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What do muscle fibers look like in stool? Causes of changes in the consistency of feces. Indications for the study

To diagnose many diseases of the stomach, intestines, pancreas, gastroenterologists prescribe, or a coprogram. The study of feces by chemical, physical and microscopic methods is carried out to determine several indicators. Their changes can be signs of diseases of the digestive system. The combination of such deviations of the coprogram from the norm, or coprological syndromes, gives the doctor valuable information about the diagnosis.

Coprogram indicators

Feces are examined by physical, chemical and microscopic methods. Identified deviations from the norm of indicators may indicate a particular disease of the digestive system.

In children and adults, when examining feces, the following indicators are determined:

Normal coprogram parameters in children and adults

Index	Norm
	In adults		In children
			Under 1 year old		Over 1 year old
Acidity (pH)	6,0 – 8,0		4.8 - 6.0, with artificial feeding - up to 7.5		7,0 – 7,5
Muscle fibers	No or single		There may be individual undigested		No or individual digested
Connective tissue	No
Neutral fat	No		In a small amount		No
Fatty acid	No, there may be a small amount of fatty acid salts		In a small amount		No
vegetable fiber	Indigestible can be in different quantities depending on the amount of plant food; digestible - single cells or their clusters
Starch	No		In a small amount		No
Epithelium	No, single cells of columnar epithelium are acceptable		No
Slime	No
Leukocytes	No or solitary neutrophilic leukocytes
red blood cells	No
Sterkobilin	The reaction is positive
Bilirubin	No	Eat		No
Iodophilic flora	No or single cells
Protozoa, mushrooms, worm eggs	No

When quantitatively measuring chemical indicators, the norms are as follows:

stercobilin 200 - 600 mg / day (according to Adler) or 30 - 100 mg / day (according to Terven);
the ratio of urobilin and stercobilin (Adler coefficient) from 1:10 to 1:30;
total nitrogen 2 - 2.5 n / day;
sucrose - up to 300 U / g;
trypsin - up to 670 U/g;
lipase - up to 200 U / g;
amylase - up to 600 U / g;
enterokinase - up to 20 U / g;
alkaline phosphatase - up to 150 U / g;
trypsin 80 - 742 g/day;
chymotrypsin 75 - 839 g / day.

Deviations from the norm

Before proceeding to the microscopic and biochemical study of feces, the laboratory assistant will note its appearance and properties.

Too dense stool is a sign, liquid is a symptom of inflammation and.
With insufficient activity of the pancreas, there is a lot of undigested fat in the feces, so they become greasy.
Bubbles in liquid intestinal contents are a symptom of fermentative dyspepsia.
If the material for the coprogram is small dense round lumps, this is the so-called sheep feces. It is observed during fasting,.
Feces in the form of a ribbon or a long cord often serve as a sign.
Finally, an unformed stool occurs at.

Changes in the color of feces may appear when eating certain foods or medicines (for example, beets). Green feces in a formula-fed baby is normal, caused by the characteristics of the mixture used, in particular, its iron content.

In other cases, they serve as signs of pathological conditions or dietary features:

bleached: ;
black: taking medications based on bismuth;
yellow: fermentative dyspepsia;
brown-red: an admixture of blood, as well as the use of cocoa;
greenish black: ;
green: plant-based diet, increased peristalsis;
orange-yellow: dairy food.

In case of indigestion, deviations in the microscopic results of the coprogram are possible:

Often in the coprogram there are deviations of several indicators at once. There are various combinations of such deviations, which are caused by different reasons and are called scatological syndromes. The detection of such a syndrome when deciphering the coprogram helps the doctor to make the correct diagnosis.

Oral syndrome is associated with pathology of teeth, gums, salivary glands. As a result of these diseases, a person cannot chew food well, process it thoroughly with saliva, and it is not completely absorbed in the gastrointestinal tract. Microscopic examination reveals a characteristic feature - the remains of undigested food.
Gastrogen syndrome is associated with diseases of the stomach and pancreas, mainly atrophic gastritis and chronic pancreatitis with reduced enzymatic function. In the coprogram, there is a sharply alkaline reaction, creatorrhea, tentorrhea, salts (oxalates), the presence of microorganisms is possible.
Pyloroduodenal syndrome develops with insufficient function of the stomach and duodenum 12, most often with dyskinesia. It is characterized by creatorrhea, lientorrhoea, slightly alkaline reaction.
Pancreatic insufficiency develops with severe pancreatitis, duodenitis, opisthorchiasis. The digestion of fats and proteins is disturbed. As a result, the coprogram shows a yellow-gray color and a large amount of liquid spotting feces, type I steatorrhea, creatorrhea.

With anomalies in the development of the biliary tract, their dyskinesia, cholecystitis, not enough bile is released into the intestine, which is necessary for the digestion of fats. In the analysis of feces, steatorrhea type II is noted. Bilirubin contained in bile does not enter the intestinal lumen, does not turn into stercobilin and does not stain feces. In this regard, the feces become light gray. The same changes occur in liver failure due to hepatitis.

Feces are formed in the large intestine. It consists of water, the remains of food taken and the discharge of the gastrointestinal tract, the products of the transformation of bile pigments, bacteria, etc. For the diagnosis of diseases associated with the digestive organs, the study of feces in some cases can be of decisive importance. General analysis of feces (coprogram) includes macroscopic, chemical and microscopic examination.

Macroscopic examination

Quantity

In pathology, the amount of feces decreases with prolonged constipation caused by chronic colitis, peptic ulcer and other conditions associated with increased absorption of fluid in the intestine. With inflammatory processes in the intestines, colitis with diarrhea, accelerated evacuation from the intestines, the amount of feces increases.

Consistency

Dense consistency - with constant constipation due to excessive absorption of water. Liquid or mushy consistency of feces - with increased peristalsis (due to insufficient absorption of water) or with abundant secretion of inflammatory exudate and mucus by the intestinal wall. Ointment-like consistency - in chronic pancreatitis with exocrine insufficiency. Foamy consistency - with enhanced fermentation processes in the colon and the formation of a large amount of carbon dioxide.

