What is a coprogram analysis. Deciphering the results of the fecal coprogram

A coprological study is an analysis of feces, which allows a specialist to diagnose pathological changes in the organs of the gastrointestinal tract, to study the process of digestion, absorption, and intestinal motility.

A coprological study helps to assess the composition of feces, find the cause of the disruption of the digestive system, problems with acidity, inflammatory processes in the gastrointestinal tract, hidden bleeding.

The analysis is assigned to patients with chronic and acute, as well as to compare the results of ongoing therapy.

After examining the physical, bacteriological, chemical composition of feces, a specialist can identify diseases of the gallbladder, pancreas, liver, intestines, and stomach.

Chyme (food bolus) passes through the digestive tract. As a result of the activity of each organ of the gastrointestinal tract, the structure of the gruel changes and in the large intestine it is converted into feces. Therefore, the contents of the stool can be used to judge the state of all digestive organs. The presence of fiber, mucus, fats, carbohydrates in the feces indicates a pathological change in a certain section of the digestive tract.

Collect fresh morning feces in a plastic or glass container. For the study, 10 grams of feces is enough. There is no need to change the diet before taking the analysis, it is advisable to limit the use of sweet and starchy foods.

Do not use laxatives, enzymes, or iron supplements before collecting samples. They act on peristalsis and change the color of feces. If a study is scheduled to determine hidden bleeding for 3-4 days, green vegetables, tomatoes, fish and meat should be excluded from the diet.

How is the analysis carried out?

This is a simple and fairly informative method that analyzes visual indicators, microscopic and chemical composition of stools.

Macroscopic examination of feces allows you to study its physical properties: shape, texture, smell, color, visible impurities.

In a healthy person, feces are cylindrical in shape. If it lingers in the intestine for a long time, it comes out in the form of small lumps. Ribbon-like stools are excreted with muscle spasm, hemorrhoids and tumors of the rectum.

Soft stools are considered normal. Its density depends on the water content. If undigested food remains in the intestines for a long time, they contain less water. Liquid consistency indicates accelerated evacuation. Foamy masses indicate an enhanced fermentation process, watery feces occur with intestinal infections, intoxications.

The normal color of feces is yellowish brown. Coloring depends on the products used. Dairy food gives a light yellow color, meat products give a dark brown tint.

By color, you can determine the place of bleeding. Stools acquire a reddish tone when bleeding from the distal small intestine. Black stools indicate bleeding from the duodenum, esophagus, and stomach. Dark red impurities appear when blood flows from the colon.

The gray tint is due to a violation of the outflow of bile. Green stool is excreted when the pancreas and liver are malfunctioning.

The smell of feces depends on the foods used. With indigestion, a sour smell appears, with a violation of the secretion of the pancreas, fetid feces come out. In case of insufficiency of digestion, a faint odor is observed.

Visible impurities in the form of fragments of undigested food are found in violation of the digestive process in the stomach and small intestine. Mucus indicates inflammation of the mucous membrane of the large intestine. With dysentery, tumor decay, ulcerative lesions of the colon, pus is released. In the feces, pancreatic and gallstones, helminths can be found. Undigested pieces of cartilage, particles of plant foods, nuts, fruit peels are considered the norm.

A chemical study can detect red blood cells that indicate hidden bleeding. A positive reaction to occult blood is present when:

intestinal tuberculosis;
nonspecific ulcerative colitis;
stomach ulcer and duodenal ulcer;
tumors of various parts of the gastrointestinal tract;
expansion of the veins of the esophagus;
damage to the intestinal walls by helminths;
typhoid.

The accuracy of the analysis can be affected by the ingress of blood from the nose, larynx, menstrual blood.

The reaction of the stool is determined using a paper universal indicator. A sharply alkaline reaction is observed with an increased process of decay, an acidic reaction indicates a violation of the absorption of fatty acids.

The test for stercobilin (a bile pigment formed during the processing of bilirubin) is performed by several methods. It helps to identify various diseases. With hemolytic jaundice, the content of this substance in the feces increases, with parenchymal hepatitis, it decreases. High levels of stercobilin are observed with blockage of the biliary tract.

Microscopic examination of feces for food residues can reveal digestive disorders.

Fatty acids in the feces indicate an accelerated evacuation of the contents of the small or rectum, dyspepsia, malfunctions of the biliary system.

Starch in the stool is found in the digestive process in the stomach and small intestine. Ammonia in the fecal masses is detected during hypersecretion in the large intestine. Soluble mucus appears as a result of irritation or inflammation in the large intestine. Muscle fibers are found in large numbers with a decrease in the acidity of gastric juice. As a result, the quality of food digestion decreases. The simplest microorganisms cause inflammation of the intestinal mucosa.

The main scatological syndromes

For each disease of the digestive tract, characteristic changes in feces are characteristic. Various pathologies of the gastrointestinal tract are determined by a combination of changes.

