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ANURBF LEC > [5] LESSON 10: FECALYSIS > Flashcards

[5] LESSON 10: FECALYSIS Flashcards

1
Q

Clinical Significance of Fecal Analysis

A

 Early detection of GIT bleeding
 Liver and biliary duct disorders
 Maldigestion and malabsorption syndromes
 Inflammation
 Causes of diarrhea and steatorrhea

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2
Q

DIARRHEA

 Increase in daily stool weight above [?] (↑liquidity; frequency > 3x/day)

A

200 g

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3
Q

DIARRHEA

 Classification based on

A

(1) duration of illness, (2) mechanism, (3) severity and (4) stool characteristics

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4
Q

DIARRHEA

 Laboratory tests performed:

A

(1) fecal electrolytes, (2) fecal osmolality and (3) stool pH.

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5
Q

Osmotic Gap

A

290 - [2 (fecal sodium + fecal potassium)]

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6
Q

Increased secretion of water and electrolytes

A

Secretory

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7
Q

Enterotoxin-producing bacteria

A

Secretory

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8
Q

> 50 mOsm/kg

A

Secretory

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9
Q

Incomplete breakdown or reabsorption of food

A

Osmotic

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10
Q

Lactose intolerance, celiac sprue, poorly absorbed sugars, amebiasis

A

Osmotic

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11
Q

< 50 mOsm/kg pH < 5.6

A

Osmotic

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12
Q

 Useful for the diagnosis of pancreatic insufficiency and small bowel disorders that cause malabsorption

A

STEATORRHEA

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13
Q

 Increase in stool fat (>6g/day)

A

STEATORRHEA

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14
Q

 Stool appears pale, greasy, bulky, spongy or pasty

A

STEATORRHEA

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15
Q

: used to differentiate malabsorption from maldigestion

A

 D-xylose Test

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16
Q

: malabsorption

A

Low D-xylose

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17
Q

: maldigestion (pancreatic insufficiency)

A

Normal D-xylose

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18
Q

: suitable for qualitative testing for blood, and microscopic examination of leukocytes, muscle fibers and fecal fats

A

 Random

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19
Q

: for quantitative testing

A

 3-Day Collection

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20
Q

MACROSCOPIC SCREENING

A

COLOR
APPEARANCE

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21
Q

Upper gastrointestinal bleeding

A

Black

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22
Q

Lower gastrointestinal bleeding

A

Red

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23
Q

Bile duct obstruction

A

Pale yellow, white, gray

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24
Q

oral antibiotics

A

Green

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25
Q

Bile-duct obstruction

A

Bulky/frothy

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26
Q

Intestinal constriction

A

Ribbon-like

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27
Q

Colitis

A

Mucus/blood-streaked mucus

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28
Q

Dysentery

A

Mucus/blood-streaked mucus

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29
Q

Malignancy

A

Mucus/blood-streaked mucus

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30
Q

Constipation

A

Mucus/blood-streaked mucus

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31
Q

Pancreatic disorders

A

Bulky/frothy

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32
Q

Green vegetables

A

Green

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33
Q

Barium sulfate

A

Pale yellow, white, gray

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34
Q

Beets and food coloring

A

Red

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35
Q

Rifampin

A

Red

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36
Q

Iron therapy

A

Black

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37
Q

Charcoal

A

Black

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38
Q

Bismuth

A

Black

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39
Q

Fecal smears are examined for the presence of leukocytes (?), undigested muscle fibers and fats (?)

A

microbial diarrhea
steatorrhea

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40
Q

Neutrophils in feces indicates irritation of the intestinal mucosa in ulcerative colitis and bacterial dysentery

A

Fecal Leukocytes

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41
Q

Fecal Leukocytes

 diarrhea is caused by invasive bacteria

A

PRESENCE

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42
Q

All smears or slide preparations must be performed on fresh specimens

A

Fecal Leukocytes

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43
Q

Fecal Leukocytes

 faster to prepare, but more difficult to interpret

A

Wet Smears

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44
Q

Fecal Leukocytes

 provide permanent slides for evaluation

A

Dry Smears

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45
Q

Fecal Leukocytes

Positive result:

A

3 neutrophils/HPF or any neutrophil/OIF

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46
Q

Fecal Leukocytes

 stained with either Wright’s or Gram stain

A

Dry Smears

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47
Q

Fecal Leukocytes

 stained with methylene blue

A

Wet Smears

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48
Q

Fecal Leukocytes

 diarrhea is caused by toxin-producing bacteria

A

ABSENCE

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49
Q

 Used in the diagnosis and monitoring of patients with pancreatic insufficiency, biliary obstruction and gastrocolic fistulas

A

Muscle Fiber

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50
Q

 Patient Preparation: include red meat in their diet prior to collection

A

Muscle Fiber

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51
Q

 Specimens should be examined within 24 hours of collection

A

Muscle Fiber

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52
Q

Muscle Fiber

 Procedure: stool is emulsified in [?]
 examine for [?]

