FECALYSIS Flashcards
feces is _______ water and _________ solid
75%
25%
feces is approximately ______________ of feces excreted in a 24-hour period
100-200 g
it contains bacteria, cellulose, undigested foodstuffs, GI secretions, bile pigment, cells from intestinal walls, electrolytes, and water.
feces
it is the examination of feces, and aids in diagnosing various gastrointestinal tract disorders
fecalysis
feces are collected in a __________ containers with ___________
plastic or glass with screw-tops
what is the fecal pigment?
stercobilin
what is the color of a normal stool?
brown
what is the color of a stool which indicates upper GI bleeding, iron, charcoal, and bismuth?
black, tarry stool (melena)
what is the color of a stool that indicates lower GI bleeding, beets, food coloring, and rifampin
red
this color of the stool indicates bile duct obstruction, barium sulfate
pale yellow, white, gray
this color indicates biliverdin, oral antibiotics, green vegetables in a stool
green
this color indicates biliverdin, oral antibiotics, green vegetables in a stool
green
the clinical significance of this stool is prussian blue, grape soda
blue
this color of stool indicates porphyria
violet/purple
this stool indicates bile duct obstruction, pancreatic disorders, and steatorrhea
bulky/frothy (whip cream-like)
the clinical significance of this stool is cystic fibrosis
butter-like
the clinical significance of this stool is colistis, dysentery. malignancy, constipation
mucus-streaked, blood-streaked
this stool indicates intestinal obstruction or constriction
slender, ribbon/noodle-like
stool appearance of cholera
rice watery
stool appearance of typhoid
pea soup
stool appearance of constipation
hard/scybalous (goat droppings)
bristole stool chart:
hard, separate pellet-like lumps that are difficult to pass
number 1, constipation
bristole stool chart:
lumpy, sausage-shaped stool
number 2, constipation
bristole stool chart:
sausage-shaped stool with cracks on the surfaces
3, healthy stool
bristole stool chart:
sausage-shaped stool but smooth and soft (snake-like). it is the most optimum
4, healthy stool
bristole stool chart:
blobs that are soft and pass easily
5, diarrhea
bristole stool chart:
mushy stool in the form of fluffy pieces with ragged edges
6, diarrhea
bristole stool chart:
entirely liquid, no solid pieces
7, diarrhea
it is an increased fats in stool (>6g/day). orange droplets in microscope
steatorrhea
this test is the microscopic examination of feces for fat globules (orange droplet)
screening test
what is the definitive test for steatorrhea?
fecal fat determination
what is the 2 qualitative fecal fat test?
- neutral fat stain (triglycerides)
- split fat stain (fatty acids)
this qualitative fecal fat test uses stool suspension + 95% ethanol + sudan III with a result of > or = 60 droplets/hpf that indicates steatorrhea.
neutral fat stain (triglycerides)
this qualitative fecal fat test uses emulsified stool + 36% acetic acid + sudan III with a result of:
normal: <100 droplets (<4 um)
slightly increased: <100 droplets (1-8 um)
increased: 100 droplets (6-75 um)
split fat stain (fatty acid)
it is the quantitative fecal fat test
Van de Kamer Titration
it is the gold standard for fecal fat determination which is used for definitive diagnosis of steatorrhea
Van de Kamer titration
this titration uses NAOH and the sample is collected within 3 days or 72 hours
van de kamer titration
what is the normal value in van de kamer titration?
1-6 g fats/day
what result in van de kamer shows the significance of steatorrhea?
> 6 g fats/day
it is the abnormal secretion of muscle fibers in feces
creatorrhea
it is the 1st stool of newborns
meconium
it is the 1st stool of newborns
meconium
it is the blood in stool
hematochezia
how to determine creatorrhea?
