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Fecalysis Flashcards

1
Q

Around __________ of fecal material is passed each day.

A

100-200g

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2
Q

Primary site for the final breakdown and reabsorption of ingested proteins, carbohydrates, and fats

A

Small intestine

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3
Q

Digestive enzymes are secreted by the __________ into the small intestine

A

Pancreas

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4
Q

Bile salts are provided by the ____________ and aids in the digestion of fats

A

LIVER

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5
Q

Digestive enzymes secreted by Pancreas

A

Trypsin
Chymotrypsin
Amino Peptidase
Lipase

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6
Q

site of water & electrolyte reabsorption; capable of absorbing ~3000 mL (3 L) of water

A

Large Intestine

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7
Q

How many liters of water does large intestine can absorb?

A

3L

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8
Q

When the amount of water reaching large intestine exceeds that amount

A

Diarrhea

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9
Q

When the fecal material stays a long time in the large intestine, it provides time for additional water to be reabsorbed producing small, hard stools.

A

Constipation

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10
Q

How many hours is needed for feces to be excreted

A

18-24 hours to be excreted

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11
Q

Brown color of stool is due to

A

Urobilin/Stercobilin/Mesobilin

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12
Q

What is the consistency of normal stool

A

Firm,Formed

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13
Q

What is the form of a normal stool

A

Tubular, Cylindrical

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14
Q

Normal odor of stool

A

Foul to Offensive

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15
Q

Wha is the normal ph of stool

A

7.0-8.0

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16
Q

Chemical Examination.
Total fat, quantitative (72-hour specimen) Reference Interval

A

<6g/day and 20% of stool

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17
Q

Chemical Examination.
Osmolality Reference Interval

A

285-430mOsm/kg H2O

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18
Q

Chemical Examination.
Potassium Reference Interval

A

30-140mEq/L

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19
Q

Chemical Examination.
Sodium Reference Interval

A

40-110 mEq/L

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20
Q

Diarrhea duration of Illness
<4 weeks

A

Acute Diarrhea

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21
Q

Diarrhea duration of Illness
>4 weeks

A

Chronic Diarrhea

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22
Q

What are the mechanisms of Diarrhea

A

Osmotic
Secretory
Intestinal Hypermotility

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23
Q

Microscopic Examination.
In qualitative assessment of stool what is the reference value for NEUTRAL FAT?

A

Few/HPF

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24
Q

Microscopic Examination.
In qualitative assessment of stool, what is the reference value for TOTAL FAT?

A

<100 fat globules (<4um)/HPF

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25
Q

Microscopic Examination.
In qualitative assessment of stool, what is the reference value for Leukocyte?

A

Not present

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26
Q

Microscopic Examination.
In qualitative assessment of stool, what is the reference value for Meat and Vegetable Fibers?

A

Few

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27
Q

Color.
Upper gastro intestinal bleeding, iron, charcoal, bismuth

A

Black

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28
Q

Color.
Lower GI bleeding beets, food coloring, rifampin

A

Red

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29
Q

Color.
Bile duct obstruction, barium sulfate

A

Pale Yellow
White
Gray

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30
Q

Color.
Biliverdin, oral antibiotics, green vegetables

A

Green

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31
Q

Color.
Porphyria

A

Violet/Purple

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32
Q

Color/Apperance.
Bile duct obstruction, pancreatic disorders, steatorrhea

A

Bulky/Frothy

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33
Q

Clinical Significance.
Bulky/Frothy appearance

A

Bile duct obstruction
Pancreatic Disorders
Steatorrhea

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34
Q

Color/Appearance.
Cystic Fibrosis

A

Butter-like

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35
Q

Clinical Significance.
Mucus. blood streaked mucus

A

Colitis
Dysentery
Malignancy
Constipation

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36
Q

Clinical Significance.
Ribbon-like

A

Bowel obstruction
Intestinal narrowing

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37
Q

Clinical Significance.
Rice watery

A

Cholera

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38
Q

Clinical Significance.
Pea-soup

A

Typhoid

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39
Q

Clinical Significance.
Hard-small/Scybalous

A

Constipation

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40
Q

Termed as the increased fats in stool
(>6 g/day)

A

Steatorrhea

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41
Q

Mushy, foul-smelling, gray stool that float.

A

Fat

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42
Q

Screening test for fecal fat

A

Microscopic examination of feces for fat globules

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43
Q

Definitive test for fecal fat

A

Fecal fat determination

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44
Q

Resistant to digestion, pass through upper intestine unchanged but are metabolized by bacteria in lower intestine.

A

Oligosaccharides

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45
Q

Approximately ___________ of ingested saliva, gas secretions, liver secretions, pancreatic secretions, and intestinal secretions enter digestive tract

A

900mL/0.9L

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46
Q

How many mL of water is excreted?