A

10% alc. eosin
5 min

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53
Q

Muscle Fiber

 Count number of [?] with well-preserved striations

A

red-stained fibers

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54
Q

: with visible striations (vertical and horizontal)

A

 Undigested fibers

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55
Q

: with striations in one direction

A

 Partially digested fibers

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56
Q

: no striations

A

 Digested fibers

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57
Q

 undigested fibers Significant Result:

A

> 10 undigested fibers

58
Q

 Screening test for the presence of excess fecal fat

A

Qualitative Fecal Fat

59
Q

 Monitoring of patients undergoing treatment for malabsorption disorders

A

Qualitative Fecal Fat

60
Q

Qualitative Fecal Fat

 Makes use of lipid dyes:

A

(1) Sudan III, (2) Sudan IV and (3) Oil Red O

61
Q

—readily stained by Sudan III and appear as large orange-red droplets

A

 Neutral Fats/Triglycerides

62
Q

[?]—steatorrhea

A

> 60 droplets/hpf

63
Q

—do not stain directly with Sudan III

A

Fatty Acid Salts and Fatty Acids

64
Q

specimen must be mixed with HAc and heated

A

Fatty Acid Salts and Fatty Acids

65
Q

size and number of fat droplets are noted

A

Fatty Acid Salts and Fatty Acids

66
Q

Normal: [?] small fat droplets, [?] in size per hpf

A

100
<4um

67
Q

Slightly Increased: [?] droplets, [?] in size per hpf

A

100
1 to 8 um

68
Q

Increased: [?] droplets, [?] in size per hpf

A

100
6 to 75 um

69
Q

—stained by Sudan III after heating and crystallizes during cooling

A

Cholesterol

70
Q

 Most frequently performed chemical screening test

A

Occult Blood

71
Q

Occult Blood

 Bleeding in excess of [?] stool is pathologically significant

A

2.5ml/150g

72
Q

 Used as a mass screening procedure for the early detection of colorectal cancer

A

Occult Blood

73
Q

Occult Blood

 Principle:

A

pseudoperoxidase activity of hemoglobin

74
Q

Occult Blood Indicator Chromogens

A

 Benzidine—most sensitive
 Ortho-toluidine
 Gum Guaiac—least sensitive; preferred for routine testing

75
Q

Indicator Chromogens

A

 Benzidine—most sensitive
 Ortho-toluidine
 Gum Guaiac—least sensitive; preferred for routine testing

76
Q

—most sensitive

A

 Benzidine

77
Q

—least sensitive; preferred for routine testing

A

 Gum Guaiac

78
Q

 Used as a confirmatory test for steatorrhea

A

Quantitative Fecal Fat

79
Q

 Patient preparation: regulated intake of fat (100g/dl)

A

Quantitative Fecal Fat

80
Q

Quantitative Fecal Fat

 Specimen required:

A

refrigerated 3-day specimen

81
Q

Quantitative Fecal Fat

 Normal values: [?] coefficient of fat retention

A

1 to 6 g/dl or at least 85%

82
Q

Quantitative Fecal Fat Methods for Quantitation

A

 Van De Kamer Titration
 Gravimetric Method

83
Q

—gold standard for fecal fat

A

Van De Kamer Titration

84
Q

 Distinguishes between fetal blood or maternal blood

A

APT Test

85
Q

 Sample: infant’s stool or vomitus

A
86
Q

 Control: cord blood and adult blood

A
87
Q

Procedure
 Sample emulsified in water to [?]  centrifuged
 [?] is added to the pink Hb containing supernatant

A

free Hb
1% NaOH

88
Q

Fetal Hb—solution remains [?];

