Stool Analysis and Interpretation Flashcards
what can cause leaky gut
-low gastric acid
-chronic maldigestion
-food allergies
-SIBO/bacterial overgrowth
-pathogenic bacteria
-yeast
-parasites
-toxic irritant
-NSAIDS
-antibiotics
information regarding the efficiency of digestion and absorption can be gleaned from measurement of these fecal levels
-elastase (pancreatic exocrine sufficiency)
-muscle and vegetable fibers
-carbohydrates
-steatocrit (% total fat)
inflammation biomarkers measured on GI panel
lysozyme
lactoferrin
eosinophil protein X (EPX)
white blood cells
mucus
only biomarker of humoral immune status in the GI tract
SIgA
functions of bacteria in GI tract
ferment unused energy
communicate with immune system
prevent growth of harmful substances
regulate gut development
produce vitamins (biotin and K)
produce hormones to store fat
obligate anaerobes (define)
bacteria that cannot survive in the presence of oxygen
bacteria that cannot survive in the presence of oxygen
obligate anaerobes
what are the obligate anaerobes (3)
(cannot survive in oxygen)
-bacteroides
-fusobacteria
-clostridia
(prevotella, streomyces, mycoplasma alt.)
what is the most abundant anaerobe known for ability to metabolize polysaccharies into SCFA–the main colonic fuel source?
bacteroides sp.
what are the obligate anerobes (3)
(cannot survive in oxygen)
-Bacteroides
-fusobacteria
-clostridia
(prevotella, streomyces, mycoplasma alt.)
what is a facultative anaerobes
makes ATP by aerobic respiration if oxygen is present but can swtich to fermentation in the absence of oxygen
name of category that makes ATP by aerobic respiration if oxygen present but can switch to fermentation in the absence
faculatative anaerobes
what are the facultative anaerobes
lactobacillus and bifidobacter
lactobacillus and bifidobacter are what type of bacteria
facultative
two most common GI tract infections
Helicobacter pylori (stomach, esophagus and upper duodenum), and cryptosporidium parvum (parasite in SI)
4 common bacterial pathogens tested
H. pylori
C. difficile
Campylobacter
E.H.E Coli
H. pylori s/s
stomach ulcers
acid reflux
burping/belching
upper GI distress
stomach CA
can be hard to irradicate and can produce a toxin that disables the body’s immune rnx against it!
cryptosporidium parvum s/s and what it does
high fever, severe diarrhea, death or none at all
damages the microvilli of the SI and inhibits absorption of nutrients and compromises the mucosal barrier defenses weaking body against other infectious agents.
where else can H pylori be found other than GI (hence important to use microbiology and immunological assays)
oral cavity and prostate gland
where else can cryptosporidium parvum be found other than GI (hence important to use microbiology and immunological assays)
lungs and conjunctiva of the eyes
where does SCFA come from
-dietary carbs that escaped digestion/absorption in the small bowel
-prebiotics that underwent fermentation in the colon
-fermentation of fiber by anaerobic bacteria in the large bowel
3 main beneficial SCFA (names)
acetate
propionate
butyrate
benefits of SCFA
energy for colonocytes/nutrition for intestinal lining
remove sodium and water from colon (anti-diarrheal)
enhance growth of lacto. and bifido.
improve GI barrier
lower ammonia uptake from intestine
stabilize blood sugar
suppress cholesterol synthesis
lower colonic pH (protects lining)
stimulate production of cytokines
enhance apoptosis of tumor cells
what is the preferred substrate for colonocytes
butyrate
benefits of butyrate
prevent colon CA (by stimulating healthy cellular growth and reducing DNA damage)
how to increase butyrate
increase fiber intake
larch arabinogalactans
normalize pH
normalize transit time
pre and probiotics (fructooligosaccharides)
Butyric acid (oral or rectal)
what are the 6 gut inflammation markers
lactoferrin
WBCs
Mucus
lysozyme
Eosinophil Protein X (EPX)
Calprotectin
lactoferrin
WBCs
Mucus
lysozyme
Esinophil protein X (EPX)
Calprotectin
6 markers of gut inflammation
what does lysozyme do
enzyme that catalyzes hydrolysis of specific glycosidic bonds in mucopolysaccharides that make up the cell wall of gram-positive bacteria (aka anti-bacterial defense of the GI)
what secretes lysozyme
granulocytes
what do granulocytes secrete and the function
lysozyme
anti-bacterial defense of the GI
moderate elevations in lysozyme
significant overgrowth of pathogens
very high levels of lysozyme
IBD, Crohns, UC
what is lactoferrin and what does it do
marker of gut inflammation
iron-binding protein released by neutrophils as antimicrobial mechanism.
released in inflammatory states such as Crohns, IBD, US
is lactoferrin increased with IBD
yes. but not IBS.
is lactoferrin increased with IBS
no. but with IBD yes.
remedies for noninfectious inflammation
tumeric
ginger
fish oils
quercitin
eliminate food sensitivities
where do eosinophils reside in a healthy individual? unhealthy?
connective tissue layer of the gut (lamina propria)
move to gut lumen (when damage to lamina propria)
what inflammatory marker is the test of choice for IBD
calprotectin
elevated calprotectin levels (50-100mg)
inflammation of the GI fract
IBD
infection
polyps
neoplasia
NSAIDs
calprotectin >250; above 500?
250: for patients with IBD suggests low to moderate disease activity
500+: for IBD suggests high disease activity. for those with IBD in remission, above 250 has high risk for relapse within the year
decreased SIgA lecels associated with
increased absorption of fod protein antigens
lowered resistance to intestinal infection ( ie yest)
increased risk for adhesion and proliferation of pathogens
atopic dermatitis
dysbiosis
what suppresses SIgA
stress
alcohol
anxiety
what are things that can normalize depressed SIgA
sacchromyces boulardii
L-glutamine
use for Anti-gliadin SIgA
assessing adherence to diet
strengthening a diagnosis of celiac disease
may also be positive in Crohns, IBS, food sensitivities.
high fecal pH risk factor for
colorectal CA
what to do for low fecal pH (too acidic)
address cause of diarrheal syndromes
viral infection
malsabsoprtion
bacterial toxins
what to do for high fecal pH (too basic)
correct constipation
too much dietary protein
improve transit time
increase fiber
increased pH (too alkaline) causes what in the stool
constipation
decreased pH (too acidic) causes what in the stool
diarrhea
Testing recommendations for occult blood
every other year after yr 50
reasons for blood in stool
early sign of digestive conditions
polyps
CA
peptic ulcer
IBD
diverticulosis
pancreatitis
clay white or tan color stool indications
absence of bile (biliary obstruction) or pancreatic insufficiency
lack tarry stool indications
upper GI bleeding
high intake of dark green veggies, red meat or iron
red stool indications
lower GI bleed or beet ingestion
elastase 1
pancreatic enzyme
use to test for pancreatic insufficiency
what does elastase 1 do
breaks down dietary protein into absorbable amino acids
elastase 1 decreased in what conditions
diabetes
gallstones/post cholecystectomy
osteoporosis
cystic fibrosis
what are the two pancreatic markers
elastase 1
chymotrypsin
abnormally high amounts of putrefactive SCFAs suggest what
protein malabsorption
how to treat high putrefactive SCAFs
pancreatic enzynes
irradicate H pylori
