1
Q
includes macroscopic, microscopic, and chemical analyses for the early detection of gastrointestinal (GI) bleeding, liver and biliary duct disorders, maldigestion/ malabsorption syndromes, pancreatic diseases, inflammation, and causes of diarrhea and steatorrhea.
A
Routine fecal examination
2
Q
Normal Fecal Specimen
A
• water
• bacteria
• cellulose
• ether undigested foodstuffs
• gastrointestinal secretions
• bile pigments
• cells from interstitial walls
• Electrolytes
3
Q
BROWN COLOR OF FECES:
A
stercobilinogen → urobilin
4
Q
Final breakdown and reabsorption of nutrients
A
SMALL INTESTINE
5
Q
food travels to the acidic environment of the stomach for additional digestion, where it transforms into
A
chyme
6
Q
uses bile from your gallbladder, liver, and pancreas to help digest food
A
DUODENUM
7
Q
carries food through rapidly, with wave-like muscle contractions, towards the ileum.
A
JEJUNUM
8
Q
the longest part of your small intestine, and connects to the large intestine
A
ILEUM
9
Q
makes pancreatic enzymes
A
PANCREAS
10
Q
stores bile salts
A
GALLBLADDER
11
Q
- provided by the LIVER- stored in the gallbladder, and bile is emptied into the duodenum for further breakdown of food
- a very alkaline, bitter-tasting, dark-green to yellowish-brown fluid produced by the liver
A
Bile Salts
12
Q
are necessary because digestive enzymes cannot efficiently break down large fat globules into smaller droplets
A
Bile salts
13
Q
act like detergents in dishwater, emulsifying fats by breaking them into smaller droplets.
A
bile salts
14
Q
Digestive enzymes
A
● Trypsin
● Chymotrypsin
● Aminopeptidase
● Lipase
15
Q
Any deficiency of Digestive enzymes will result in
A
MALDIGESTION OR MALABSORPTION
16
Q
Major Function: ABSORPTION OF WATER, some minerals, and vitamins as the continents slowly moved through the colon
A
LARGE INTESTINE
17
Q
can absorb ~3000mL (3L) of water
A
LARGE INTESTINE
18
Q
> 3000 mL of water absorption in large intestine can result to
A
DIARRHEA
19
Q
hours are required for material to pass through the large intestine
A
18-24 hours
20
Q
Sections of colon or large intestine:
A
ASCENDING COLON
TRANSVERSE COLON
DESCENDING COLON
21
Q
storage area for feces
A
DESCENDING COLON
22
Q
absorbs the remaining water and other nutrients from the indigestible food material, solidifying it into stool
A
ASCENDING COLON
23
Q
absorbs water and salts from the indigestible material
A
TRANSVERSE COLON
24
Q
Contains NO digestive enzymes
A
LARGE INTESTINE
25
Undigested food in the intestine is decomposed by intestinal bacteria leading to the production of
GAS
26
can cause bloating, discomfort, and flatulence
*Gas
27
The intestine secretes a large amount of mucus, serving as
LUBRICANT
28
typically SLUGGISH or a slow but steady progress
PERISTALSIS
29
is the wave-like muscle contractions that move food through the digestive tract
Peristalsis
30
Vigorous peristalsis occurs only
two to four times a day
31
Formation of feces involves
absorption of water and salts
secretion of mucus
extensive action of microorganism
32
is activated when the rectum fills with feces, stretching its walls
DEFECATION REFLEX
33
stimulate muscular contractions, increasing pressure within the rectum and relaxing the internal anal sphincter
Parasympathetic action potentials
34
Foodstuffs that are bulky, such as dietary fiber, produce a ______________ effect because of their ability to cause intestinal distention
natural laxative effect
35
occurs if the external anal sphincter is voluntarily relaxed.
Defecation, or expulsion of feces
36
type of foods that attract water, change the osmotic balance, and help keep bowel movements regular
fiber-rich foods
37
problems in the GI
Malabsorption
38
deficiency in the digestive enzymes
Maldigestion
39
- fecal material stays long time in the large intestine drawing more time for additional water to be reabsorbed
Constipation
40
stool is small, hard, spherical
Constipation
41
increased liquidity of stools
Diarrhea
42
an increase daily stool weight above 200 g
Diarrhea
43
frequency of Diarrhea
>3x a day
44
may be linked to enhanced motility or hypermotility, which involves increased muscle activity and contractions in the digestive tract, leading to faster movement of food and waste through the intestines.
