In the large intestine, instead of the normal pulp in the upper portion, and firm masses in the lower, indicate that diarrhea existed. The color depends essentially upon the quantity of bile present: when the latter is entirely absent (icterus), the faeces are gray. When blood is present, the color is light or dark red, according to the quantity, or it may even be perfectly black, as is also the case when certain drugs, especially iron, have been given. Calomel stains the intestinal contents dark green. Typhoid stools have a peculiar yellow color, resembling pea-soup, and those in cholera are whitish, resembling rice-water. The consistency varies from a watery condition to a stony hardness. Cholera stools are the most liquid (rice-water), and typhoid evacuations are pulpy. In very severe constipation (coprostasis), small round fecal masses of almost stony hardness are found in the pouches of the colon. The odor depends wholly upon the quantity of fecal matter: fresh cholera stools are entirely free from smell; the thin stools of dysentery have a very offensive odor; those in typhoid fever possess but little odor, while the gray stools in jaundice have a most offensive stench.
- Abnormal Constituents. Among the abnormal constituents which arise from indigestible food are peculiar round balls of fat, which resemble the large balls of caseine found in the stomachs of children; when found in adults they represent undigested and spherically moulded fat. The remains of animal food, undigested portions of fruit (seeds, orange peel), etc., may also be found. The abnormal ingredients arising from the body may be either secretions (mucus, especially in the small intestine), or desquamated epithelium (for instance, the white flakes that give the peculiar appearance to the cholera stools [post-mortem]), or strips of mucous membrane, such as are present in many forms of dysentery. Finally, fecal concretions (see vermiform appendage), gall-stones, etc., are sometimes found.
Blood is found in connection with ulcers, especially the dysenteric and typhoid forms, and in extreme passive congestion, particularly in cirrhosis of the liver. In these cases it is often impossible to discover the point at which the blood escapes from the vessels, as it usually comes from a great number of small ones. It is then intimately mixed with the contents, as has been mentioned in connection with the stomach, while considerable masses arise when the hemorrhage comes from a large vessel.
<Callout type="important" title="Identifying Parasites">Trichinae remain temporarily in the intestine and are found mostly in the upper part of the small intestine. They can be identified by their size and presence of young inside them.</Callout>
There are three varieties of cestoid parasites: the taenia solium, taenia mediocannelata, and the bothryocephalus dispar, all of which usually live in the jejunum. The taenia solium is the most common and smallest (two to three meters long), originating from the Cysticercus cellulosae of swine. It has four lateral suckers and a rostrum on top with booklets. When old, these parts become black.
The lumhricoid worms (ascaris lumbricoides) belong to the class of round worms and are easily recognized by their resemblance to earth-worms. They live in the middle of the small intestine but frequently appear in the duodenum and even in the stomach. The oxyuris vermicularis inhabits the rectum but sometimes ascends higher, rarely as far as the small intestine.
In addition to animal parasites, vegetable organisms are always present in the intestine, belonging to the group Schistomycetes, which has recently become important. Both the small spherical forms (micrococci), and the rod-like forms (bacteria) occur in every drop of the intestinal contents and in very large numbers, especially in cases of diarrhea.
(d.) The Walls of the Intestine. In examining the intestinal walls special attention is to be paid to the villi, folds (valvulse conniventes), solitary and agminated follicles (Peyer's patches). 1. General Characteristics. An increase in the thickness of the whole intestinal wall, and also of its separate layers, is frequently observed. A thickening of all the coats over a large area is a frequent result of general chronic peritonitis; the same occurs in a circumscribed form in the vicinity of chronic ulcers, etc.
<Callout type="risk" title="Thickened Intestinal Walls">Thickening of the intestinal walls can indicate serious conditions such as chronic peritonitis or ulceration. Early detection is crucial for treatment.</Callout>
Simple swelling is indicated in the small intestine by an elongation and thickening of the folds, and by the formation of folds where none normally exist (ileum). Swelling of the mucous membrane in the lower portion of the ileum may be diagnosed by such folds alone. Enlargement of the villi is usually due to an increase in their morphological parts, especially of the epithelium in catarrh, or to a cellular infiltration of the substance.
Key Takeaways
- Diagnosing intestinal conditions involves examining stool color and consistency for signs of illness such as diarrhea, cholera, or typhoid fever.
- Identifying abnormal constituents in the intestine can help diagnose specific health issues like undigested food particles or secretions from the body.
- Recognizing blood presence and its origin is crucial for diagnosing conditions like ulcers or liver disease.
Practical Tips
- Use stool color as an initial diagnostic tool to identify potential intestinal diseases such as cholera, typhoid fever, or jaundice.
- Look for signs of parasites in the intestine by examining round balls of fat and identifying specific worm species like trichinae or taenia solium.
Warnings & Risks
- Thickened intestinal walls can indicate serious conditions such as chronic peritonitis or ulceration, requiring immediate medical attention.
- Blood presence in the stool may be a sign of severe health issues including ulcers and liver disease; early detection is critical for treatment.
Modern Application
While this chapter provides detailed historical insights into diagnosing intestinal diseases through physical examination and symptom observation, modern medicine relies heavily on advanced diagnostic tools like endoscopy and imaging. However, understanding the classic signs described here remains valuable for recognizing symptoms in remote or resource-limited settings where such technology is unavailable.
Frequently Asked Questions
Q: What does the presence of blood in stool indicate?
The presence of blood in stool can indicate various conditions including ulcers (dysenteric and typhoid forms), extreme passive congestion, particularly in cirrhosis of the liver. It is often difficult to pinpoint the exact source due to bleeding from numerous small vessels.
Q: How do you identify trichinae parasites?
Trichinae can be identified by their presence mostly in the upper part of the small intestine and by their size, with females being about three millimeters long and containing young inside them. They are easily distinguished from males which are smaller.
Q: What does thickening of intestinal walls suggest?
Thickening of the intestinal walls can indicate serious conditions such as chronic peritonitis or ulceration, especially when it occurs over a large area or in circumscribed forms near ulcers. Early detection is crucial for proper treatment.