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Mercy CLS 3: Urinalysis > 7. Fecal Analysis > Flashcards

7. Fecal Analysis Flashcards

1
Q

normal adult excretes —– g/day of feces

A

100-200 g

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2
Q

4 major digestive enzymes from pancrease

A
  • trypsin
  • chymotrypsin
  • amino peptides/elastase
  • lipase
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3
Q

aid in fat digestion

A

bile salts from liver

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4
Q

—– mL enters GI tract each day

A

9000 mL

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5
Q

fecal electrolyte content is similar to that of…

A

plasma

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6
Q

large intestine can absorb around —— mL water

A

3000 mL

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7
Q

diarrhea definition (3)

A
  • increase in daily stool weight > 200g
  • liquidity
  • frequency of > 3x/day
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8
Q

chronic diarrhea

A

> 4 weeks

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9
Q

3 major mechanisms of diarrhea

A
  • secretory
  • osmotic
  • intestinal hypermotility
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10
Q

——— = 290 - [2(fecal Na) + (fecal K)]

A

osmotic gap

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11
Q

osmotic vs secretory diarrhea

osmo gap

A

osmotic: ↑ (> 50)
secretory: ↓ (< 50)

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12
Q

osmotic vs secretory diarrhea

fecal Na

A

osmotic: ↓ (< 60 mmol/L)

secretory: ↑ (> 90 mmol/L)

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13
Q

osmotic vs secretory diarrhea

fecal K

A

osmotic: ↓ K

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14
Q

osmotic vs secretory diarrhea

pH

A

osmotic: ↓ (< 5.3)

secretory: ↑ (> 5.6)

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15
Q

osmotic vs secretory diarrhea

reducing substance

A

osmotic: +

secretory: =

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16
Q

osmotic vs secretory diarrhea

stool output

A

osmotic: ↓ (< 200 g)

secretory: ↑ (> 200 g)

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17
Q

secretory diarrhea

A

increased secretion of water
overrides absorptive ability
often infections (enterotoxin-producing—think cholera)

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18
Q

osmotic diarrhea

A

poor absorption that exerts osmotic pressure across intestinal mucosa

water and electrolyte retention

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19
Q

malabsorption and maldigestion contribute to ——– diarrhea

A

osmotic

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20
Q

osmotic diarrhea causes

A

lactose intolerance
laxatives
Mg-containing antacids
amebiasis
antibiotics

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21
Q

intestinal motility is altered by…

A

dietary fiber
chemicals
nerves
hormones
emotions

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22
Q

nerves and muscles of the bowel are extra sensitive

A

IBS

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23
Q

causes of hypermotility

A

enteritis
parasympathetic drugs
complications of malabsorption
secretory & osmotic diarrhea

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24
Q

causes of constipation

A

diet
↓ exercise
↓ water, fiber
dairy products
antacids
resisting the urge
stress
long term laxative use
pain medications
IBS
pregnancy
etc

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25
Q

fecal fat

A

steatorrhea

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26
Q

absence of bile salts gives > — g/day of fecal fat

A

6 g

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27
Q

pale, greasy, bulky, spongy, pasty foul stools

A

steatorrhea

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28
Q

differentiates malapsorption from pancreatitis as causes of steatorrhea

A

D-xylose test

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29
Q

low urine D-xylose after ingestion

A

malabsorption condition

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30
Q

no D-xylose in blood after ingestion (normal)

A

pancreatitis

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31
Q

3 colorless tetrapyrroles
(general name)

A

urobilinogens

conjugated bilirubin –> intestinal bacteria –> urobilinogens

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32
Q

3 urobilinogens

A
  • urobilinogen
  • stercobilinogen
  • mesobilinogen
33
Q

what happens to urobilinogens in the lower GI tract?