A

150mL

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47
Q

Qualitative Fecal Fat Determination.
Emulsified stool + 95% Ethanol + Sudan III

A

Neutral Fat Stain

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48
Q

Are readily stained by SUDAN III and appear as large orange-red droplets, often located near the edge of the coverslip

A

Neutral Fat Stain

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49
Q

> 60 droplets/HPF for Neutral Fat Stain

A

Steatorrhea

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50
Q

Stool + 36% acetic acid + SUDAN III + heat

A

Split Fat Stain

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51
Q

___________ and ___________ do not stain directly with Sudan III,
so, a second slide must be examined after the specimen has been mixed with acetic acid and heated

A

Soaps and Fatty acids

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52
Q

An increased amount of total fat on the second slide with normal fat content on the first slide is an indication of ______________ , whereas ______________ is indicated by increased neutral fat on the first slide

A

malabsorption, maldigestion

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53
Q

Split Fat Stain.
100 small droplets, less than 4 μm/hpf

A

NORMAL

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54
Q

Split Fat Stain.
100 droplets (1-8 um)

A

Slightly Increased

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55
Q

Split Fat Stain.
100 droplets (6-75 um)

A

Increased

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56
Q

Stained by SUDAN III after heating and as the specimen cools forms crystals that can be identified microscopically

A

Cholesterol

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57
Q

Can occur in combination with diarrhea and can result from malabsorption or maldigestion

A

Steatorrhea

58
Q

Gold standard for fecal fat determination
Titration with NaOH

A

Van de Kamer Titration

59
Q

Specimen for Van de Kamer Titration

A

3 day stool/ 72-hour stool

60
Q

Normal Value or fecal fat for Van de Kamer Titration

A

1-6 g fats/day

61
Q

Value for px with Steatorrhea in Van de Kamer Titration

A

> 6g fats/day

62
Q

Measures all fecal fat at 1400nm-2600 nm, but time consuming, uses corrosive & flammable solvents

A

Gravimetric, Near Infrared Reflectance Spectroscopy (NIRS)

63
Q

The homogenized specimen is microwaved-dried and analyzed.

A

Hydrogen Nuclear Magnetic Resonance Spectroscopy (NMRS)

64
Q

Rapid test to estimate/ monitor the amount of fat excretion/screen pediatric patients

A

Acid Steatocrit

65
Q

Specimen for Gravimetric, Nuclear Infrared Reflectance Spectroscopy (NIRS)

A

48-72 hour stool

66
Q

Acid Steatocrit
Normal
Adults
Infants
Steatorrhea
Adults
Infants

A

Normal
Adult: <31%
Infants: <10%
Steatorrhea
Adult: >31%
Infants: .20%

67
Q

Abnormal excretion of muscle fibers in feces

A

Creatorrhea

68
Q

Emulsified stool + 10% alc. Eosin= examine for 5 minutes

A

Muscle Fiber Examination

69
Q

Microscopic Examination of Muscle Fiber should

A

Quantitate the number of red-stained undigested fibers

70
Q

Conditions in increased >10 undigested Muscle Fibers

A

Maldigestion
Hypermotility
Pancreatic Disease

71
Q

Fecal Leukocyte.
>/=3 Neutrophil/HPF

A

Invasive Condition

72
Q

Stool + Loeffler’s methylene blue
Faster but may be more difficult to interpret

A

Wet Preparation

73
Q

Stool + Wright’s/ Gram stain

A

Direct Preparation

74
Q

Provide permanent slides for evaluation

A

Gram stain

75
Q

Detection of fecal leukocyte in refrigerated and frozen specimen

A

Lactoferrin Latex Agglutination

76
Q

Diarrhea + Neutrophil

A

Bacterial dysentery caused by invasive pathogens:
Salmonella
Shigella
Campylobacter
Yersinia and
Enteroinvasive E. coli

77
Q

Diarrhea + w/o Neutrophil

A

Toxin producing bacteria:
Staphylococcus aureus
Vibrio spp.
Virus
Parasite

78
Q

Fecal White Blood Cell Absent Conditions

A

Amoebic colitis
Viral gastroenteritis
Malabsorption

79
Q

Fecal White blood cell
Leukocyte present

A

Celiac disease
Tropical spruce
Microscopic colitis

80
Q

Fecal White Blood Cell
Neutrophil Present

A

Ulcerative colitis
Crohn’s disease
Bacillary dysentery
Pseudomembranous colitis
Ulcerative diverticulitis
Intestinal tuberculosis
Abcessess or Fistula

81
Q

Screening Test for Colorectal Cancer

A

Fecal Occult Blood Test

82
Q

Pathologic Significance for FOBT

A

> 2.5mL of blood/150g of stool

83
Q

Chromogen of choice for FOBT

A

Gum guaiac

84
Q

Principle of FOBT

A

Pseudoperoxidase Activity of Hemoglobin

85
Q

Sample for FOBT

A

Center of Stool

86
Q

Bright red stool in feces

A

Hematochezia

87
Q

Black, tarry stool

88
Q

Most sensitive chromogen in FOBT

89
Q

Sensitive chromogen in FOBT

A

O-Toluidine

90
Q

3 DAYS
Red Meat
Melon
Brocolli’
Cauliflower
Horseradish
Turnip

A

False Positive

91
Q

7 DAYS
Aspirin
Nonsteroidal anti-inflammatory drugs (NSAIDs)

A

False Positive

92
Q

Exemption for NSAIDs

A

Acataminophen

93
Q

3 DAYS
Vitamins C
Iron supplement containing Vit. C

A

False Negative

94
Q

More specific for lower GI bleeding than are guaiac-based tests

A

Immunochemical Fecal Occult Blood Test

95
Q

Example of iFOBT

A

Hemocult-ICT

96
Q

more sensitive to upper GI bleeding
fluorometric assays, this test includes porphyrins from intestinally converted hemoglobin.