Form

The form of feces in the form of "large lumps" - with a long stay of feces in the colon (hypomotor dysfunction of the colon in people with a sedentary lifestyle or who do not eat coarse food, as well as with colon cancer, diverticular disease). The form in the form of small lumps - "sheep feces" indicates a spastic state of the intestine, during starvation, a stomach ulcer and duodenal ulcer, a reflex character after appendectomy, with hemorrhoids, an anal fissure. Ribbon-like or "pencil" shape - in diseases accompanied by stenosis or severe and prolonged spasm of the rectum, with tumors of the rectum. Unformed feces are a sign of maldigestion and malabsorption syndrome.

Color

If staining of feces with food or drugs is excluded, then color changes are most likely due to pathological changes. Grayish-white, clayey (acholic feces) occurs with obstruction of the biliary tract (stone, tumor, spasm or stenosis of the sphincter of Oddi) or with liver failure (acute hepatitis, cirrhosis of the liver). Black feces (tarry) - bleeding from the stomach, esophagus and small intestine. Pronounced red color - with bleeding from the distal colon and rectum (tumor, ulcers, hemorrhoids). Inflammatory gray exudate with fibrin flakes and pieces of the colonic mucosa ("rice water") - with cholera. Jelly-like character of deep pink or red color in amoebiasis. With typhoid fever, the feces look like "pea soup". With putrefactive processes in the intestines, the feces are dark in color, with fermentative dyspepsia - light yellow.

Slime

When the distal colon (especially the rectum) is affected, the mucus is in the form of lumps, strands, ribbons, or a vitreous mass. With enteritis, the mucus is soft, viscous, mixing with feces, giving it a jelly-like appearance. Mucus covering the formed feces from the outside in the form of thin lumps occurs with constipation and inflammation of the large intestine (colitis).

Blood

When bleeding from the distal colon, the blood is located in the form of veins, shreds and clots on the formed feces. Scarlet blood occurs when bleeding from the lower parts of the sigmoid and rectum (hemorrhoids, fissures, ulcers, tumors). Black feces (melena) occur when bleeding from the upper digestive system (esophagus, stomach, duodenum). Blood in the stool can be found in infectious diseases (dysentery), ulcerative colitis, Crohn's disease, decaying tumors of the colon.

Pus

Pus on the surface of the feces occurs with severe inflammation and ulceration of the mucous membrane of the colon (ulcerative colitis, dysentery, decay of the intestinal tumor, intestinal tuberculosis), often along with blood and mucus. Pus in large quantities without the admixture of mucus is observed at the opening of paraintestinal abscesses.

Leftover undigested food (lientorrhoea)

Isolation of the remnants of undigested food occurs with severe insufficiency of gastric and pancreatic digestion.

Chemical research

fecal reaction

An acidic reaction (pH 5.0-6.5) is noted with the activation of the iodophilic flora, which forms carbon dioxide and organic acids (fermentative dyspepsia). An alkaline reaction (pH 8.0-10.0) occurs with insufficient digestion of food, with colitis with constipation, sharply alkaline with putrefactive and fermentative dyspepsia.

Reaction to blood (Gregersen's reaction)

A positive reaction to blood indicates bleeding in any part of the gastrointestinal tract (bleeding from the gums, rupture of varicose veins of the esophagus, erosive and ulcerative lesions of the gastrointestinal tract, tumors of any part of the gastrointestinal tract in the stage of decay).

Reaction to stercobilin

The absence or a sharp decrease in the amount of stercobilin in the feces (the reaction to stercobilin is negative) indicates obstruction of the common bile duct by a stone, compression of it by a tumor, strictures, choledochal stenosis, or a sharp decrease in liver function (for example, in acute viral hepatitis). An increase in the amount of stercobilin in the feces occurs with massive hemolysis of red blood cells (hemolytic jaundice) or increased bile secretion.

Reaction to bilirubin

The detection of unchanged bilirubin in the feces of an adult indicates a violation of the process of restoring bilirubin in the intestine under the influence of microbial flora. Bilirubin can appear with rapid evacuation of food (a sharp increase in intestinal motility), severe dysbacteriosis (a syndrome of excessive bacterial growth in the colon) after taking antibacterial drugs.

Vishnyakov-Tribulet reaction (for soluble protein)

The Vishnyakov-Tribulet reaction is used to detect a latent inflammatory process. The detection of soluble protein in feces indicates inflammation of the intestinal mucosa (ulcerative colitis, Crohn's disease).

microscopic examination

Muscle fibers - with striation (unchanged, undigested) and without striation (altered, digested). A large number of altered and unchanged muscle fibers in the feces (creatorrhoea) indicates a violation of proteolysis (protein digestion):

in conditions accompanied by achlorhydria (lack of free HCl in gastric juice) and achilia (complete absence of secretion of HCl, pepsin and other components of gastric juice): atrophic pangastritis, condition after gastric resection;
with accelerated evacuation of food chyme from the intestine;
in violation of the exocrine function of the pancreas;
with putrefactive dyspepsia.

Connective tissue (remains of undigested vessels, ligaments, fascia, cartilage). The presence of connective tissue in the feces indicates a deficiency of proteolytic enzymes of the stomach and is observed with hypo- and achlorhydria, achilia.

Fat is neutral. Fatty acid. Salts of fatty acids (soaps)

The appearance in the feces of a large amount of neutral fat, fatty acids and soaps is called steatorrhea. This happens:

with exocrine pancreatic insufficiency, a mechanical obstruction to the outflow of pancreatic juice, when steatorrhea is represented by neutral fat;
in violation of the flow of bile into the duodenum and in violation of the absorption of fatty acids in the small intestine, fatty acids or salts of fatty acids (soaps) are found in the feces.

vegetable fiber

Digestible - found in the pulp of vegetables, fruits, legumes and grains. Indigestible fiber (skin of fruits and vegetables, plant hairs, epidermis of cereals) has no diagnostic value, since there are no enzymes in the human digestive system that break it down. It occurs in large numbers with rapid evacuation of food from the stomach, achlorhydria, achilia, with a syndrome of excessive bacterial growth in the colon.