A

spontaneously oxidized to bile pigments (“bilin” form)
orange brown color

34
Q

black stool

A

upper GI bleed
iron therapy
charcoal
bismuth

35
Q

red stool

A

lower GI bleed
beets
rifampin

36
Q

pale yellow, white, gray stools

A

bile duct obstruction
barium sulfate

37
Q

green stools

A

biliverdin
oral antibiotics
green veg

38
Q

claylike white stools

A

bile duct obstruction
pancreatic disorders

39
Q

ribbonlike stools

A

intestinal constriction

40
Q

mucus/bloody mucus in stools

A

colitis
dysentery
malignancy
constipation

41
Q

—- WBCs/hpf indicates invasive, inflammatory condition

A

1-3

42
Q

——– bacteria are usually the cause of fecal leukocytes

A

invasive
(not toxin producing, viruses or parasites)

43
Q

methods for detecting fecal WBCs (3)

A

wet prep + methylene blue (fresh specimen)
dried smear + wright/gram stain (fresh specimen, permanent slides)
lactoferrin latex agglutination (refrigerated/frozen specimen)

44
Q

muscle fiber examination useful in diagnosing… (3)

A
  • pancreating insufficienty (CF)
  • biliary obstruction
  • gastrocolic fistulas
45
Q

——– slides are used for muscle fiber exam

A

emulsification

46
Q

muscle fiber exam

emulsify stool in —- drops of ———

A

2 drops
10% alcoholic eosin

47
Q

muscle fiber exam

only count…

A

undigested fibers
vertical and horizontal striations
> 10 is reported as increased

48
Q

2 parts of qualitative fecal fat exam
why?

A
  • neutral fat stain—only neutral fats
  • split fat stain—also stains fatty acid salts (soaps), fatty acids, cholesterol
49
Q

neutral fat stain

A

water
95% ethyl alcohol
Sudan III

50
Q

split fat stain

A

acetic acid
Sudan III

51
Q

how to quantify fats for both types of stain

A
  • neutral: large orange droplets/HPF
  • split: all orange droplets/HPF
52
Q

steatorrhea indicated by each stain’s droplet count

A
  • neutral: > 60/HPF
  • split: > 100/HPF
53
Q

normal neutral stain count
elevated split stain count

A

malabsorption

54
Q

elevated neutral and split stain count

A

maldigestion

55
Q

detects early stages of colorectal cancer

A

FOBT

56
Q

amount of occult blood that is clinically significant

A

2.5 mL/150 g

57
Q

3 FOBT methods

A
  • Guaiac-based FOBT
  • Immunochemical FOBT
  • Porphyrin-based FOBT
58
Q

point of care FOBT

A

guaiac

59
Q

gFOBT relies on the ——– of hemoglobin

A

pseudoperoxidase

60
Q

gFOBT false positives

A

red meats (myoglobin)
horseradish, melons, broccoli, cauliflower, radishes, turnips
aspirin, NSAIDs
rehydration of dried sample prior to developer

61
Q

gFOBT false negatives

A

vitamin C
failure to wait for sample to dry

62
Q

iFOBT relies on the ——— of hemoglobin

A

globin portion (anti-human Ab)

63
Q

FOBT with no dietary or medication restrictions

A

iFOBT

64
Q

porphyrin FOBT relies on…

A

conversion of heme to fluorescent porphyrins

65
Q

FOBT more sensitive to upper GI bleeds

A

porphyrin

66
Q

porphyrin FOBT false positives

A

red meat

67
Q

confirmatory, quantitative fecal fat test

A

3-day collection

68
Q

coefficient of fat retention and reference value

A

100[(dietary fat - fecal fat)/dietary fat] = coefficient of fat retention

should be at least 95%

69
Q

5 methods of measuring fat in a 3-day collection

A

time consuming
- Van de Kamer titration (gold standard)
- gravimetric

rapid
- near-infrared reflectance spectroscopy
- NMR
- acid steatocrit

70
Q

VDK titration gets —-% of fecal fat

A

80%

71
Q

test to find out if blood in neonate stool is from them or from swallowing mom’s

A

APT test (fetal hemoglobin)

72
Q

positive for fetal hemoglobin

A

remains pink after alkali treatment (1% NaOH)

(mom’s Hgb will denature)

73
Q

3 fecal enzyme tests

A
  • trypsin (not used)
  • chymotrypsin (not used)
  • elastase 1
74
Q

elastase 1 test is an ——- test

A

ELISA

75
Q

CHO in stool produces —— diarhhea

A

osmotic

76
Q

2 examples of what can cause CHO in feces

A

Celiac
lactose intolerance

77
Q

test for CHO in stool

A

Clinitest
screening only; needs to be confirmed with serum test

78
Q

pH < —– can correlate with + stool clinitest

A

5.5

Mercy CLS 3: Urinalysis (10 decks)

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