Gastrogenic Decrease in the secretory function of the stomach and pancreas is characterized by profuse liquid gray-yellow stools. In the feces there are muscle fibers, fats, connective tissue. Enteral Observed with inflammation of the small intestine (enteritis). In the feces of a dirty yellow color with a fetid odor, starch, leukocytes, soluble proteins, epithelial cells are found. Colitis Manifested with inflammation of the mucous membrane of the colon (colitis). Stool hard with mucus. Detected: blood, epithelial cells, leukocytes. Ileocecal It is noted with inflammation of the large and small intestine (enterocolitis). Foamy stools with a sour smell contain mucus, starch, iodophilic bacteria. Oral As a result of poor chewing of food, remains of undigested food are found during macroscopic scatological examination. Pyloroduodenal Insufficiency of gastric digestion and enzymatic action of the Brunner glands of the duodenum. The coprogram shows the presence of plant fiber and muscle fibers. Secretory pancreatic insufficiency Observed with helminthic invasion, pancreatitis. Copious, unformed, dirty yellow stool contains fat and muscle fibers. Insufficiency of bile secretion Occurs with violations in the development of the bile ducts and cholecystocholangitis. Gray stool contains a large amount of fatty acids.

Of course, scatological research does not give accurate results. The color, the amount of food residue is affected not only by digestive disorders, but also by the diet. For example, when eating meat, a large amount of muscle fibers is observed in the feces, and when eating plant foods, the fiber content increases.

Therefore, before diagnosing, consult your doctor about a special diet and medication.

We get used to taking tests from childhood, and we don’t really think about what exactly they show. For example, when donating feces, we are more worried about the not very pleasant process of preparing laboratory material than about the results of the study. Meanwhile, this is a kind of litmus test of the state of the body. And the analysis of feces for coprology is one of the most revealing ways to diagnose the digestive system. How to take a stool test for a coprogram, what does it show, and who needs it?

Fecal analysis for scatology: what is it?

A coprology test, or simply a coprogram, is a laboratory study of fragments of human feces. The main task of the study is to assess the state of the digestive organs. The coprogram allows you to determine:

In other words, a coprogram is a comprehensive analysis of feces, with the help of which it is possible to reliably assess the state of the digestive tract and identify possible pathologies. Indicators such as the results of diagnosing the physical properties of feces based on macroscopic and microscopic, as well as chemical studies are taken into account.

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Chemical analysis is carried out for:

determination of fecal reaction to acid-base balance (pH), occult blood, detection of soluble proteins (Triboulet-Vishnyakov reaction);
tracking bile pigments.
Important indicators of microscopic examination are:
the remains of digested food fragments (detritus);
the presence in the feces of muscle fibers and connective tissues, fragments of fiber, starch;
detection of fatty acids and neutral fats;
the ratio of elements of the intestinal mucosa;
bacteria, etc.

Normally, stool samples are taken at least once a year. Usually, the adult population undergoes research as part of a medical examination, when applying for a job or applying for sanatorium treatment. Children must undergo scatology when entering educational and preschool institutions, and even to get a certificate in the pool.

An unscheduled analysis can be scheduled for:

diseases of the digestive tract;
hemorrhoids and anal fissures;
cirrhosis of the liver;
poisoning;
suspicion of helminthiasis or giardiasis;
diarrhea of unknown origin;
lactose intolerance in children;
preparation for surgical operations, etc.

The coprogram is often rarely prescribed as an isolated study, but mainly serves as an additional, and at the same time very informative, diagnostic method.

What does the coprogram show

After a fecal analysis for a coprogram has been passed, what he shows, you can find out from your doctor. The result is prepared from one to several days. Self-deciphering the analysis of feces for a coprogram can be difficult. What do the results of the study show?

In an adult

The analysis-coprogram of feces, the decoding of which is usually given in the plate on the photo on the laboratory form, normally looks like this in an adult:

Although the analysis requires about 20 grams of stool, the patient should pay attention to the approximate daily amount of excrement. Usually, 200-500 g is excreted per day. If this figure is higher, there may be diseases such as ulcerative colitis, enteritis, oncology of the large intestine, etc. Lack of feces is a possible symptom of ulcers, colitis, myxedema, anorexia, and etc.

The consistency of feces may vary normally, but not significantly. A good indicator is the average density. The density of feces is a symptom of constipation and lack of fluid, and thinness is a symptom of dysbacteriosis or intestinal infection.

The color of feces is an important indicator for a coprogram. Getting into the intestines with bile, a special pigment bilirubin decomposes to stercobilin. The latter provides the brown faecal color. Color change is a symptom of certain intestinal problems, such as:

a light yellow tint occurs when eating milk and products based on it, while bright yellow is a symptom of diarrhea provoked by an infection or indigestion;
dark brown feces occur both with the abuse of meat food, and in the presence of stones in the bile ducts;
a black shade of feces is possible due to foods rich in iron (and with iron medication), and with bleeding in the stomach or intestines;
a green tint may be due to a lack of bile;
red stools are a sign of either a diet with a predominance of coloring foods, or internal bleeding;
colorless stools occur when there is a violation of the intake of stercobilin, which indicates problems with the gallbladder or cirrhosis of the liver, as well as with a whole list of other diseases.

The smell is also evaluated: a specific fecal one is normal, which is provided by the presence of volatile substances produced by intestinal bacteria. A sour smell can indicate a high content of fatty acids, and a sharp putrefactive smell can indicate poisoning or rotting in the intestines.

Impurities visible in the feces with the naked eye are also studied:

undigested food lumps signal gastritis or indigestion, although some foods (nuts, seeds, tomato peel, etc.) in the fecal mass are the norm;
mucus indicates inflammation of the gastrointestinal tract, infections and ulcerative colitis;
fat - symptomatic of impaired pancreatic function;
blood indicates internal intestinal bleeding or hemorrhoids;
impurities of pus are found in inflammatory processes.