Starch

The presence of a large amount of starch in the feces is called amylorrhea and is observed more often with increased intestinal motility, fermentative dyspepsia, less often with exocrine insufficiency of pancreatic digestion.

Iodophilic microflora (clostridia)

With a large amount of carbohydrates, clostridia multiply intensively. A large number of clostridia is regarded as fermentative dysbiosis.

Epithelium

A large amount of columnar epithelium in the feces is observed in acute and chronic colitis of various etiologies.

Leukocytes

A large number of leukocytes (usually neutrophils) is observed in acute and chronic enteritis and colitis of various etiologies, ulcerative-necrotic lesions of the intestinal mucosa, intestinal tuberculosis, dysentery.

red blood cells

The appearance of slightly altered erythrocytes in the feces indicates the presence of bleeding from the colon, mainly from its distal sections (ulceration of the mucous membrane, a decaying tumor of the rectum and sigmoid colon, anal fissures, hemorrhoids). A large number of erythrocytes in combination with leukocytes and columnar epithelium is characteristic of ulcerative colitis, Crohn's disease with damage to the colon, polyposis and malignant neoplasms of the colon.

worm eggs

Eggs of roundworm, broad tapeworm, etc. indicate the corresponding helminthic invasion.

Pathogenic protozoa

Cysts of dysenteric amoeba, Giardia, etc. indicate the corresponding invasion by protozoa.

yeast cells

They are found in feces during treatment with antibiotics and corticosteroids. Identification of the fungus Candida albicans is carried out by inoculation on special media (Saburo's medium, Microstix Candida) and indicates a fungal infection of the intestine.

Calcium oxalate (lime oxalate crystals)

Detection of crystals is a sign of achlorhydria.

Tripelphosphate crystals (ammonia-magnesium phosphate)

Tripelphosphate crystals found in faeces (pH 8.5-10.0) immediately after defecation indicate increased protein putrefaction in the colon.

Norms

Macroscopic examination

Parameter	Norm
Quantity	In a healthy person, on average, 100-200 g of feces are excreted per day. Normal feces contain about 80% water and 20% solids. With a vegetarian diet, the amount of feces can reach 400-500 g per day, when using easily digestible food, the amount of feces decreases.
Consistency	Normally, formed feces have a dense texture. Mushy feces can be normal, and is due to the intake of predominantly plant foods.
Form	Normally cylindrical.
Smell	Normally, feces have a mild smell, which is called fecal (normal). It can increase with the predominance of meat products in food, with putrefactive dyspepsia, and weaken with a dairy-vegetarian diet, constipation.
Color	Normally, feces are brown in color. When eating dairy foods, feces turn yellowish-brown, and meat foods turn dark brown. The intake of plant foods and certain medications can change the color of feces (beets - reddish; blueberries, blackcurrants, blackberries, coffee, cocoa - dark brown; bismuth, iron color feces black).
Slime	Normally absent (or in scarce amounts).
Blood	Normally absent.
Pus	Normally absent.
Leftover undigested food (lientorrhoea)	Normally absent.

Chemical research

Parameter	Norm
fecal reaction	Normally neutral, rarely slightly alkaline or slightly acidic. Protein nutrition causes a shift in the reaction to the alkaline side, carbohydrate - to the acidic.
Reaction to blood (Gregersen's reaction)	Normally negative.
Reaction to stercobilin	Normally positive.
Reaction to bilirubin	Normally negative.
Vishnyakov-Tribulet reaction (for soluble protein)	Normally negative.

microscopic examination

Parameter	Norm
Muscle fibers	Normally absent or single in the field of view.
Connective tissue (remains of undigested vessels, ligaments, fascia, cartilage)	Normally absent.
Fat is neutral. Fatty acid. Salts of fatty acids (soaps).	Normally, there are no or a meager amount of salts of fatty acids.
vegetable fiber	Normally, single cells in p/z.
Starch	Normally absent (or single starch cells).
Iodophilic microflora (clostridia)	Normally, it is single in rare cases (normally, the iodophilic flora lives in the ileocecal region of the colon).
Epithelium	Normally, there are no or single cells of the cylindrical epithelium in the p / s.
Leukocytes	Normally, there are no or single neutrophils in p / z.
red blood cells	Normally absent.
worm eggs	Normally absent.
Pathogenic protozoa	Normally absent.
yeast cells	Normally absent.
Calcium oxalate (lime oxalate crystals)	Normally absent.
Tripelphosphate crystals (ammonia-magnesium phosphate)	Normally absent.

Diseases for which the doctor may prescribe a general fecal analysis (coprogram)

Muscle fibers in the stool indicate a violation of the digestive process. By the composition of the feces, we can conclude which organ has ceased to perform its functions.

If it is noted in the coprogram that muscle fibers are found in the feces, then what can this mean?

Reasons for the appearance

Digestion is a complex mechanism in which many organs are involved, united under the general concept of the "gastrointestinal tract".

The gastrointestinal tract begins with the oral cavity, where food is crushed and digestion begins under the action of salivary enzymes.

The digestive tract ends at the anus, from where food remains that the body could not absorb come out.

Having examined this substance, one can say how the process of digestion proceeded - normally or with deviations, and what stages of the digestive process were violated.

Feces is a homogeneous mixture of a variety of substances:

products produced by the digestive tract;
digested and semi-digested food;
cells of the mucous membrane of the tract;
microorganisms that make up the intestinal microflora.

Food leftovers in the stool are called detritus. These are very small particles, consisting of the remains of products, bacteria and the dead upper layer of the intestinal epithelium.

With a good digestion process, there is always a lot of detritus in the feces and no undigested substances. The stool itself is a soft but well-formed mass. There is little detritus in the liquid feces, which indicates a violation of digestion.

If digestion proceeds normally, then only single muscle fibers can be found in the feces.