- patient should include red meat in diet
- emulsified stool + 10% eosin = coverslip and stand for 3 minutes
- count the # of undigested fibers (HPF)
this suggested completely digested muscle fibers
no striations
this suggested completely digested muscle fibers, and should be ignored
no striations
this suggests partially digested muscle fibers in stool, and should be ignored
striations in one direction
this suggest undigested muscle fibers and needed to be counted then reported
striations in both direction
clinical significance of an abnormal value of > 10 undigested muscle fibers
cystic fibrosis
biliary obstruction
invasive condition in fecal leukocyte
> 3 neutrophils/HPF
this indicates the presence of Salmonella, Shigella, Yersinia, Enteroinvasive E. coli, Campylobacter
diarrhea with WBC
this indicates the presence of toxin producing (S. aureus, V. cholerae), viruses, parasites
diarrhea without WBC
what is the wet preparation for fecal leukocyte?
stool + Loeffler’s methylene blue
what is the dried preparation for feal leukocyte?
stool + wright’s or gram stain
it uses lactoferrin for fecal leukocyte determination
lactoferrin latex agglutination test
it is found in secondary granules of neutrophils which indicates + invasive bacterial pathogen
lactoferrin
it is the most frequently performed fecal analysis
fecal occult blood test
it is the most frequently performed fecal analysis
fecal occult blood test
fecal occult blood test is the screening for
colorectal cancer
what portion of specimen is used in FOBT
center portion
what is the significant result in FOBT?
> 2.5 mL blood/150 g stool
it is the principle in FOBT
pseudoperoxidase activity of hemoglobin (Hgb)
chromogens in FOBT
benzidine (most sensitive)
guaiac (most preferred)
o-toluidine
what are the macroscopic consistency of stool?
formed
semi-formed
soft
watery
avoid for 3 days (contains peroxidase):
red meat
melon
brocolli
cauliflower
horseradish
turnip
false positive interference
avoid for 7 days (falsely suggests presence of intrinsic lesions):
aspirin = often causes erosion/gastric mucosa)
nonsteroidal anti-inflammatory agent
false positive interferences
avoid for 3 days (decreases sensitivity):
vitamin C (>250 mg/dL)
iron supplements containing vitamin C
*failure to wait specified time after sample is applied to add the developer reagent
false negative interferences
bloody stools and vomitus are sometimes seen in neonates as a result of swallowing maternal blood during delivery
APT test (APT-Downey)
APT Test pink solution
fetal blood
APT Test yellow-brown supernatant
maternal blood
it detects pancreatic enzyme called trypsin
X-ray Film test
clearing of film in X-ray film test
+ trypsin
no clearing in X-ray film tets
- trypsin
absence of trypsin in x-ray film test
cystic fibrosis (malabsorption)
it is the most valuable in assessing cases if infant diarrhea
fecal carbohydrates
determination tests in fecal carbohydrates
- clinitest
- fecal pH
clinitest of >0.5 g/dL
carbohydrate intolerance
normal stool ph
7.0-8.0 pH
stool pH for CHO disorders
<5.5 pH
sensitive indicator of exocrine pancreatic insufficiency, immunoassay using an ELISA test
elastase-1
this test differentiates malabsorption and maldigestion
d-xylose test
specimen for d-xylose test
2-hr post prandial blood and 5-hr urine
low urine d-xylose =
malabsorption
normal urine d-xylose
maldigestion
increase in daily stool weight (>200 g/day), liquidity of stools, and frequency of more than 3x per day
diarrhea
acute diarrhea =
<4 wks
chronic diarrhea =
> 4 wks (1 month)
increased secretion of water and electrolytes.
caused by: bacterial, viral, protozoan infections, drugs, laxatives, hormones, endocrine disorders, neoplasms, collagen vascular disease, inflammatory bowel disease
secretory diarrhea
most common in lactose intolerance.
retention of water and electrolytes.
caused by: maldigestion, malabsorption, disaccharidase deficiency (lactose intolerance), laxatives, antacids, amoebiasis, antibiotics
osmotic diarrhea
enhanced (hypermotility) or slow (constipation) motility
caused by: irritable bowel syndrome (IBS), rapid gastric emptying (RGE), dumping syndrome
altered motility
parasite in watery stool =
tropozoite
parasite in hard stool =
cyst