The coprogram-norm does not show non-specific impurities. There shouldn't be any protein. Its presence can be caused by chronic inflammation or dysbacteriosis. And bilirubin in its pure form in the fecal material for research should not be. If it is found, the function of the gallbladder is most likely impaired.

The study of the intestinal microflora allows you to determine whether the processes of digestion are normal and whether there are infectious diseases. The microflora (microbiota) consists of microorganisms living in the gastrointestinal tract in symbiosis with humans. On average, the gut is inhabited by about 50 trillion bacteria, and feces are approximately 60% composed of microorganisms. Almost 95% of the microflora are beneficial bacteria, the remaining 5% are pathogens. When this balance is disturbed, dysbacteriosis begins.

The child has

The children's coprogram, in general, differs slightly from the adult. Of course, it is worth making a "discount" for the age-related features of digestion. Normally, a child's alkaline reaction is neutral or slightly alkaline pH 6-8. Moderately present and detritus in the coprogram (which is discussed above). It differs from the adult and iodophilic flora in the coprogram in a child. It appears in the stool when the number of beneficial microorganisms decreases and the pathogenic flora increases. In the case when in adults even a slight deviation from this balance can indicate a violation of the state and functioning of the gastrointestinal tract, in children this is not necessarily the case. If the child feels well, and diarrhea is rare, there is no reason to worry.

At the baby

The coprogram of children of the first year of life is somewhat different even from a normal child. This is especially true for the presence of bilirubin: in infants, its presence in the feces is the norm. At the same time, the baby's stool has a green tint - these are the features of the formation of intestinal microflora and nutrition with milk. Small amounts of fecal matter may contain fatty acids, soaps, muscle fibers, mucus and leukocytes. The acidity of the infant stool is slightly alkaline (pH 4.5-6).

Coprogram: how to pass

The delivery of feces for scatology does not require special preparation. But some rules for the purity of the result should be observed:

it is impossible to donate feces while taking antibiotics, at least a week after their cancellation;
it is worth adhering to a couple of days before analyzing a diet with a low content of fat, coloring foods;
refuse sorbents on the eve of stool collection;
reschedule the change if you are menstruating.

The feces are relatively “fresh”, no more than 8-10 hours of storage. It is allowed to hand over in the morning the evening collected, but it should be stored overnight in an airtight container in a cool place.

How to collect feces for a coprogram

Before you make a "control" defecation for analysis, you should not wash yourself - water and soap will destroy possible traces of pinworms. And it is recommended to empty the bladder - the presence of urine in the feces will "smear" the result of the study.

The toilet bowl or container for defecation must be clean. After the intestines are emptied, they collect a little from different parts of the “heap”. Ideally, they use a pharmacy jar - it has a collection spoon, and the jar itself meets all sanitary and hygienic standards. If it is not forbidden in the clinic, a small glass jar or, for example, a penicillin tube with a tight lid, pre-disinfected with boiling water, will do.

Feces in children are taken from the pot if the baby is accustomed to it. It is worth making sure that the baby urinates in advance, only then they collect material for research. The pot is pre-washed and treated with boiling water.

In infants, it is better to collect an analysis from a diaper previously spread under the ass. Diapers as a “reservoir” for biomaterial are not very suitable, as they mix feces with urine.

How much is a fecal analysis done

After the feces are passed, you will have to wait a couple of days - so much time is being prepared for the analysis. Sometimes it takes up to 5 days. In paid laboratories, as a rule, the waiting time is reduced.

Feces are not just waste products. Despite the neglect of feces, which is inherent in us at the genetic level, this is a valuable material for diagnosing health. Laboratory studies of feces allow you to diagnose a huge number of diseases in time! And although now you know what a coprogram is, what kind of analysis it is and what it is for, you can familiarize yourself with the decoding of the results obtained by hand, but it is more reliable to entrust the reading of the tablet to a specialist.

Coprogram - a study of fecal contents to determine its properties, physical and chemical composition, the presence of pathological inclusions in order to diagnose diseases and monitor the dynamics of the disease, the treatment process.

Fecal masses are formed when a food bolus (chyme) passes through the entire human digestive tract from the oral cavity to the rectum. Therefore, these coprograms are most valuable in the diagnosis of diseases of the gastrointestinal tract.

Table of contents: What does a coprogram show How to take a coprogram How to collect feces for a coprogram Features of collecting feces in young and infants Deciphering a coprogram in adults Features of deciphering a coprogram in children

What does the coprogram show

In the feces, microorganisms of various types and quantities, particles of undigested food, fecal pigments, and epithelium of various parts of the intestine are found.

note: knowing these features, the laboratory assistant can determine the pathological processes in certain parts of the intestine in certain diseases.

The coprogram is indicated for:

Coprological examination allows to identify dysbacteriosis (violation of the ratio of microorganisms and reproduction of pathogenic forms).

The coprogram is rarely used as an isolated study, most often it is an additional, but at the same time informative diagnostic method.

How to take a coprogram

Preparation for passing the analysis is not difficult, but some rules must be strictly observed.

If the patient is taking medications containing iron and bismuth, then they must be canceled. Also, do not take laxatives, rectal suppositories. It is forbidden to wash the intestines with enemas.

