Fecalysis Flashcards by LUIMER RAMOS

<1-2 weeks but it may persist until 4 weeks, most
common cause is toxic ingestion or infection by bacteria,
pathogens, or virus

Acure

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last for >4 weeks but is often 8 weeks or longer,
can be inflammatory (intestinal, inflammatory bowel
disease like Crohn’s disease) or noninflammatory (can be
subcategorized by the effect of fasting on the diarrhea).

Chronic

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The
third cause is altered motility. This describes the condition
where it is whether enhanced motility or slowed motility
(constipation)

Chronic

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Lactose intolerant (those who cannot absorb lactose in the
milk that causes LBM, this caused by the incomplete
breakdown or reabsorption of lactose)

Osmotic diarrhea

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an also be caused by celiac sprue, malabsorption of sugar,
amebiasis, and antibiotic administration

Osmotic diarrhea

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Fecal fluid pH

> 5.6

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Caused by increase secretion of water and electrolytes that is
cased by bacteria that produces enterotoxins.

Secretory diarrhea

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Can also be caused by drugs, laxatives, inflammatory bowel
disease, and endocrine disorders

Secretory diarrhea

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Electrolytes is increased

Secretory diarrhea

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The laboratory tests used to differentiate between them are
fecal electrolytes (fecal sodium, and fecal potassium), fecal
osmolality, and stool pH

Osmotic gap

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Fecal sodium

30mmol/ L

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Fecal potassium

75 mmol/L

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> 50 mOsm/ kg

Osmotic diarrhea

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<50 mOsm/kg

Secretory diarrhea

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Normal fat/fecal (?) content of stool

6g/day

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The clinical significance of___ is for the diagnosis of
pancreatic insufficiency and small bowel disorders that cause
malabsorption

Steatorrhea

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used to differentiate malabsorption (low D-
xylose) and maldigestion (normal D-xylose), urine and blood
can be tested

D xylose test

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Malabsorption

Low D xylose

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Maldigestion

Normal D xylose

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Specimen suitable for qualitative testing for blood, and
microscopic examination of leukocytes, muscle fibers, and
fecal fat

Random

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Specimen For quantitative twsting

3 day collection

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Normal color; this is caused degradation of
urobilinogen to urobilin, and stercobilin

Orange brown

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This what
bile duct (post-hepatic obstructions) blockage may cause?

Acholic stool

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Upper gastrointestinal bleeding (esophagus,
stomach, duodenum; the blood may take 3 days
before excreted that is why it will exhibit black
color), iron therapy, charcoal, bismuth

Black

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Lower gastrointestinal bleeding, beets and food coloring, rifampin

Red

Bile duct obstruction, barium sulfate

Pale yellow, white, gray

Biliverdin/oral antibiotics, green vegetable

Green

Normal stool appearance

Formed cylindrical masses

Appearance: Bile duct obstruction, pancreatic disorders

Bulky / frothy

Appearance: Intestinal constriction

Ribbon like

Appearance: Colitis, dysentery, malignancy (colon cancer), constipation

Blood -streaked mucus

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

Neutrophils

Presence of neutrophils indicates

Invasive bacteria

Absence of neutrophils indicates

Toxin producing bacteria

All smears or slide preparations must be performed on

Fresh specimens

faster to prepare, but more difficult to interpret; stained with methylene blue

Watery smear

provide permanent slides for evaluation; stained with either Wright’s or Gram stain

Dry smears

Positive result for neutrophils

3 neutrophils/hpf

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

Mucus fibers

In mucus fiber test stool is emulsified in what and in how many minutes

10% alcoholic eosin and examine for 5 mins

with visible striations in one direction

Undigested fibers

with striations in one direction

Prtially Digested fibers

no striations

Digested fibers

Significant result of mucus fibers

10 undigested fibers

Screening test for the presence of excess fecal fat

Qualitative Fecal Fat test

Monitoring of patients undergoing treatment for malabsorption disorders

Qualitative fecal fat test

Lipid dyes

Sudan III Sudan I V Oil red O

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

Neutral fats

Steatorrhea is indicative of

>60 droplets/hpf

do not stain directly with Sudan III

Fatty acid salts and fatty acids

For fatty acid salts and fatty acids, specimen must be mixed with?

Acetic acid and heated

stained by Sudan III after heating and crystallizes during cooling

Cholesterol

Most frequently performed chemical screening test

Occult blood

Bleeding in excess of ____stool is pathologically significant

2.5mL/150g

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

Occult blood test

Principle of occult blood test

pseudoperoxidase activity of hemoglobin

most sensitive; not preferred because it is expensive, and detects everything (prone to false (+) results); ascorbic acid (false (-))

Benzidine

least sensitive; preferred for routine testing’

Gum guaiac

Occult blood indicator chromogens

Benzidine Ortho toluidine Gum guiaic

Used as a confirmatory test for steatorrhea

Quantitative Fecal Fat Testing

Specimen required for quanti fecal fat test

Refrigerated 3 day specimen

Normal valuws for quanti fecal fat twst

1-6g/dL

Methods of Quantitation

Van de kamer titration -gold standard Gravimetric methos

Distinguishes between fetal blood or maternal blood

Alkali denaturation test

Sample of ADT

infant’s stool or vomitus

Control for ADT

cord blood or adult blood

Reagent for ADT

1%NaOh

Adt: solution remains pink

Fetal hb

Adt: solution turns yellow brown

Maternal hb

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

Trypsin

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

Presence of trypsin

inability to digest gelatin = no change

Absence of trypsin

False pos or neg? proteolytic activity of bacterial enzymes

False pos

False pos or neg? intestinal degradation of trypsin; inhibitors in feces

False neg. Trypsin

More sensitive indicator of less severe cases of pancreatic insufficiency

Chymotrypsin

More resistant to intestinal degradation

Chymotrypsin

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

Chymotrypsin

Measured spectrophotometrically

Chymotrypsin

Pancreas specific and a very sensitive indicator of exocrine pancreatic insufficiency

Elastase I

Easy to perform and requires only a single stool sample

Elastase I

Measured by immunoassay using the ELISA kit

Elastase I

Inability to reabsorb carbohydrates

Celiac diseasw

Lack of digestive enzymes

Lactose intolerance

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

Copper reduction test

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

Copper reduction tes

Normal stool ph

7-8

Carbohydrate disorders pH:

<5.5

Result of —— → carbohydrate intolerance

0.5g/dL

Performed after a positive fecal Clinitest

Serum Carbohydrate Intolerance Test