Case study- Gastric Fluid and Fecal Analysis

Question 1

A prematu re i nfant in the neonata l i ntensive care developed abdominal bloati ng and bloody diarrhea . The child suffered from apnea and respi ratory distress. Rad iological examination revea led pneu matosis intesti nal is (trapped gas in the i ntesti nal
wa ll). The i nfa nt’s complete blood cell count showed an elevation of the wh ite blood cell cou nt and elevation of neutrophils with an increase in bands. A stool culture, fecal leu kocytes, fecal carbohydrate test, and a fecal pH were ordered . The culture was set up and
the fecal leukocyte exami nation showed a few neutrophils. The Clin itest was performed for the feca l carbohyd rates and the result
was positive and the feca l pH was 5.0.

1. What condition is the physician most concerned with in this case?
2. What is the significance of a pH 5.0 fecal sample?

Answer 1

1. What condition is the physician most concerned with in this case?
   =>he physician is concerned that the baby might have diarrhea associated with inflammatory necrotizing
   enterocolitis. Necrotizing enterocolitis (NEC) is
   the leading cause of death from gastrointestinal disease in preterm neonates and will likely soon overtake respiratory disease as the leading cause of
   death overall in these patients. This enterocolitis is diagnosed in between 0.9 and 2.4 per 1 ,000 births,
   and the increase in survival rates of premature infants have led to an overall increase in the incidence of this
   disease. NEC is both an acute and a chronic disorder, characterized initially by intestinal inflammation which may progress to intestinal necrosis. Intestinal perforation is a great concern in this condition. In
   its most serious states, NEC may lead to severe acute infection and overwhelming multisystem organ failure and death from systemic sepsis or chronic
   infection and failure to thrive. This condition is more common in low-weight premies and it is thought to be helped by breast feeding rather than bottle feeding.
   Another concern the physician might have is that the child may have a congenital disaccharidase deficiency
2. What is the significance of a pH 5.0 fecal sample?
   =>infant fecal samples typically have a pH between 7 and 8. The 5.0 pH is definitely decreased because of bacterial overgrowth with acid byproducts from the bacterial metabolism of the increased carbohydrates.

Question 2

A patient was seen by a gastroenterologist beca use of visible bleeding i nto the toilet during a bowel movement.
An FOBT was positive, however the physician does not s uspect colorecta l cancer.

1. What is the most likely cause of positive FOBT in this patient?
2. NOT including dietary substances, what other conditions can cause the FOBT to be positive for blood and yet be a
   false indicator for colorectal cancer?
3. Explain how one’s diet may contribute to false-positive and false-negative FOBT test results.

Answer 2

1. What is the most likely cause of positive FOBT in this patient?
   =>The bleeding into the toilet may indicate
   hemorrhoids, which when bleeding cause a
   false-positive FOBT.
2. NOT including dietary substances, what other conditions can cause the FOBT to be positive for blood and yet be a
   false indicator for colorectal cancer?
   => Other conditions that can cause a false-positive FOBT include gastrointestinal infection and Inflammation, ulcers, and even bleeding gums.
3. Explain how one’s diet may contribute to false-positive and false-negative FOBT test results.
   =>False-positive FOBT can result from ingesting red meat, fish, bananas, cantaloupe, pars, plums, turnips, horseradish, broccoli, cauliflower, or aspirin. Falsenegative FOBT can occur with ingestion of vitamin C.