If the person under study underwent radiography with a contrast agent (barium), then the coprogram should not be done earlier than 7-10 days after the study. Barium can change the properties of feces.

In the patient's diet during the few days preceding the test, excessive variety, exotic dishes, etc. should be limited.

Preparatory rule for donating feces for a coprogram:

2 days before collecting the material, you should completely abandon tomatoes, tomato juice, pasta, beets and other vegetables and fruits that contain dyes. 3 days before the collection of feces, it is necessary to stop taking antibiotics, drugs that cause a change in the motor function of the intestine, drugs based on enzymes. Nutrition should consist of vegetables, fruits, cereals, dairy products, the amount of food should be within normal limits. You should refrain from fatty foods, smoked meats, spicy and pickled. Women should not be tested during menstruation. Feces must be collected so that urine does not get into it. Evacuation of feces for analysis should occur naturally, without the use of stimulants and enemas.

How to collect feces for coprogram

Important: the collection rules are simple, but they should be followed carefully.

To collect feces, you must:

empty the bladder, conduct a thorough toilet of the genitals and anal area using warm water and neutral soap without aromatic additives. Then rinse the washed areas with warm, boiled water; in pre-prepared clean dishes with a wide neck, using a spatula (which is available in pharmacy containers for collecting feces), collect material from different parts of the resulting feces; after collection, the stool is closed with a lid and signed with the name and surname of the patient, as well as the date of collection.

Wooden boxes, food cans should not be used as dishes for feces. The total amount of material collected should be 15-20 grams (approximate volume of a teaspoon). Try to bring approximately this amount of stool to the laboratory.

Feces should be collected in the morning and delivered to the study as soon as possible.

Note: the faster the material is brought to the laboratory, the more accurate and reliable the results of the coprogram will be.

If necessary, the container with the biomaterial is placed in a refrigerator, where it can be stored for no more than 8 hours, at a temperature of about 5 degrees Celsius.

The results of the coprogram are usually obtained within 2-3 days, sometimes the analysis takes 5-6 days.

Features of the collection of feces in small and infants

If a child goes to the potty on his own, then the same rules apply to him as to adults.

In infants, a diaper or oilcloth is used (if the stool is liquid).

In case of constipation, to stimulate defecation, it is necessary to massage the abdomen, in some cases, you can put a gas outlet tube that stimulates the act of defecation.

All materials must be clean, hands must be washed with soap and water before collection.

Deciphering the coprogram in adults

First, a macroscopic examination of the stool is performed.

In deciphering the coprogram in adults, it is estimated:

the appearance of the stool; density of feces; staining (normal or pathological); the presence of a specific smell; the presence of bloody inclusions, veins, undigested food, purulent discharge, mucous lumps; the presence of mature forms of helminths; possible isolation of gallstones and pancreatic stones.

Microscopic analysis allows you to assess the ability of the gastrointestinal tract to digest food.

Microscopic examination may reveal:

squirrel, which appears during inflammatory processes in the digestive tract system, with ulcerative changes in the mucosa, polyposis formations, oncological diseases. Normally, there is no protein in the feces; blood- appearing with hidden intra-intestinal bleeding, which can cause ulcers, tumors, polyps, helminths. Altered blood indicates processes in the upper intestines, unchanged - in the lower. Occult blood is characteristic of tumors; stercobilin. This is a pigment that is a metabolite of bilirubin, which gives the feces a specific color. About 75-350 mg of this pigment is formed per day. An increase in the rate in deciphering the coprogram in adults is characteristic of hemolytic anemia. A decrease indicates a possible process of obstruction of the bile ducts (stones, tumor); bilirubin. The appearance of this chemical indicates an acceleration of the digestion process, as a result of which bilirubin does not have time to be metabolized into stercobilin. This situation occurs with acute inflammation and with dysbacteriosis; slime. Mucus performs a protective function in the intestine, so its increased formation indicates strong inflammatory changes in the intestine in acute infectious pathology (salmonellosis, dysentery, infectious colitis, etc.); iodophilic flora. The appearance in the decoding of the coprogram in children and adults of pathological bacteria is characteristic of dysbacteriosis; detritus. Cellular destroyed material that emerges from the intestinal epithelium. A decrease in the amount is observed in violation of the digestive process; neutral fats. Excessive content is characteristic of insufficient excretion (bile production), as well as the process of absorption of bile in the intestine; muscle fibers. The appearance of these elements in an unchanged form (normally they change) indicates a disease process in the pancreas, due to violations of the composition of the juice, which is involved in the digestion of meat food; starch. Normally, it undergoes a splitting process, if during the study it is found in the form of grains, then the accelerated passage of the food bolus in malabsorption syndrome should be suspected, and this symptom also appears in chronic pancreatitis; soaps. Soapy substances are normally present in small amounts. The increase can be with digestive insufficiency of the small intestine, stomach and duodenum. These problems occur with inflammation of the pancreas, with gallstones; leukocytes. Not normally defined. Their appearance in the decoding of the coprogram indicates inflammatory diseases of the digestive tract; fatty acids. In the secretions of a healthy intestine are absent. Appear with digestive and enzymatic insufficiency, violations of the outflow of bile, accelerated intestinal activity;
vegetable fiber. If soluble fibers are noted in the decoding of the coprogram in adults, then we can talk about insufficient secretion of hydrochloric acid in the stomach. Normally, soluble plant fibers are absent in feces. Insoluble fibers (peel of fruits and vegetables, outer shell of grains and legumes) are part of the normal contents of the intestine. Insoluble fibers remove indigestible foods, poisons, cholesterol from the intestines. The amount of these elements depends on the qualitative composition of the food; connective tissue fibers. These fibers are formed from the undigested remains of animal food. Normally, they shouldn't be. The appearance of fibers is characteristic of conditions in which the acidity of gastric juice decreases - (antacid gastritis). Also, these elements are noticeable with a decrease in the production of hydrochloric acid in the stomach, enzymatic deficiency that occurs with pancreatitis; ammonia. An increase in the content of this chemical compound is characteristic of processes accompanied by decay in the intestinal lumen. Normally, ammonia in feces contains 20-40 mol / kg. If an increased value of ammonia is indicated in the decoding of the coprogram in adults, then the presence of intestinal inflammation in a person should be suspected; pathological and conditionally pathological microorganisms causing bowel disease, dysbacteriosis.