With poor functioning of the gastrointestinal tract, all indicators of the coprogram differ sharply from normal values.

Each laboratory has its own standards, due to the accuracy of equipment and reagents. In the form of a laboratory study, they are indicated in the column "reference values".

A large amount of digested or undigested muscle fibers in the stool is called creatorrhea.

Muscle fibers found in feces indicate the following pathologies:

increased secretion of enzymes in the colon;
poor performance of the PJ;
lack of bile;
poor digestion in the small intestine;
accelerated motility of the colon.

A large amount of undigested muscle fibers in the feces may indicate:

chronic pancreatitis - a disease of the prostate gland, leading to a decrease in the production of enzymes necessary for the breakdown of proteins;
chronic atrophic gastritis;
hepatitis or gallstone disease;
dysbacteriosis (fermentative dyspepsia, putrefactive dyspepsia);
colitis (ulcerative or constipated).

If the muscle fibers left the intestines completely undigested, then this indicates a poor functioning of the stomach.

With weak digestion of fibers, one can confidently speak of defects in the work of the pancreas.

If the muscle fibers are well digested, but look like orange lumps, then this indicates insufficient production of enzymes in the small intestine.

Transformation of muscle fibers in the gastrointestinal tract

To understand why muscle fibers appear in feces, you need to know what happens to meat products in the human gastrointestinal tract.

The digestion of meat in the human body is very difficult due to the presence of fibers and tissues in this product. For their decomposition, the gastrointestinal tract must produce many specific enzymes.

In the mouth, the meat is only crushed, but not digested at all. Digestion starts in the stomach.

The basis of meat is fiber - these are large protein molecules that the body needs to divide into smaller fragments.

In the stomach, pepsin and chymosin act on the fibers - two enzymes that can work in conditions of increased acidity of gastric juice.

Next, a semi-digested and chopped piece of meat, still having a large amount of fibers and films, enters the intestine, where it is affected by enzymes of the small intestine and pancreas: trypsin, elastase and others.

After contact with these enzymes, meat can already be absorbed by the body in the form of amino acids, fatty acids and mineral components.

Parts that are difficult to digest (cartilage, tendons and skin) pass further - into the large intestine, and then leave the gastrointestinal tract with feces.

The degree of digestion of muscle fibers is indicated by a special indicator - striation. Usually, the coprogram form has separate columns for muscle fibers with and without striation.

Striated muscle fibers are fragments of meat food, partially processed in the stomach and intestines.

Under a microscope, striated fibers look like long cylindrical formations with smoothed corners. Stripes are clearly visible across or along them, indicating insufficient exposure to enzymes.

Fibers without striation - completely digested, look like small lumps. Normally, the striation should disappear even in the stomach under the influence of gastric juice. Finally, the striation should disappear in the duodenum when bile enters the chyme.

The main enzyme for digesting meat in the intestine is pancreatic elastase.

It automatically begins to be produced in the pancreas when the body gives a signal that protein food has entered the stomach.

From PJ elastase in the composition of pancreatic juice enters the intestine, where it breaks down the protein into amino acids that can be absorbed by the intestinal wall and assimilated.

Passing through the gastrointestinal tract, pancreatic elastase does not change chemically at all. In feces, the enzyme is in the same form in which it was synthesized by the pancreas, therefore, by analyzing feces for pancreatic elastase, we can conclude that the pancreas is working.

In newborns, the content of elastase is low, but already from the age of two weeks in the feces of infants, the content of the enzyme reaches the level of an adult.

In newborns, fecal elastase analysis is taken to diagnose or exclude cystic fibrosis, a genetic disease that results in a change in the structure of gland cells, which is manifested by lesions of the lungs, gastrointestinal tract, and disorders of digestive mechanisms.

Analysis of the feces of a newborn for elastase allows you to diagnose cystic fibrosis at an early stage and prevent death.

What to do if muscle fibers are found in the feces?

If muscle fibers are found in the feces, the study should be repeated. The fact is that meat is a hard-to-digest food.

The reason for the appearance of muscle fibers in the feces may not be health problems, but other factors that make digestion difficult: insufficient heat treatment of the product, its poor grinding in the oral cavity, or excessive consumption.

Complicates the digestion of meat and fish mixed diet.

Supporters of a separate diet are right - meat is digested easier, faster and more completely when it is in the stomach without carbohydrate products, along with the same protein or raw plant foods that contain a lot of fiber and natural enzymes.

The norm is the complete absence of muscle fibers in the feces. The exception is children under one year old, whose complementary foods are meat and fish.

In the feces of babies, there can be a lot of underdigested or undigested muscle fibers - this is due to the unpreparedness of the digestive system. Over time, the child's body will learn to absorb meat food.

Creatorrhea in an adult speaks of violations of the pancreas and stomach. Your doctor may suggest additional examinations of these organs.

The pancreas can be examined using plain radiography or computed tomography. The most informative method is magnetic resonance imaging.

With the help of this study, chronic pancreatitis, tumors and other pathologies of the pancreas can be detected with maximum reliability.

FGDS is used to examine the stomach. During the study, a probe with a video camera at the end is inserted into the patient's stomach, which allows the doctor to see with his own eyes what is happening inside the stomach, and, if necessary, take a tissue sample for analysis. In addition to FGDS, the stomach can be examined using ultrasound, computed tomography and MRI.

Pathologies of the small intestine are detected using endoscopy and colonoscopy.

There is a method for examining the intestines, and at the same time the stomach, using a capsule with a built-in video camera.

Passing through the gastrointestinal tract, the capsule video camera captures the pathology of the gastrointestinal tract: polyps, tumors.

Thus, by analyzing feces for muscle fibers, it is possible to identify diseases of the gastrointestinal tract, which can be almost asymptomatic for a long time, including such dangerous ones as stomach cancer and chronic pancreatitis.

