg / ml of fecal emulsion.

The reactive sensory zone in the presence of a large amount of bilirubin turns yellow no earlier than after 60 seconds, and then turns green. This practically does not affect the determination of the content of stercobilinogen, since pink coloration in the presence of stercobilinogen appears in the first 60 seconds.

Test score

In the presence of stercobilinogen, a positive pink or crimson color appears immediately or within the first 60 seconds. The absence of color indicates obturation of the biliary system, pink or pale pink color indicates incomplete obturation, bright pink, raspberry color indicates normal.

negative positive

3.5 17.5 35.0 70.0 140.0≥ 210.0 µmol/l

BILIRUBIN

Clinical aspects

Normally, bilirubin is found in the meconium and feces of a breastfed child up to about 3 months of age. By this time, a normal bacterial flora appears in the gastrointestinal tract, which partially restores bilirubin to stercobilinogen. By 7-8 months of life, bilirubin is completely oxidized by the intestinal flora to stercobilinogen-stercobilin. In a healthy child aged 9 months and older, only stercobilinogen-stercobilin is present in the feces.

The detection of bilirubin in the feces indicates a pathology: rapid evacuation of food through the intestines, severe dysbacteriosis (lack of normal bacterial flora in the colon, suppression of the intestinal microflora with prolonged use of antibiotics and sulfanilamide drugs).

The combination of stercobilin with bilirubin indicates the appearance of pathological flora in the colon and the displacement of normal flora by it (latent, sluggish dysbacteriosis) or the rapid evacuation of chyme through the intestines.

Test principle

The method is based on the azo coupling reaction in an acidic medium. The reactive zone contains p-nitrophenyldiazonium-p-toluenesulfonate, sodium bicarbonate and sulfosalicylic acid. Upon contact with bilirubin, a purple-red color appears after 30 seconds, the intensity of which depends on the amount of bilirubin detected.

Specificity and sensitivity

The test is specific for conjugated bilirubin. The color of the reactive sensory zone appears already at a concentration of bilirubin of 2.5 - 3.0 μg / ml of fecal emulsion.

Ascorbic acid at very high concentrations (approximately 500 mg/l) causes a faint pink coloration that can be taken as a positive test. In the presence of stercobilinogen at a very high concentration (over 60 µg/ml), the color of the reactive zone that reacts to bilirubin takes on a pale orange tint. In this case, it is recommended to read the test 90-120 seconds after wetting the reactive zone, when the purple-red color characteristic of bilirubin appears.

Test score

In the presence of bilirubin, the reagent sensory zone or within 30-60 seconds turns lilac, lilac-pink or purple-red, depending on the amount of conjugated bilirubin. The result is assessed as weakly positive, positive or sharply positive, respectively.

negative positive

0,0 9 ,0 17 ,0 ≥ 50.0 µmol/l