The reaction of feces (pH) can be different (weakly alkaline, neutral, slightly acidic). This indicator depends on the nature of the diet.

Features of decoding the coprogram in children

The main indicators of the coprogram in children are similar to those in adults. But there are some features.

Most children have a normal coprogram with a neutral or slightly alkaline reaction (in the pH range of 6-7.6.

note: in infants, the reaction is most often sour in nature, as a result of the nutritional habits characteristic of this age category.

The alkaline reaction in children is determined by a violation of the absorption process, with increased putrefactive processes in the intestines, a long stay in the stomach and intestines of undigested food.

Until the age of three months, a child with breastfeeding, the presence of bilirubin in the feces is a variant of the norm. After 3 months, in deciphering the coprogram in children, only stercobilin should normally be determined.

Lotin Alexander, medical columnist

A fecal analysis for a coprogram is one of the first studies that a doctor prescribes to a patient with digestive disorders. The appearance, chemical composition and microflora of feces can tell a lot about the state of the gastrointestinal tract.

The content of the large intestine consists not only of liquid and food debris, it includes elements of digestive juices, enzymes, bile, blood, and bacteria.

General analysis of feces (coprogram) is aimed at a comprehensive study of excrement: physical, chemical and microscopic.

Indications

Coprogram analysis is performed for the following diseases:

Haemorrhoids; anal fissures; chronic constipation; stomach ulcer, duodenal ulcer; pancreatitis; Diverticula of the intestine; Crohn's disease; Colitis; Cirrhosis of the liver; colon polyps; irritable bowel syndrome; malignant tumors; Worm infestations; amoebic dysentery; Acute intestinal infections (cholera, salmonellosis, etc.); Anemia and a number of other pathologies.

The reason for coprology are abdominal pain, cramps, bloating, nausea, heartburn, problems with defecation, blood in the stool and other symptoms that indicate disorders in the digestive tract.

A general analysis of feces according to the coprogram is prescribed for suspected poisoning, infection, helminthiasis - it allows you to quickly identify pathogens and make a diagnosis, which is especially important in such urgent cases as acute intoxication, the need to isolate a patient with an infectious disease.

Feces for the coprogram of children are handed over for any digestive problems, allergic reactions, suspicion of worms, with colic.

Coprogram is invaluable in the diagnosis of pathologies of the digestive tract. Those violations that this simple and painless analysis shows require additional examinations.

The study of feces helps the doctor to make a preliminary diagnosis and subsequently refer the patient to the necessary procedures.

What is an analysis?

The technique for performing fecal analysis for a coprogram provides:

Visual study of excrement by qualitative and quantitative parameters and the presence of foreign inclusions. Carrying out chemical tests to determine impurities. Examination of material under a microscope.

Let us consider in more detail what is included in the fecal coprogram:

macroscopic	Volume of feces
	Consistency
	Form
	Color
	Presence of mucus
	Blood
	Purulent discharge
	Leftover undigested food
Chemical	Gregersen reaction
	Reaction to bilirubin
	Acid-base balance
	Analysis for stercobilin
	Vishnyakova-Tribule test
Microscopy	The presence in the feces of muscle fibers, undigested connective tissue
	Fats, fatty acids and salts
	Starch
	Cellulose
	Iodophilic microflora
	Leukocytes
	erythorocytes
	epithelial cells
	helminth eggs
	Protozoa and fungi
	salt

Normal indicators of the coprogram

Normally, stool is a thick brown mass with a pronounced fecal odor, free of blood, mucus and pus, with a minimum amount of unprocessed food (insoluble fiber is allowed).

The nature of nutrition, the intake of certain medications can significantly affect the physical parameters of feces: change color, texture, smell. Small deviations related to nutritional characteristics are considered acceptable.

The norm of the comp program in adult patients is shown in the table:

pH	42588
Gregersen occult blood reaction	negative
Vishnyakuwa-Tribulet reaction for protein	negative
Reaction to stercobilin	positive
Reaction to bilirubin	negative
Muscle fibers	absent, single fibers in the field of view
Undigested connective tissue	absent
Neutral fat, fatty acids	missing
Salts of fatty acids	small amount allowed
vegetable fiber	single cells
Starch	absent
Iodophilic flora	absent, single presence of normal iodophilic microorganisms is acceptable
crystals	missing
Epithelium	absent, single cylindrical cells are allowed
Leukocytes	absent, single neutrophils are acceptable
red blood cells	missing
Protozoa	missing
worm eggs	missing
yeast mushrooms	missing

The norm in children differs from the indicators in adults due to the characteristics of nutrition. This applies to the amount, consistency and other physical parameters of feces, as well as the level of acidity.