General analysis of feces - normal indicators

Age and type of feeding
Analysis indicators	Breast-feeding	Artificial feeding	older children	adults
Quantity	40-50 g / day.	30-40 g / day.	100-250 g / day.	100-250 g / day.
Consistency	sticky, viscous (mushy)	putty consistency	decorated	decorated
Color	yellow, golden yellow, yellow green	yellow-brown	brown	brown
Smell	sourish	putrefactive	Fecal, not sharp	Fecal, not sharp
Acidity (pH)	4,8-5,8	6,8-7,5	7,0-7,5	7,0-7,5
Slime		absent	absent	absent
Blood	absent	absent	absent	absent
Soluble protein	absent	absent	absent	absent
Sterkobilin	present	present	75-350 mg / day.	75-350 mg / day.
Bilirubin	present	present	absent	absent
Ammonia			20-40 mmol/kg	20-40 mmol/kg
Detritus	Various quantity	Various quantity	Various quantity	Various quantity
Muscle fibers		Little or none	absent	absent
Connective tissue fibers	absent	absent	absent	absent
Starch	absent	absent	absent	absent
Plant fiber (digestible)	absent	absent	absent	absent
Neutral fat	Drops	A small amount of	absent	absent
Fatty acid		Small amount of crystals	absent	absent
Soaps	In a small amount	In a small amount	Minor amount	Minor amount
Leukocytes	single	single	single in the preparation	single in the preparation

Quantity.

The amount of feces can be estimated according to the patient. Normally, 100–200 g of feces are excreted per day, depending on the nutritional structure (protein food reduces the amount of feces, vegetable food increases). A decrease in the amount of feces occurs with constipation. More than the norm is allocated in the following cases:

violations of the flow of bile
accelerated evacuation of feces from the small and large intestines;
disorders of food digestion in the small intestine (inflammatory processes, fermentative and putrefactive dyspepsia,)
inflammatory bowel disease (including colitis with diarrhea, colitis with peptic ulcer)
pancreatic insufficiency (up to 1 kg of feces per day can be excreted).

Consistency of feces.

The consistency of feces is determined by the content of water, fat and mucus in it. With normal bowel movements, the water content reaches 80–85%, with constipation it decreases to 70%. With diarrhea, feces contain up to 95% water. Inflammatory processes in the large intestine and increased mucus content give the feces a liquid consistency. A large amount of undigested fats makes the feces greasy or pasty.

The norm is a dense decorated feces.

Ointment feces are formed when the secretory activity of the pancreas is disturbed, with poor flow of bile into the large intestine.

Liquid stool characterizes insufficient digestion in the small intestine (enteritis, accelerated evacuation) and large intestine (ulcerative colitis, putrefactive colitis, or increased secretory activity)

Mushy feces are characteristic of accelerated evacuation from the colon; colitis accompanied by diarrhea; chronic enteritis.

Feces in the form of dense balls are formed during constipation.

Ribbon-like feces are formed with spasms of the sphincter, hemorrhoids, in the presence of a tumor of the sigmoid or rectum.

Smell of feces. The breakdown of proteins is the cause of the characteristic odor of feces. With painful processes of the digestive tract, a change in smell can be distinguished.

A decrease in the characteristic odor (up to complete disappearance) occurs with constipation, due to the absorption of aromatic substances, and with the use of antibiotics; with accelerated evacuation in the intestines.

A fetid odor (rancid oil) characterizes impaired pancreatic secretion, obstructed flow of bile into the intestines. In this case, fat and fatty acids are decomposed, mainly due to the activity of bacteria.

A putrid smell (hydrogen sulfide) occurs with ulcerative colitis, insufficient gastric digestion, fermentative dyspepsia (digestion disorder characterized by bloating, rumbling and transfusion in the intestines, a feeling of heaviness, paroxysmal pain).

A sour smell is formed with fermentative dyspepsia.

stool color. The color of feces is normally brown, and it is due to the presence in the feces of the substance stercobilin, the end product of the breakdown of bilirubin. Nutrition affects the color of feces: meat food stains dark brown, dairy food makes the color less intense, vegetables add their own pigment.

Color changes in diseases of the gastrointestinal tract:

Dark brown color is characteristic of insufficient gastric digestion, colitis with constipation or ulceration, for increased secretory function of the large intestine; appears with constipation and putrefactive dyspepsia (increased processes of putrefaction in the large and partly in the small intestine).
Light brown color appears with accelerated evacuation from the large intestine.
A red tint is characteristic of ulcerative colitis.
The yellow color appears from insufficiency of digestion in the small intestine and fermentative dyspepsia (an indigestion characterized by bloating, rumbling and transfusion in the intestines, due to a carbohydrate diet).
Gray or light yellow color is characteristic of insufficient activity of the pancreas.
White color (clay) with infectious lesions of the liver, with stagnation of bile or complete blockage of the bile duct with cholelithiasis or tumors.
Black or tarry color is a sign of gastrointestinal bleeding.

fecal reaction.

Normal is considered a neutral or slightly alkaline reaction of feces. Such a reaction corresponds to the vital activity factor of the large intestine flora (pH 6.8–7.6).

Deviations of the reaction of feces from the norm:

An alkaline reaction (pH 8.0–8.5) is characteristic of poor functioning of the stomach and small intestine. Proteins in this case are susceptible to putrefaction due to the activation of the corresponding intestinal flora. As a result, ammonia and other alkaline components are formed.
A sharply alkaline reaction (pH over 8.5) is characteristic of putrefactive dyspepsia (increased putrefaction processes in the large intestine) with colitis.
An acidic reaction (pH 5.5–6.7) is formed when fatty acids are not absorbed in the small intestine.
A sharply acidic reaction (pH less than 5.5) is observed during the formation of carbon dioxide and organic acids as a result of fermentative dyspepsia (digestion, characterized by bloating, rumbling and transfusion in the intestine, due to a carbohydrate diet). This occurs as a result of the activation of the fermentative flora (normal and pathological).

