FECALYSIS Flashcards
(125 cards)
1
Q
•An end product of body metabolism
A
Feces
2
Q
•Produced by the intestines after reabsorption of necessary substances
A
Feces
3
Q
Clinical Significance of Fecal Analysis
•Early detection of [?]
•[?] disorders
•[?] syndromes
•Inflammation
•Causes of[?]
A
GIT bleeding
Liver and biliary duct
Maldigestion and malabsorption
diarrhea and steatorrhea
4
Q
•Increase in daily stool weight above 200 g
A
DIARRHEA
5
Q
: less than 4 weeks
A
•Acute DIARRHEA
6
Q
: >4 weeks
A
•Chronic DIARRHEA
7
Q
↑liquidity; frequency > 3x/day
A
DIARRHEA
8
Q
Incompletebreakdown or reabsorption of food
A
Osmotic Diarrhea
9
Q
> Lactose intolerance
A
Osmotic Diarrhea
10
Q
> Celiac sprue
A
Osmotic Diarrhea
11
Q
> Malabsorptionof sugar
A
Osmotic Diarrhea
12
Q
> Amebiasis
A
Osmotic Diarrhea
13
Q
> Antibiotic administration
A
Osmotic Diarrhea
14
Q
> 50 mOsm/kg
A
Osmotic Diarrhea
15
Q
<60 mmol/L
A
Osmotic Diarrhea
16
Q
<5.3
A
Osmotic Diarrhea
17
Q
Increased secretion of water and electrolytes
A
Secretory Diarrhea
18
Q
> Enterotoxinproducing bacteria
A
Secretory Diarrhea
19
Q
> Drugs,laxatives
A
Secretory Diarrhea
20
Q
> Inflammatory bowel disease
A
Secretory Diarrhea
21
Q
> Endocrine disorders
A
Secretory Diarrhea
22
Q
<50 mOsm/kg
A
Secretory Diarrhea
23
Q
> 90 mmol/L
A
Secretory Diarrhea
24
Q
> 5.6
A
Secretory Diarrhea
25
•Increase in stool fat (>6g/day)
STEATORRHEA
26
•Useful for the diagnosis of pancreatic insufficiency and small bowel disorders that cause malabsorption
STEATORRHEA
27
•Stool appears pale, greasy, bulky, spongy or pasty
STEATORRHEA
28
: used to differentiate malabsorptionfrom maldigestion
•D-xylose Test
29
Low D-xylose:
malabsorption
30
Normal D-xylose:
maldigestion(pancreatitis)
31
: suitable for qualitative testing for blood, and microscopic examination of leukocytes, muscle fibers and fecal fats
Random
32
: for quantitative testing
3-Day Collection
33
•Specimen Containers
34
•Type and Amount Collected
35
•Contaminants to Avoid
36
•Gas Formation
37
Upper gastrointestinal bleeding
Black
38
Ingestion of iron,charcoal,bismuth
Black
39
Lower gastrointestinal bleeding
Red
40
Beets and foodcoloring
Red
41
Rifampin
Red
42
Bile duct obstruction
Pale yellow,white, gray
43
Diagnostic procedures that use barium sulfate
Pale yellow,white, gray
44
Biliverdin/oral antibiotics
Green
45
Green vegetables
Green
46
Separate hard lumps, like nuts (hard to pass)
Type 1
47
Sausage-shaped, but lumpy
Type 2
48
Sausage-shaped, but with cracks on surface
Type 3
49
Sausage or snake like, smooth and soft
Type 4
50
Soft blobs with clear-cut edges (easy to pass)
Type 5
51
Fluffy pieces with ragged edges, mushy
Type 6
52
Watery, no solid pieces (entirely liquid)
Type 7
53
Fecal smears are examined for the presence of leukocytes (?), undigested muscle fibers and fats (?)
microbial diarrhea
steatorrhea
54
indicates irritation of the intestinal mucosa in ulcerative colitis and bacterial dysentery
Neutrophils in feces
55
PRESENCE : diarrhea is caused by
invasive bacteria
56
ABSENCE: diarrhea is caused by
toxin-producing bacteria
57
All smears or slide preparations must be performed on
fresh specimens
58
Types of Smears
Wet Smears
Dry Smears
59
faster to prepare, but more difficult to interpret; stained with methylene blue
Wet Smears
60
provide permanent slides for evaluation; stained with either Wright’s or Gram stain
Dry Smears
61
Fecal Leukocytes Positive result:
3 neutrophils/HPF or any neutrophil/OIF
62
Used in the diagnosis and monitoring of patients with pancreatic insufficiency, biliary obstruction and gastro colic fistulas
Muscle Fiber
63
Patient Preparation: include red meat in their diet prior to collection
Muscle Fiber
64
Specimens should be examined within
24 hours of collection
65
Procedure:
1.Stool is emulsified in [?] ---> examine for [?]