The norms of the coprogram in children under one year old have deviations in chemical composition, which is associated with the immaturity of the digestive tract, postpartum changes in the body of newborns, and mainly the milk diet in infants.

daily amount of feces	34 - 45 g	58 - 215 g
consistency	sticky	mushy, decorated
color	light brown to pale yellow	brown
smell	sourish	regular stool
pH	5,1 - 6	1,2 – 1,7
bilirubin, ammonia	present	missing
stercobilin, muscle fibers	present	missing
fatty acids and salts	present	missing

How to decipher the results?

The results of the coprogram should be evaluated by a specialist, taking into account all the conditions: the patient's complaints, the characteristics of his diet, the available history, indicators of other studies.

Consider how to decipher deviations from the norm:

Too little feces happens with constipation, colitis, ulcerative conditions. An increase in stool indicates accelerated evacuation, inflammation in the digestive tract. Very dense feces are formed with excessive absorption of fluid through the intestinal walls, constipation. Liquefied stools give active peristalsis, impurities of inflammatory mucus. Ointment-like consistency is a possible consequence of chronic pancreatitis. Foaminess indicates fermentation in the intestines. A large form of feces indicates a long stay of the contents in the intestine, which may be associated with colon dysfunction due to malnutrition, a sedentary lifestyle, diverticulosis, and tumors. Small lumps (sheep feces) occur with intestinal spasms, hemorrhoids, anal fissures, starvation, peptic ulcers. Excrement in the form of a tape, a thin column indicates stenosis of the rectum, the presence of a neoplasm. Unformed stool is a sign of impaired digestion and absorption of food due to enzymatic deficiency. Color changes not related to food coloring are likely symptoms of disease. Discoloration of feces is caused by liver failure and blockage of the bile ducts. Tar-colored feces - a sign of bleeding of the upper gastrointestinal tract, if it bleeds in the colon and rectum - red feces. Mushy green stools are excreted in typhoid fever. Yellow feces are produced during fermentation in the intestines. The mucus in the coprogram has a different consistency and shade depending on the pathology. Gray inclusions resembling rice water indicate cholera infection. Amoebic dysentery is manifested by a jelly-like mucous mass of pink hues. When the rectum is damaged, mucus impurities are found in the material in whole lumps, ribbons. With colitis and constipation, mucus envelops the formed feces from above, with inflammation of the small intestine, it mixes with food masses and gives them a semi-liquid character. In some cases, blood does not stain the feces, but is excreted along with them in the form of separate clots, veins. We are talking about bleeding in the lower digestive sections, ranging from anal fissures and ending with necrosis of the colon tumor. Hidden blood in the feces is determined by the Gregersen test. Purulent discharge in the stool is a sign of severe inflammation, an ulcer, abscess, tuberculosis, or a decaying tumor. With infectious lesions, suppuration is supplemented by mucus and blood. Pieces of undigested food in the analysis of feces are called tentorrhea. Occurs in violation of the stomach and pancreas. Small elements of digested food mixed with the remains of bacteria and epithelial cells (detritus) are the normal contents of stool. Only a violation of their homogeneity with the isolation of individual particles, for example, an increased content of bacteria during a coprogram, makes it possible to suspect an inflammatory process. Detritus in the coprogram in combination with mucous and bloody impurities is an unequivocal sign of pathology. Detritus in a coprogram in an infant or a child older than a year without associated symptoms is not a cause for concern. The iodophilic flora in the coprogram causes fermentation in the intestines. These bacteria are determined by staining with iodine and the acid reaction of feces (pH 5.0-6.5). Pathological iodophilic flora (clostridia) leads to active fermentative dyspepsia. If yeast fungi are found in the stool, candidiasis caused by antibiotics is possible. Muscle fibers in the coprogram can be detected both in digested and unchanged form, which is not the norm. The presence of muscle tissue in the feces is called creatorrhea and indicates poor digestion of proteins: a violation of the secretion of gastric juice, pancreatic enzyme deficiency. The same applies to the remnants of connective tissue in the stool. Problems with lipid digestion are expressed in steatorrhea. Neutral fat in the coprogram is released with pancreatic dysfunction and blockage of the pancreatic ducts. Disorders in the duodenum lead to poor absorption of fatty acids. Soaps in the coprogram are fatty acid salts in the feces as a result of bile deficiency. Starch in the coprogram (amilorrhea) is a consequence of enzymatic deficiency and too active peristalsis. The release of intracellular carbohydrates indicates that the source of the pathology is the stomach: starch is not absorbed due to the fact that the gastric juice does not process plant cells. Extracellular starch in the coprogram appears due to amylase deficiency. Leukocytes in the coprogram are not normally detected. Their presence indicates an infectious lesion of the intestine, enteritis, colitis, ulcerative lesions. The combination of leukocytes with erythrocytosis, a large amount of squamous and cylindrical epithelium in the feces shows a coprogram in intestinal cancer, polyposis, Crohn's disease. If leukocytes are found in a coprogram in an infant, it is necessary to analyze the results in a complex. In the absence of other alarming symptoms, a positive analysis occurs in healthy children with an improperly organized diet. to content

How to prepare and pass?