Mucus in stool

Jelly-like mucus is formed in the intestines for better evacuation of food, to reduce friction. However, mucus is normally not detected in feces without a microscope, since it mixes with feces. The abundance of mucus indicates:

Inflammation of the large intestine (colitis).
Irritable Bowel Syndrome.
Poisoning, infectious diseases of the intestine (for example, dysentery, but in this case the symptoms are multiple: pain, diarrhea, and others).

stool blood. Normally, blood is not present in the feces. Blood visible to the naked eye (as well as occult blood) is an alarming symptom that is observed:

With exacerbation of colitis.
With bleeding from any part of the gastrointestinal tract, including ulcers.
With intestinal polyps.
With hemorrhoids and varicose veins of the digestive tract.
With malignant tumors in the gastrointestinal tract.

A positive test for occult blood has the same causes

Leftover undigested food

With proper preparation for stool collection, undigested food should not normally be found. If undigested fiber is found, this may indicate a low acidity of gastric juice or an excessively rapid evacuation of food. In the diagnosis of diseases of the gastrointestinal tract, the remains of plant foods do not matter. The remains of undigested meat food are examined under a microscope.

Soluble protein in feces should normally be absent. The causes of the appearance of soluble protein in the feces can be: inflammatory processes in the gastrointestinal tract (gastritis, colitis, enteritis, pancreatitis), ulcerative colitis, putrefactive dyspepsia, excessive secretion of the large intestine, bleeding from the gastrointestinal tract

Sterkobilin A pigment that gives feces a characteristic dark brownish tint. This pigment is a product of the transformation of bile pigments and, at the same time, the result of the exchange of bilirubin.

The reasons for the increase in the amount of stercobilin in the feces: hemolytic anemia, increased bile secretion.

The reasons for the decrease in the amount of stercobilin in the feces: obstructive jaundice, cholangitis, cholelithiasis (cholelithiasis), acute pancreatitis, chronic pancreatitis, viral pathologies of the liver.

Bilirubin in feces in children older than 9 months and in adults should not be. The reasons for the appearance of bilirubin in the feces: treatment with strong antibiotics, intestinal dysbacteriosis, increased intestinal motility, accelerated evacuation of feces from the intestines.

Ammonia, as a product of decay, is formed by the action of bacteria on food protein residues and digestive juices in the lower intestine. An increase in ammonia in the feces indicates hypersecretion and inflammatory exudation in the colon.

Detritus- These are small particles of food that has been digested by the body, and destroyed bacterial cells.

Muscle fibers are a product of processed food of animal origin. The fewer of them in the feces, the better the digestive system works. Normally, a small amount of muscle fibers can be found in the feces, they must be digested and have lost their transverse striation.

The reasons for the increased content of muscle fibers: hypoacid gastritis or anacid gastritis, achilia, dyspepsia, acute or chronic pancreatitis, increased intestinal motility.

Connective tissue fibers in feces- the remains of animal products that the body could not digest. In a healthy person, the analysis does not detect these fibers. And their presence indicates the development of gastritis or pancreatitis.

Starch found in large quantities in vegetables, fruits and cereals. But normally, starch should not be in the feces, since it should be completely broken down in the digestive tract. However, there are a number of cases when starch is found in feces. The causes of the appearance of starch in the feces: pancreatitis, fermentative dyspepsia, accelerated evacuation of intestinal contents, gastritis.

plant fiber in feces It can be of two types: digestible and indigestible. Digestible fiber normally should not be in the feces. The content of indigestible fiber in the stool has no diagnostic value. The reasons for the appearance of digestible fiber in the feces: the use of large volumes of plant foods, accelerated evacuation of the contents of the large intestine, gastritis, putrefactive dyspepsia, ulcerative colitis, pancreatitis.

Neutral Fats(or triglycerides) in the feces should be absent, as they must be completely processed. In infants, there may be a small amount of neutral fats in the feces, since their enzyme system is not fully developed. Causes of the appearance of neutral fats in the feces: accelerated evacuation of intestinal contents, pancreatitis, impaired bile production and impaired flow of bile into the small intestine, malabsorption in the intestine.

Fatty acid are completely absorbed in the intestines, so they should not be in the feces. Causes of the appearance of fatty acids in the feces: fermentative dyspepsia, impaired secretory function of the pancreas (pancreatitis), impaired bile production and impaired bile flow into the small intestine (liver and biliary tract diseases), malabsorption in the intestine, accelerated evacuation of intestinal contents. The same applies to neutral fats.

Soaps are recycled fats. Normally, they should be present in the feces in a small amount. The reasons for the absence of soaps in the feces: fermentative dyspepsia, violation of the secretory function of the pancreas (pancreatitis), violations of the production of bile (liver disease) and violation of the flow of bile into the small intestine (cholelithiasis), malabsorption in the intestine, accelerated evacuation of intestinal contents.

Leukocytes- these are cells that are able to "digest" microorganisms, bind and break down foreign protein substances and decay products that are formed in the body during life. Sometimes the presence of white blood cells in the stool can be the cause of improperly collected feces for analysis (leukocytes can enter the stool from the urethra or from the vagina). In infants, single leukocyte cells may occur, this is the norm and has no diagnostic value. Usually, the presence of leukocytes in the feces can indicate the presence of any inflammatory processes in the gastrointestinal tract: gastrointestinal infections, colitis, enteritis, enterocolitis, ulcerative colitis, rectal fissures.

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Microscopic examination in feces can reveal detritus, food debris, elements of the intestinal mucosa, crystals, microorganisms.

Detritus represents the remains of elements of food, microorganisms, decayed rejected epithelium of the intestines, leukocytes, erythrocytes, etc. It has the appearance of small amorphous formations of a predominantly granular form. Since detritus makes up the bulk of feces, the largest amount of it is contained in formed feces and the smallest in liquid. The thinner the stool, the less detritus. By the amount of detritus, one can judge the digestion of food. The nature of the detritus is not noted during the registration of microscopic examination data.

Slime. With a macroscopic examination of the feces, mucus may not be detected, since normally it covers the surface of the feces with a thin, barely noticeable layer. Microscopically, mucus is revealed as a structureless substance with single cells of a cylindrical epithelium.