A

Porphyrin-Based FOBT

97
Q

Example for pFOBT

98
Q

Red Meat will cause _______ in pFOBT

A

False positive

99
Q

Bloody stools & vomitus are sometimes seen in neonates as a result of swallong maternal blood during delivery.
Differentiates fetal blood & maternal blood

A

APT TEST (Apt-Downey Test)

100
Q

Alkali Resistant

101
Q

Denatured by NaOH

102
Q

Pink solution

A

Fetal blood

103
Q

Yellow-brown supernatant

A

Maternal Blood

104
Q

Emulsified stool + X-ray Paper
Clearing Film

105
Q

Emulsified stool + X-ray Paper
No Clearing Film

A

Negative Trypsin

106
Q

more sensitive indicator for less severe case of pancreatic insufficiency.

A

Chymotrypsin

107
Q

Chymotrypsin remains stable in fecal specimens for up to ________ days at room temperature.

108
Q

pancreas specific; provides a very sensitive indicator of exocrine pancreatic insufficiency

A

Elastase I

109
Q

Most valuable in assessing cases of infant diarrhea

A

Fecal Carbohydrates

110
Q

Test for reducing sugars

111
Q

> 0.5g/dL for Clinitest

A

Carbohydrate intolerant

112
Q

Carbohydrate Fecal pH

113
Q

What is used to detect lactase

A

Mucosal Biopsy

114
Q

3-4 L of mucus / 24hr seen in ____________ of the colon

A

villous adenoma

115
Q

Stool weight of >200 g/day with increased liquidity and frequency of more than 3x/day

116
Q

Increased secretion of water and electrolytes, which override the reabsorptive ability of the large intestine

A

Secretory Diarrhea

117
Q

Causes of Secretory Diarrhea

A

Enterotoxin producing organisms:
E. coli
Clostridium
V. cholerae
Salmonella
Shigella
Staphylococcus
Campylobacter
Protozoa
Parasite: Cytosporidium
Drugs, Stimulants, laxatives
Inflammatory bowel disease

118
Q

Retention of water and electrolytes in the large intestine due to incomplete breakdown or reabsorption of food

A

Osmotic Diarrhea

119
Q

Causes of Osmotic Diarrhea

A

Maldigestion
Malabsorption
Disaccharide Deficiency
laxative
Antacids
Amoebiasis
Antibiotic

120
Q

Enhanced (hypermotility) or slow (constipation) motility

A

Altered Motility

121
Q

Altered Motility causes

A

Irritable bowel syndrome
Rapid gastric emptying dumping syndrome

122
Q

Fecal Osmotic gap formula

A

290 - [2x(Fecal Na+ + Fecal K+)]

123
Q

Distinguish secretory vs. osmotic diarrhea

A

Fecal osmotic gap

124
Q

EIA for toxins A and B

A

Stool C. difficile toxin assay

125
Q

Pseudomembranous colitis

A

Stool C. difficile toxin assay

126
Q

Radioimmunoassay

A

Serum Gastrin

127
Q

Zollinger-Ellison syndrome

A

Serum Gastrin

128
Q

Carbon 13 or 14 labelled Urea →CO2 + NH3 (HCO3 in blood)

A

Urea Breath Test

129
Q

Urea Breath Test

130
Q

25g pentose sugar Orally→urine after 5 hr
<3g enterogenous malabsorption

A

Xylose absorption Test

131
Q

Culture w/ Axenic medium
PAS (+) duodenum biopsy (pathognomonic sign)

A

Whipple’s disease: Tropheryma whipplei

132
Q

NOTE: assoc. vitamin K malabsorption

A

Whipple’s disease: Tropheryma whipplei

133
Q

Used to diagnose Cystic Fibrosis

A

Sweat Test

134
Q

Autosomal recessive metabolic disorder affecting the mucous secreting glands of the body (epithelial chloride channel protein).

A

Cystic Fibrosis

135
Q

Increase ___________ and ____________ due to inability of the sweat glands to reabsorb them before the sweat is secreted

A

sodium and Chloride

136
Q

Pilocarpine + Mild current

A

induce sweat production

137
Q

Flame photometry, Ion exchange electrode

138
Q

Manual or automated titration

139
Q

60 mmol/L in 2 occassions

A

Diagnostic for Cystic fibrosis

140
Q

50 to 60 mmol/L

A

suggestive for Cystic fibrosis

Clinical Microscopy (6 decks)

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