A

pink

89
Q

Maternal Hb—

A

yellow-brown

90
Q

Fecal Enzymes
 Clinical significance

A

 Pancreatic insufficiency
 Steatorrhea

91
Q

 X-ray paper is exposed to the stool sample emulsified in water

A

Trypsin

92
Q

—digestion of gelatin on the x-ray paper = clear area

A

Trypsin Presence

93
Q

—inability to digest gelatin = no change

A

Trypsin Absence

94
Q

 Insensitive procedure and only detects severe cases

A

Trypsin

95
Q

Trypsin

: proteolytic activity of bacterial enzymes

A

 False (+)

96
Q

Trypsin

: intestinal degradation of trypsin; inhibitors in feces

A

 False (-)

97
Q

 More sensitive indicator of less severe cases of pancreatic insufficiency

A

Chymotrypsin

98
Q

 More resistant to intestinal degradation

A

Chymotrypsin

99
Q

 Remains stable in fecal samples for up to 10 days at room temp

A

Chymotrypsin

100
Q

 Measured spectrophotometrically

A

Chymotrypsin

101
Q

 Pancreas specific and a very sensitive indicator of exocrine pancreatic insufficiency

A

Elastase I

102
Q

 Easy to perform and requires only a single stool sample

A

Elastase I

103
Q

 Measured by immunoassay using the ELISA kit

A

Elastase I

104
Q

 Inability to reabsorb carbohydrates

A

(Celiac disease)

105
Q

 Lack of digestive enzymes

A

(lactose intolerance)

106
Q

Detects congenital disaccharidase deficiency and enzyme deficiencies due to nonspecific mucosal injury

A

Copper Reduction Test (Clinitest)

107
Q

Most valuable in assessing cases of infant diarrhea and may be accompanied by a pH determination

A

Copper Reduction Test (Clinitest)

108
Q

normal stool pH: 7 to 8

A

Copper Reduction Test (Clinitest)

109
Q

carbohydrate disorders = pH < 5.5

A

Copper Reduction Test (Clinitest)

110
Q

 Procedure: Clinitest tablet + emulsified sttol

A

Copper Reduction Test (Clinitest)

111
Q

 Copper Reduction Test (Clinitest) Result of 0.5g/dl =

A

carbohydrate intolerance

112
Q

 Performed after a positive fecal Clinitest

A

Serum carbohydrate intolerance test

113
Q

—for malabsorption

A

Serum carbohydrate intolerance test

 D-xylose

114
Q

 Lactose tolerance test—for maldigestion

A

Serum carbohydrate intolerance test

115
Q

Microscopic count of neutrophils in smear stained with methylene blue, Gram or Wright’s stain

A

Examination of neutrophils

116
Q

/HPF indicates condition affecting intestinal wall

A

Examination of neutrophils

117
Q

Microscopic examination of direct smear stained with Sudan III

A

60 large orange-red droplets indicates malabsorption

118
Q

Microscopic examination of smear heated with HAc and Sudan III

A

100 orange-red droplets measuring 6 to 75 um indicates malabsorption

119
Q

Pseudoperoxidase activity of Hb liberates O2 from H2O2 to oxidize Guaiac reagent

A

Occult blood

120
Q

Blue color indicates gastrointestinal bleeding

A

Occult blood

121
Q

Addition of H2O2 to Hb containing emulsion determines presence of maternal or fetal blood

A

APT test

122
Q

Pink color indicates presence of fetal blood

A

APT test

123
Q

Emulsified specimen placed on x-ray paper determines ability to digest gelatin

A

Trypsin

124
Q

Inability to digest gelatin indicates lack of trypsin

A

Trypsin

125
Q

Addition of Clinitest tablet to emulsified stool detects presence of reducing substances

A

Clinitest

126
Q

Reaction of 0.5g/dl reducing substances suggests carbohydrate intolerance

A

Clinitest

127
Q

shape of Type 2 stool

A
128
Q

hidden blood

A
129
Q

pale, greasy, bulky stool

A
130
Q

detected by Dxylose

A
131
Q

blood that appears pink

A
132
Q

used for fecal carbohydrates

A
133
Q

stain used for dry smears

A
134
Q

muscle fiber counted microscopically

A
135
Q

Stool color indicating upper GIT bleeding

A
136
Q

very sensitive indicator of pancreatic insufficiency

A
137
Q

testing that uses a 3day stool sample

A
138
Q

type of diarrhea with osmotic gap > 50 mOsm/kg

A
139
Q

fecal leukocyte examined microscopically

A
140
Q

detected by lactose intolerance test

A
141
Q

lipid readily stained in Sudan III

A

ANURBF LEC (9 decks)

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