An increase in the amount of mucus in the feces in adults indicates a pathological condition. In newborns, small flakes of mucus are found under physiological conditions.

Epithelium. In feces, cells of squamous and cylindrical epithelium can be detected.

squamous epithelial cells from the anal canal are located separately or in layers. Their discovery is of no practical importance.

Cylindrical epitheliocytes enter the feces from all parts of the intestines. They may be unchanged or undergo degenerative changes. In the latter case, the epithelial cells are wrinkled, reduced, waxy, sometimes non-nuclear, and may look like dull grains.

There are such epithelial cells in the mucus from the colon. Normally, the stool contains a small number of cells of the cylindrical epithelium. With catarrhal inflammation of the intestinal mucosa, epitheliocytes can be found in a significant number of individual cells and whole layers. In ribbon-like films with mucosal colic (membranous colitis), cylindrical epitheliocytes can also be detected in large numbers.

Leukocytes, predominantly neutrophilic granulocytes, are either in the mucus or outside it. With catarrhal inflammation of the intestinal mucosa, the number of leukocytes is small, with an ulcerative process it increases sharply, especially if it is localized in the distal intestines.

Eosinophilic granulocytes are observed in spastic colitis, amoebic dysentery, and some helminthiases. When a 5% aqueous solution of eosin is added to the mucus, their grains turn bright orange. Often, along with eosinophilic granulocytes, Charcot-Leyden crystals are found.

macrophages are found in stained preparations, of various sizes, most often large, with round nuclei, in their cytoplasm there are inclusions: erythrocytes, neutrophilic granulocytes (whole or their fragments). With dysentery, macrophages are found in small numbers, with amoebiasis - single.

red blood cells either unchanged, or in the form of shadows that are difficult to recognize. They can be excreted with feces and in the form of amorphous decay, colored brownish. The presence of erythrocytes indicates, as a rule, the presence of an ulcerative process. Unaltered erythrocytes are usually found in feces with bleeding from the lower parts of the alimentary canal (with hemorrhoids, rectal cancer, etc.) and with heavy bleeding from the upper parts of the alimentary canal. Sometimes red blood cells are found in the stool along with mucus.

vegetable fiber is present in the feces constantly and often in large quantities, which is associated with the constant use of plant foods.

Digestible plant fiber chemical composition refers to polysaccharides. It consists of cells that have a delicate, thin, easily collapsing membrane. Digestive enzymes easily penetrate the cell membrane of digestible fiber, even if it is not damaged, and break down their contents.

Cells of plant fiber are interconnected by a layer of pectin, which dissolves first in the acidic contents of the stomach, and then in the slightly alkaline contents of the duodenum. With achilia, the cells of digestible fiber are not separated and are found in the feces in the form of groups (potato cells, carrots, etc.). There is no digestible fiber in the formed feces.

in indigestible plant fiber contains lignin, which gives it hardness and rigidity. Cells of indigestible fiber have thick double-circuit shells. Enzymes capable of breaking down plant cell membranes are not produced in the human alimentary canal. The breakdown of fiber is facilitated by some microorganisms of the large intestine (clostridia, Bcellulosae disssolvens, etc.). The longer the feces are in the intestines, the less fiber remains in it. The structure of indigestible plant fiber is very diverse, the most characteristic of it is the presence of residues of leguminous plants in the form of narrow, long, parallel palisade cells that refract light; vessels of plants, spirals, hairs and needles, epidermis of cereals, etc.

grains of starch are found in feces extracellularly and in the cells of potatoes, beans, etc. They are easily detected by adding iodine.

Starch grains, located extracellularly, lose their layering and look like irregular fragments. Depending on the stage of digestion, starch grains are stained differently when Lugol's solution is added: amylodextrin becomes purple, erythrodextrin - red-brown; the color of archodextrin does not change. Normally, there are no grains of starch in the feces. Incomplete breakdown of starch is observed in diseases of the small intestines and the associated accelerated evacuation of food.

Muscle fibers. Remains of protein food in the form of muscle fibers can sometimes be detected already with a macroscopic examination of feces. Microscopically, the remnants of muscle fibers are found in any preparation, even if the patient ate food with a small amount of meat.

Digested muscle fibers look like ovoid non-striated fragments of various sizes. Insufficiently digested fibers are longitudinally striated, some of the angles are sharp. In unchanged muscle fibers, transverse striation is preserved, all angles are sharp.

With insufficient flow of bile into the duodenum, the muscle fibers are pale-colored. Under the influence of hydrochloric acid of gastric juice, muscle fibers of food origin are released from intermuscular connective layers and sarcolemma. At the same time, the structure of muscle fibers, their transverse and longitudinal striation are disturbed. In this state, most of the muscle fibers enter the duodenum. The final digestion of muscle fibers occurs mainly under the influence of pancreatic juice. The appearance in the feces of a large number of groups of muscle fibers with preserved transverse and longitudinal striation indicates a lack of digestion of food in the stomach.

A large number of muscle fibers (creatorrhoea) may be due to:

achilia (the presence in the preparation of groups of striated, or striated, muscle fibers);
insufficient secretion of the pancreas (the presence in the preparation of sufficient and insufficiently digested, separately located muscle fibers);
pathologically accelerated evacuation of food (the presence of undigested fibers);
nutritional overload, which should not be after a trial diet. The method of cooking meat and the state of the chewing apparatus also matter.

Connective tissue. In stool, highly diluted with water, particles of connective tissue look like scraps and strands of a grayish color of irregular shape with shaggy torn edges. Microscopically, they are characterized by a delicate fibrous structure, but differ from mucus in sharper outlines, denser consistency and opacity. After the addition of acetic acid, the structure of the connective tissue disappears, and layering and striation appear in the mucus. When eating poorly fried and boiled meat, the presence of connective tissue in the feces is a physiological phenomenon.

Detection of connective tissue after a trial diet (especially the Schmidt diet) indicates a lack of digestion of food in the stomach.