Special preparation for the analysis of feces is not required, since the material obtained naturally is taken for the study.

In order not to distort the results of the study, it is necessary to follow simple rules on how to prepare for a coprogram.

A week before the date, refuse:

antibiotics; Iron-containing preparations; Any laxatives; Applications of rectal suppositories; Enema; Procedures through the anus; X-ray with barium.

Preparation for the coprogram includes dietary restrictions 4 to 5 days before stool delivery. The diet before the coprogram consists of the following menu:

Dairy products; Mashed potatoes; Lean meat; Kashi; Soft-boiled eggs; Fresh fruits; White bread with butter.

Preparation for the study in case of suspected occult bleeding requires a complete rejection of meat, green vegetables, tomatoes, most fruits, otherwise the analysis may give a false result.

Preparing the patient directly for the delivery of the material consists in buying a container for analyzes and organizing hygienic conditions for defecation. It is forbidden to collect feces from the toilet - only from a clean surface. You need to take care of the pot or disposable lining in advance.

How to take the test correctly:

Perform a natural bowel movement, avoiding the ingress of urine and discharge from the genitals; With a special spatula, collect the material in an amount as much as you need feces for analysis - about a third of the jar; For the best result of the study, it is advisable to follow the recommendations on how to collect feces for a coprogram - at least from three different stool sites; Screw and sign the container.

How to pass a fecal analysis correctly so that the biomaterial does not deteriorate: take the biomaterial to the laboratory on the same day, no later than 12 hours after defecation. If necessary, place the container on a refrigerator shelf.

The stool coprogram in the baby is collected whenever possible, since it is difficult to control the frequency and time of the child's bowel movements. For analysis, a teaspoon of biomaterial placed in a sterile container is sufficient. If the child does not go to the potty, the problem of how to collect feces from the baby is solved with the help of disposable diapers - feces can be taken from their surface.

Where to take the analysis?

A general analysis of feces in the direction of a doctor is usually taken at a polyclinic. Research is also carried out in many diagnostic centers where you can make a coprogram:

Sinevo, Gemotest, Invitro, Helix and others.

You can contact any laboratory where coprogram and coprology are presented - this is one and the same study.

How much is done and how much the analysis costs depends on the specific honey. center: the maximum period is 6 working days, and the average price is about 500 rubles.

Where to take the tests, the patient has the right to choose independently, focusing on the cost, the declared period, how many days the coprogram is done, and the reviews of the laboratory's clients.

Coprogram (general analysis of feces) is one of the most frequent analyzes in a domestic children's clinic or hospital. If you open the medical history of a patient with acute respiratory viral infections, tonsillitis, or even with a traumatic brain injury, along with a clinical analysis of blood and urine, you will definitely find a coprogram. Most doctors from Soviet times have become so accustomed to this that they don’t even think of the question: why, in fact, stool microscopy in the treatment of otitis media or pneumonia?

The same picture is sometimes observed in outpatient settings. Suppose a child is healthy, gaining weight well, he has a normal stool - it seems that what else is needed for happiness? Of course, a coprogram that pediatricians must prescribe to all healthy infants at least twice, without any evidence.

According to the "protocol", the coprogram is the most important diagnostically significant analysis and is used to diagnose various diseases of the gastrointestinal tract (GIT).

But I, for example, almost never use it in my practical work, since I consider it 90% useless. Why? Let's take it in order.

So perhaps we need this analysis in order to...

Find out what kind of stool the patient has? But this is already evident, why take the feces to the laboratory for this ?! I unfolded the diaper or looked into the pot, the toilet (yes, doctors, especially pediatricians, have to do this all the time, especially since parents see it all), in general, at first glance everything is immediately clear - color, shape, mucus. Even the smell is very noticeable ...
Determine the presence of blood? Again, this is already noticeable. And if it is not visible or incomprehensible whether it is blood in the stool or not, the coprogram will not help! In such a situation, a special analysis for occult blood is needed - and here laboratory diagnostics have advanced and now offer high-precision immunochemical express methods.
See signs of inflammation? I will tell you that the coprogram is a terribly subjective method for detecting white blood cells in the stool. I knew laboratory assistants who never saw leukocytes in the analysis, even with obvious salmonellosis or dysentery. On the contrary, there are laboratory assistants who always detect dozens of leukocytes in a coprogram in a healthy child. So if you really need to understand whether there is inflammation in the intestines or not - for example, with a differential diagnosis of irritable bowel syndrome and inflammatory diseases - donate feces for calprotectin. Even more reliable ways to detect inflammation are a clinical blood test and a C-reactive protein test. Well, if you suspect ulcerative colitis or Crohn's disease, you will have to do a sigmoidoscopy.
Clarify the causes of intestinal infection? But intestinal infections - viruses and bacteria - cannot be detected by microscopy of feces. To find out the cause of the infection, you need to donate feces for sowing or, even better and faster, do a PCR that will detect rota-, nora-, astroviruses, adenovirus type F, campylobacter, pathogenic escherichia, shigella and salmonella.
Identify Giardia and worms? Well, it's really possible. True, rather by chance, since the coprogram is not a sensitive method. It is more reliable, if there are suspicions, to pass feces for the antigen of lamblia (worms) or, again, do PCR.
Assess malabsorption and digestion disorders? Here everything is not so clear. Theoretically, with an ideally executed coprogram, it is really possible to find out in which part of the gastrointestinal tract food is digested worse. For example, if a lot of undigested muscle fibers and fat are found, it is logical to suspect that there is a lack of pancreatic function. But, given the low sensitivity of the coprogram, it is much more reliable to do other tests: for example, feces for elastase (pancreatic enzyme), also take blood biochemistry, perform an ultrasound scan, in the end. If lactase deficiency is suspected, the coprogram will theoretically show reduced acidity, but even here it will be more reliable to study feces for carbohydrates or a load test with lactose.