2.Count number of [?] with well-preserved striations
10% alcoholic eosin
5 min
red-stained fibers
66
: with visible striations (vertical and horizontal)
-Undigested fibers
67
: with striations in one direction
-Partially digested fibers
68
: no striations
-Digested fibers
69
Muscle Fiber Significant Result:
>10 undigested fibers
70
•Screening test for the presence of excess fecal fat
Qualitative Fecal Fat
71
•Monitoring of patients undergoing treatment for malabsorptiondisorders
Qualitative Fecal Fat
72
Qualitative Fecal Fat makes use of lipid dyes:
(1) Sudan III, (2) Sudan IV and (3) Oil Red O
73
—readily stained by Sudan III and appear as large orange-red droplets
Neutral Fats/Triglycerides
74
Neutral Fats/Triglycerides —steatorrhea
>60 droplets/hpf
75
—do not stain directly with Sudan III
Fatty Acid Salts and Fatty Acids
76
—stained by Sudan III after heating and crystallizes during cooling
Cholesterol
77
-Specimen must be mixed with HAcand heated
Fatty Acid Salts and Fatty Acids
78
-Size and number of fat droplets are noted
Fatty Acid Salts and Fatty Acids
79
Fatty Acid Salts and Fatty Acids Normal:
100 small fat droplets, <4um in size per hpf
80
Fatty Acid Salts and Fatty Acids Slightly Increased:
100 droplets, 1 to 8 um in size per hpf
81
Fatty Acid Salts and Fatty Acids Increased:
100 droplets, 6 to 75 um in size per hpf
82
CHEMICAL EXAMINATION TESTS
1.Fecal Occult Blood Test
2.Quantitative Fecal Fat
3.Alkali Denaturation Test
4.Fecal Enzymes
5.Carbohydrates
83
•Most frequently performed chemical screening test
Fecal Occult Blood Test
84
In Fecal Occult Blood Test, bleeding in excess of [?] stool is pathologically significant
2.5ml/150g
85
Used as a mass screening procedure for the early detection of colorectal cancer
Fecal Occult Blood Test
86
Fecal Occult Blood Test Principle:
pseudoperoxidase activity of hemoglobin
87
Fecal Occult Blood Test Indicator Chromogens:
Benzidine
Ortho-toluidine
Gum Guaiac
88
: most sensitive
Benzidine
89
: least sensitive
Gum Guaiac
90
; preferred for routine testing
Gum Guaiac
91
False positive: Guaiac-Based Fecal Occult Blood Tests
Turnips, cauliflower, fish, meat, bananas, apples, aspirin
92
False negative: Guaiac-Based Fecal Occult Blood Tests
Ascorbic acid
93
•Used as a confirmatory test for steatorrhea
Quantitative Fecal Fat
94
Quantitative Fecal Fat
•Patient preparation: regulated intake of fat (?)
100g/dl
95
Quantitative Fecal Fat
•Specimen required:
refrigerated 3-day specimen
96
Quantitative Fecal Fat
•Normal values: [?] or at least [?] coefficient of fat retention
1 to 6 g/dl
85%
97
Methods for Quantitation
1.Van De KamerTitration
2.Gravimetric Method
98
—gold standard for fecal fat
1.Van De KamerTitration—
99
•Distinguishes between fetal blood or maternal blood
APT Test (Fetal Hemoglobin)
100
APT Test (Fetal Hemoglobin) Sample:
infant’s stool or vomitus
101
APT Test (Fetal Hemoglobin) Control:
cord blood and adult blood
102
APT Test (Fetal Hemoglobin) Procedure
-Sample emulsified in water to [?] ---> centrifuge
-[?] is added to the pink Hbcontaining supernatant
free hb
1% NaOH
103
APT Test (Fetal Hemoglobin) Result:
—solution remains pink
— yellow-brown
Fetal Hb
Maternal Hb
104
—solution remains pink
— yellow-brown
Fetal Hb
Maternal Hb
105
Fecal Enzymes Clinical significance
•Pancreatic insufficiency: Chronic pancreatitis, cystic fibrosis
•Steatorrhea
106
-X-ray paper is exposed to the stool sample emulsified in water
1. Trypsin/GELATIN TEST
107
-Insensitive procedure and only detects severe cases
1. Trypsin/GELATIN TEST
108
Trypsin/GELATIN TEST
Presence—digestion of gelatin on the x-ray paper =
clear area
109
Trypsin/GELATIN TEST
Absence—inability to digest gelatin =
no change
110
Fecal Enzymes False (+):
proteolyticactivity of bacterial enzymes
111
Fecal Enzymes False (-):
intestinal degradation of trypsin; inhibitors in feces
112
-More sensitive indicator of less severe cases of pancreatic insufficiency
Chymotrypsin
113
-More resistant to intestinal degradation
Chymotrypsin
114
-Remains stable in fecal samples for up to 10 days at room temp
Chymotrypsin
115
-Measured spectrophotometrically
Chymotrypsin
116
-Pancreas specific and a very sensitive indicator of exocrine pancreatic insufficiency
Elastase I
117
-Easy to perform and requires only a single stool sample
Elastase I
118
-Measured by immunoassay using the ELISA kit
ElastaseI
119
•Valuable assessment of infantile diarrhea
Carbohydrates
120
•Accompanied by pH determination
Carbohydrates
121
Carbohydrates
-Normal:
7-8
122
Carbohydrates
-Increased fermentation:
5.5
123
-Detects congenital disaccharidase deficiency
Copper reduction Test
124
Copper reduction Test
[?] ---> Carbohydrate intolerance
-0.5g/dl
125
Serum carbohydrate intolerance test
a. [?]: for malabsorption
b. [?]: for maldigestion
D-xylose
Lactose tolerance