Fat. Normally, feces always contain a small amount of fatty acids and their salts. There is no neutral fat.

In the native preparation, neutral fat has the form of rounded or oval colorless or slightly yellowish droplets. When pressure is applied to the coverslip, the drops change shape. If there is a lot of fat, they merge. In the preparation stained with methylene blue, drops of neutral fat are colorless, while in the preparation treated with Sudan III they are bright red.

Fatty acid found in feces in the form of long, pointed needles (crystals), sometimes folded into bundles, and also in the form of lumps and drops, sometimes with spikes.

If needles and lumps are found in the native preparation, it is heated, not brought to a boil, and examined under a microscope. Fatty acids, when heated, form droplets, which, when cooled, again turn into lumps. Heating can be repeated several times. Drops of fatty acids stain blue with methylene blue.

Soaps (salts of fatty acids) occur in the form of clumps and crystals, similar to fatty acid crystals, but shorter, often arranged in bundles.

If, when the preparation is heated, needles and lumps do not form drops, it is necessary to heat the preparation with acetic acid (20-30%) to a boil. The formation of droplets indicates the presence of soaps: acetic acid breaks down soaps and releases fatty acids, which melt to form droplets.

In the digestion and absorption of fat, pancreatic juice lipase and bile play the most important role. Violation of the secretion of the pancreas leads to the fact that fats are not broken down and are excreted in large quantities with feces. If bile does not enter the duodenum, then fatty acids formed from neutral fat under the action of lipase are not absorbed and are present in feces in large quantities. Feces with a significant fat content (steatorrhea) have a peculiar pearly sheen, grayish color and ointment consistency. It may also contain pieces of undigested adipose tissue. This is observed in violation of digestion in the stomach, where normally fat is released from the connective tissue.

crystals. Tripelphosphates in the form of crystals are most often found in liquid stools and mucus. The reaction of feces is alkaline. Diagnostic value has their detection only in freshly excreted feces. Usually the appearance of these crystals is associated with an increase in putrefactive processes in the feces and the admixture of urine to it.

Oxalates found in feces when taking a large amount of plant foods. Normally, hydrochloric acid converts calcium oxalate to calcium chloride, so the presence of oxalate in feces may indicate a low acidity of gastric juice.

Cholesterol crystals in the feces are difficult to recognize and have no diagnostic value.

Charcot Leiden Crystals observed in feces when eosinophilic granulocytes enter it. In amoebiasis, these crystals sometimes reach large sizes.

Bilirubin crystals can be detected with profuse diarrhea, when bilirubin does not have time to recover into stercobilin due to the rapid evacuation of food through the intestines. They are small needle-like crystals of yellowish-brown color, pointed at both ends, located in the form of bundles.

Hematoidin crystals appear in the feces after intestinal bleeding in the form of long needles and rhombic plates. Their color ranges from golden yellow to brownish-orange.

Microflora. The human gut contains a large number of microorganisms. They make up 40-50% of the mass of feces and are part of the detritus. Of practical importance is the detection of iodophilic flora and Mycobacterium tuberculosis in the feces.

TO iodophilic flora include microorganisms (cocci and rods of various lengths and thicknesses) that have the ability to stain with Lugol's solution in black due to the presence of granulosa in them. The iodophilic flora grows on media containing carbohydrates, which it assimilates.

Under physiological conditions, the iodophilic flora is located in the lower part of the ileum and caecum. Normally, its content in the feces is very small, and with constipation, it is absent. An increase in the content of iodophilic flora in the feces is combined with an acid reaction, an accelerated release of chyme from the intestines and the appearance of fermentation processes. With pronounced fermentation processes in the feces, there are long, slightly curved sticks, located in heaps and chains - leptothrix and thick spindle-shaped bacilli, sometimes with swelling at one end (in the form of a drumstick) - clostridia, forming groups and chains, and sometimes lying intracellularly. Clostridia are stained with iodine either entirely or only in the middle part.

If fermentation is not pronounced and is combined with the process of putrefaction, small cocci and rods can be found in the feces. Yeast fungi are stained with Lugol's solution in a yellowish color. Their detection in large numbers in fresh feces indicates candidiasis.

Mycobacterium tuberculosis are found in the feces with tuberculosis of the intestines. Preparations for research according to the special prescription of a doctor are prepared from mucous, mucous-bloody and purulent lumps, in the absence of mucus, blood, pus - from feces thoroughly mixed with water, fixed and stained according to Ziehl-Nelsen.

What do muscle fibers look like in stool? Causes of changes in the consistency of feces. Indications for the study

Coprogram indicators

Deviations from the norm

Macroscopic examination

Quantity

Consistency

Form

Color

Slime

Blood

Pus

Leftover undigested food (lientorrhoea)

Chemical research

fecal reaction

Reaction to blood (Gregersen's reaction)

Reaction to stercobilin

Reaction to bilirubin

Vishnyakov-Tribulet reaction (for soluble protein)

microscopic examination

Fat is neutral. Fatty acid. Salts of fatty acids (soaps)

vegetable fiber

Starch

Iodophilic microflora (clostridia)

Epithelium

Leukocytes

red blood cells

worm eggs

Pathogenic protozoa

yeast cells

Calcium oxalate (lime oxalate crystals)

Tripelphosphate crystals (ammonia-magnesium phosphate)

Norms

Macroscopic examination

Chemical research

microscopic examination

Diseases for which the doctor may prescribe a general fecal analysis (coprogram)

Crohn's disease

Colon diverticulosis

Duodenal ulcer

stomach ulcer

Chronic pancreatitis

Hemolytic anemia

Benign neoplasms of the colon

Intestinal helminthiases

Cirrhosis of the liver

Ulcerative colitis

Constipation

Malignant neoplasm of the colon

irritable bowel syndrome, chronic colitis

Cholera

Amoebiasis

Typhoid fever

Peptic ulcer of the stomach and duodenum

Reasons for the appearance

Transformation of muscle fibers in the gastrointestinal tract

What to do if muscle fibers are found in the feces?