Thus, from my point of view, the coprogram in most cases is a useless analysis, for which a lot of funds are annually transferred from the CHI system. A coprogram assigned to a healthy child without indications leads to a large number of false conclusions, the appointment of unnecessary drugs, and a coprogram assigned to a sick child does not really clarify anything in the diagnosis.

Of course, if your doctor insists on this analysis - well, hand it over, what can you do. But you can draw the attention of your doctor that today there are much more accurate studies. And certainly you should not "assign" yourself a coprogram on your own, you will just waste your money in vain.

Mikhail Nikolsky

Photo istockphoto.com

When diagnosing gastrointestinal diseases, very important information can be obtained from the analysis of feces. For this, various types of studies are used, the appropriateness of which is determined by the attending physician. One of the most informative is the coprogram, and our article will tell you more about this analysis.

What is this analysis?

In medical terminology, you can often find a second name - coprology. This is actually a synonym, because in literal translation it means "the science of feces."

A coprogram is a detailed study of fecal masses, giving an idea of dysfunctions not only of the digestive system, but also of possible problems with the pancreas, bile production, and even.

The physical, chemical and biochemical parameters of the substance are determined. Even a change in color can serve as a symptom of the disease, and the presence of microorganisms or bacteria will give complete information about the work of internal organs.

Indications

As a rule, the analysis is carried out by patients upon admission to inpatient treatment or when contacting the clinic with certain complaints.

After some time, it is necessary to repeat the analysis in order to make sure that the chosen treatment is correct, to confirm or refute the diagnosis.

Preparation

To ensure that the results of the analysis are not affected by other factors, it is necessary to adhere to a certain diet. Foods that can change the color of feces, as well as fatty, smoked and spicy foods, are completely excluded from the diet.

There are also a number of restrictions on medications, such as antibacterial and laxatives, as well as rectal suppositories. Women should not be tested during menstruation.

Do not allow urine or other foreign matter to enter during sampling.

You can not do an enema - the collection is carried out only after a natural bowel movement. If earlier than three days was carried out with the use of a contrast agent, the results of the study will be unreliable.

How to assemble?

Before collecting feces, it is necessary to empty the bladder, toilet the intimate areas with detergents. For more reliable results, it is necessary to rinse the genital area and the anus with warm boiled water.

The sampling of the test material is carried out in a special sterile test tube. You can buy such a container at any pharmacy. For the convenience of the patient, a spatula is usually attached to the lid, which captures the feces.

It is necessary to take several samples from different parts of the feces. The total volume is about a teaspoon of bowel movements.

Algorithm for fecal sampling in infants and older children

Referral for fecal analysis for infants is often perceived as an unnecessary procedure. However, it is this study that helps to identify possible dysfunctions of the digestive system.

Indications may include indigestion, frequent diarrhea or constipation, as well as changes in the color, consistency and frequency of bowel movements.

In order for the results to be reliable, it is necessary to use reusable diapers or diapers, from which the feces are transferred into a sterile container with a special spatula - a spatula (included with the standard fecal collection kit).

If the child is already using the potty, the procedure is much simpler, but it is necessary to prepare in advance.

Firstly, the container used must be thoroughly washed, rinsed with boiled water and wiped dry. The second problem is to prevent urine from entering the container.

To do this, you can use special urinals, which are sold taking into account the gender of young patients. If you put it on a child, when emptying the intestines, the liquid will remain outside the pot.

The same device can collect liquid stool from babies if another procedure was not effective.

What does the coprogram show?

During the examination, dysfunctions of the internal organs and the gastrointestinal tract can be detected. All studied parameters are compared with normal values and can be symptoms of many diseases.

In addition, the dynamics of the selected methods of treatment is observed. To do this, it is necessary to conduct a series of tests, the results of which are compared by a specialist.

That is why the coprogram is not considered as a separate analysis, but is included in the complex of laboratory studies.

Deciphering the results

Despite the information content of this analysis, the final diagnosis is specified by a personal examination, patient interviews and additional studies.

Deadlines, where to hand over and cost?

The results of the coprogram can be obtained within six working days. Typically, the appointment is made to patients in the inpatient department.

Along with a general blood test, it also allows you to determine possible problems with internal organs, as well as the presence of an inflammatory process.

You can take it in any hospital or clinic, where it is usually free. In private clinics, its cost is determined by many factors, but usually ranges from 250 to 400 rubles.

The video program of the school of Dr. Komarovsky will tell you about the analysis for coprogram in children: