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In the study of physical properties, the quantity, texture, shape, color and smell of feces are evaluated. Macroscopically visible impurities are examined.
The amount of excreted excreted per day depends on the composition and amount of food taken on the eve, can vary significantly.
With a normal diet, the composition approaching trial diets, the daily amount of feces is 120-200 g. The amount of feces decreases with the predominance of animal proteins in the diet and increases with a predominantly plant diet. An increase in the daily amount of feces (polypecal) occurs with impaired functional state of the gastrointestinal tract: malabsorption, bile secretion (achilia), damage to the pancreas, with enteritis, etc.
A decrease in the daily amount of feces develops with chronic constipation.
Consistency and form depend on the percentage of water. Normally, feces are formed, has a sausage shape, contains 75-80% of water. With an increase in the percentage of water due to increased intestinal motility (inadequate absorption of water), abundant secretion of inflammatory exudate and mucus by the wall of the intestine, the feces become unformed, gruel or liquid. Liquid feces contains up to 90-95% of water. With constant constipation, due to excessive absorption of water, the feces become dense and may look like small balls - “sheep feces”. With stenosis or spastic narrowing of the lower part of the sigmoid or rectum, special forms of feces can be observed: “ribbon-like shape”, “pencil shape”.
The color of feces in a healthy person is due to the presence of stercobilin and mesobilifuscin, which are formed from bile bilirubin under the influence of intestinal microflora and give it various shades of brown. However, the color of fecal matter, in addition to sterkobilin, is determined by a number of factors, such as the nature and composition of food, the presence of food pigments, the intake of various drugs, and the presence of pathological impurities (Table 24).
Table 24. Change in color of feces depending on various conditions
| Color || When observed |
| Dark brown || Normal feces on a mixed diet |
| Black brown || Meat diet |
| Light brown || Plant diet |
| Brown red || Unchanged blood, purgen, cocoa |
| The black || Altered blood (bleeding in the upper digestive tract) when taking bismuth |
| Greenish black || When taking iron |
| Green || With the content of bilirubin and biliverdin, in conditions of increased peristalsis, with a purely vegetable diet |
| Greenish yellow || With carbohydrate fermentation |
| Golden yellow || With the content of unchanged bilirubin (in infants) |
| Orange light yellow || Milk diet |
| White or grayish white (acholic feces) || When bile flow to the intestines ceases |
The smell is normally unpleasant, but not sharp, and is mainly due to skatol, indole and, to a lesser extent, phenol, ortho and paracresols. These aromatic organic compounds are formed during the breakdown of proteins. The smell intensifies with the predominance of protein-rich foods in the diet, with diarrhea, and putrefactive dyspepsia. The smell weakens with a predominantly plant and milk diet, with constipation, with starvation. With fermentative dyspepsia, feces acquire an acidic smell. In the analysis, the smell of feces is indicated if it differs sharply from normal.
Macroscopically visible impurities in the feces can be represented by undigested food debris, mucus, blood, pus, calculi, and parasites. Normally, undigested food residues in the stool are not macroscopically detected. Severe insufficiency of gastric and pancreatic digestion is accompanied by the release of lumps of undigested food - lientorea.
The presence of undigested residues of meat food is creatorrhea. Significant content of feces fat - steatorrhea. Excess mucus is detected macroscopically in the form of strands, flakes, dense formations and indicates inflammation of the intestinal mucosa. An admixture of blood in significant quantities changes the color of feces, with minor bleeding, an admixture of blood is determined by a chemical study.
Pus is found in ulcerative processes mainly in the lower intestine. Fecal calculi can be biliary, pancreatic or intestinal (coprolites) by origin.
Gallstones are cholesterol, calcareous, bilirubin, mixed, are found, as a rule, after an attack of hepatic colic.
Pancreatic stones are composed of lime carbonate or phosphate, are small in size and have an uneven surface.
Coprolites are formations of a dark brown color, they consist of an organic core and layered mineral salts (phosphates), undigested food debris, insoluble drugs, etc.
and. False coprolites are distinguished - stool thickened in the area of the excesses of the colon. False coprolites can reach especially large sizes.
Parasites can be detected with the naked eye in the form of whole individuals (roundworms, whipworms, pinworms), as well as their fragments: scolexes and joints (pork and bovine tapeworms, wide ribbon).
In a chemical study of feces, its reaction (pH), the presence of blood, sterkobilin, bilirubin, as well as other chemical components are determined. The fecal reaction (pH) is determined using universal litmus test paper for measuring pH from 1.0 to 10.0. Pre-moistened with distilled water, litmus paper is applied to several places on the surface of fresh bowel movements. The result is taken into account after 2-3 minutes, comparing the developed coloring of the surface of the litmus paper with a control scale. The normal pH value of feces is 6.0-8.0.
The fecal reaction mainly depends on the vital activity of the intestinal microflora. With the predominance of protein foods and the activation of bacteria that break down protein, a lot of ammonia is formed, which gives the feces an alkaline reaction. With a carbohydrate diet and activation of fermentation microflora, the formation of CO2 and organic acids, which give an acid reaction, is enhanced.
Activation of the fermentative flora is associated with increased peristalsis of the colon, which underlies the development of fermentative dyspepsia with enteritis. The processes of decay are enhanced by the decomposition of proteins secreted by the intestinal wall (cells, inflammatory exudate). Thus, putrefactive dyspepsia often develops with colitis.
The presence of blood in the feces indicates pathological processes in the gastrointestinal tract, accompanied by ulceration of the mucosa or decay of the tumor. Most often, benzidine and amidopyrine tests are used to detect occult blood. The essence of these samples is that they add to the feces a substance that easily gives off oxygen when interacting with blood, and a substance that changes its color when interacting with the released oxygen.
Express method. Dry reagent (orthotoledin - 1 part, tartaric acid - 1 part, barium peroxide - 1 part, calcium acetate - 20 weight parts) in an amount of 0.3 g (at the tip of a knife) is placed on a white filter paper and moistened with 2-3 drops of fecal emulsions. The detection after 2 minutes of blue staining of the reagent and a blue halo around the powder is regarded as a positive test result. The sample has a high sensitivity, detects 4000-4500 red blood cells in 1 ml (3-5 red blood cells in the field of view).
Benzidine test. A stool is applied in a thick layer, 2-3 drops of a solution of benzidine in acetic acid are added (the reagent is prepared ex tempore: a little benzidine at the tip of the knife is dissolved in 5 ml of glacial acetic acid or in a 50% solution of it) and the same 3% hydrogen peroxide. Stirred with a glass rod. With a positive reaction to the blood, a blue-green color appears within 2 minutes. Staining after 2 minutes is not considered. The test with benzidine is extremely sensitive - it reveals a small blood content (0.2%) in feces.
Amidopyrine test. Feces are diluted with water approximately 10 times. To 4 ml of the prepared emulsion, 4 ml of a 5% alcohol solution of amidopyrine and 10-12 drops of a 30% solution of acetic acid and hydrogen peroxide are added. If there is blood in the stool, lilac staining appears. A test with amidopyrine is less sensitive and reveals more significant bleeding.
Currently, various firms offer various test strips for detecting occult blood in the stool, based on both chemical reactions and immunochromatographic ones. The latter are the most specific, since they determine hemoglobin using monoclonal antibodies.
Sterkobilin is formed spontaneously from sterkobilinogen (urobilinogen) under the influence of light and oxygen. In a healthy person with feces, 250 to 320 mg of stercobilin per day is excreted. Sterkobilin is the main pigment of feces, which gives it a certain color. In the absence of stercobilin, feces become discolored (clay color). The reaction to sterkobilin is put when the patient has unpainted feces. Sterkobilin is determined by the method with mercuric chloride - mercuric chloride (Schmidt test). 7 g of mercuric chloride is dissolved in 100 ml of distilled water with heating. After cooling, it is filtered through a paper filter (saturated solution). A small amount of feces is ground in a mortar with 3-4 ml of reagent to the consistency of liquid slurry, poured into a Petri dish and left to stand until the next day. In the presence of stercobilin, feces acquire a pink color, the intensity of which depends on the pigment content.
In the presence of unchanged bilirubin in the feces, the color is green due to the formation of biliverdin. Bilirubin, which enters the intestine with bile, is completely restored to sterkobilinogen and sterkobilin under the action of the bacterial flora of the large intestine. In feces, unchanged bilirubin appears with accelerated peristalsis. Bilirubin can also appear with intestinal dysbiosis (after mass antibiotic therapy). Bilirubin is detected by Fouche reagent: 25 g of trichloroacetic acid, 100 ml of distilled water and 10 ml of a 10% solution of iron chloride. Study progress: the feces are triturated with water in a ratio of 1: 20 and Fouchet reagent is added dropwise (but not more than the volume of diluted feces). If bilirubin is present, a green or blue color appears.
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