Diarrhea
45
This can lead to reduced water reabsorption, resulting a more watery stool
Diarrhea
46
ACUTE Diarrhea Illness duration
less than 4 weeks
47
CHRONIC Diarrhea Illness duration
more than 4 weeks
48
Diarrhea is
Classified based on four factors:
1. Illness duration
2. Mechanism
3. Severity
4. Stool characteristics
49
Caused by increased secretion of water and electrolytes, which override the reabsorptive ability of the large intestine
Secretory Diarrhea
50
where sodium goes, ____ follows
water
51
type of watery diarrhea that is increased in secretion of water due to enterotoxin-producing organisms
secretory
52
type of watery diarrhea that is poor in absorption due to incomplete breakdown (maldigestion) or reabsorption of food (malabsorption)
osmotic
53
bacterias that causes secretory watery diarrhea
e. coli
clostridium
v. cholerae
salmonella
shigella
staphylococcus
campylobacter
protozoa
cryptosporidium
54
other causes of watery secretory diarrhea
drugs
laxatives
hormones
inflammatory bowel disease
endocrine disorder
neoplasms
collagen vascular disease
55
causes of osmotic watery diarrhea
disaccharide deficiency (lactose intolerance)
malabsorption (celiac sprue)
poor absorbed sugars (lactose, sorbitol, mannitol)
laxatives
magnesium containing antacids
amebiasis
antibiotic administration
56
osmotic gap for secretory watery diarrhea
<50 Osm/kg
57
osmotic gap for osmotic watery diarrhea
>75 Osm/kg
58
osmotic gap for secretory and osmotic watery diarrhea
OG = 290 - [2 (fecal sodium + fecal potassium)]
59
stool Na in secretory watery diarrhea
>90 mmol/L
60
stool Na in osmotic watery diarrhea
<60 mmol/L
61
stool output in secretory watery diarrhea
>200g in 24 hrs
62
stool output in osmotic watery diarrhea
<200 g in 24 hrs
63
pH for secretory watery diarrhea
>5.6
64
pH for osmotic watery diarrhea
<5.3
65
reducing sugar for secretory watery diarrhea
negative
66
reducing sugar for osmotic watery diarrhea
positive
67
common tests for secretory watery diarrhea
stool culture
ova and parasite exams
rotavirus immunoassay
fecal leukocytes
68
common tests for osmotic watery diarrhea
microscopic fecal fats
muscle fiber detection
qualitative and quantitative fecal fats
trypsin screening
clinitest
d-xylose tolerance test
lactose tolerance test
fecal electrolytes
fecal osmolality
stool pH
69
Increased stool fat that exceed 6 g per day
Steatorrhea
70
Stool is pale, greasy spongy, or pasty inconsistency with a very strong odor
Steatorrhea
71
Caused by Pancreatic insufficiency/ pancreatic disorders that decreases the production of digestive enzymes, particularly lipase
Steatorrhea
72
Caused by Absence of bile salts that assists pancreatic lipase in the breakdown
Steatorrhea
73
to differentiate Steatorrhea
for MALABSORPTION and MALDIGESTION
D-xylose Absorption Test
74
MALDIGESTION or MALABSORPTION:
Pancreatitis
MALDIGESTION
75
MALDIGESTION or MALABSORPTION:
Beta-lipoproteinemia
MALABSORPTION
76
MALDIGESTION or MALABSORPTION:
Bile duct obstruction
MALDIGESTION
77
MALDIGESTION or MALABSORPTION:
Cystic fibrosis
MALDIGESTION
78
MALDIGESTION or MALABSORPTION:
Celiac disease
MALABSORPTION
79
A test for malabsorption
D-Xylose Absorption Test
80
is a pentose sugar that does not need to be digested but need to reabsorbed to be present in the urine
D-xylose
81
Specimen of D-Xylose Absorption Test
blood or urine
82
in D-Xylose Absorption Test
____ g dose of pentose sugar in water is administered orally, and the amount excreted over a _-hour period in the urine is determined
25g ; 5-hour period
83
LOW urine D-xylose indication:
steatorrhea caused by MALABSORPTION
84
NORMAL urine D-Xylose indication:
pancreatitis
85
Causes of NORMAL urine D-Xylose: pancreatitis
➔ Bacterial overgrowth
➔ Intestinal resection
➔ Celiac disease
➔ Tropical sprue
➔ Lymphoma
➔ Whipple disease
➔ Giardia lamblia infestation
➔ Crohn disease
➔ Intestinal ischemia
86
Also called gluten-sensitive enteropathy
Celiac Disease
87
Most common cause of malabsorption in developed countries
Celiac Disease
88
Characterized by the presence of severe mucosal lesions in the proximal small intestine following exposure to gluten
Celiac Disease
89
can be used as differential diagnosis of malabsorption
D-xylose test
90
type of specimen that is collected in plastic or glass containers and suitable for qualitative testing of blood and microscopic examination of leukocytes, muscle fibers and fecal fats
RANDOM
91
type of specimen of material collected on the physician’s gloves and applied to filter paper in occult blood testing
FOBT
92
type of specimen that is collected in large containers for quantitative fecal fat testing
3-day or 72-hours
93
the gold standard for fecal fat testing
Van de Kamer
94
usually collected in a big container that can accommodate a 3 days stool and preserved through refrigeration
Van de Kamer
95
Preservation for Physical
REFRIGERATION
96
Preservation for Chemical
formalin
95% ethanol
glycerol in NSS, MIF, PVA
97
type of specimen used for
Early detection of Gastrointestinal bleeding
FOBT
98
pale stool
Liver and biliary duct disorders
99
indication of GI disturbances are (macroscopically)
changes on the color and consistency of the stool
100
Clay-color or gray, pale yellow or white (ALCOHOLIC) stool for pathologic:
Biliary obstruction/post hepatic obstruction
101
Clay-color or gray, pale yellow or white (ALCOHOLIC) stool for nonpathologic:
Barium sulfate
102
it is used as an X-Ray contrast media
Barium sulfate
103
Red stool (4 causes)
lower GI bleeding
Beets
Food dyes
Drugs ( rifampin, PSP dye)
104
black stool (4 causes)
upper GI bleeding
Iron therapy
Charcoal ingestion
Bismuth (medications, suppositories)
105
green stool (2 causes)
Spinach & Green Vegetables
Biliverdin (during antibiotic therapy)
106
body parts of upper GI bleeding
esophagus
stomach
duodenum (small intestine)
107
body parts of lower bleeding
colon (large intestine) or rectum
108
Watery Pea Soup stool
Typhoid fever
109
Watery Rice water stool
Cholera
110
Hard, small, round stool
Constipation
111
Narrow, ribbon-like, flattened, slender stool
Intestinal constriction/ narrowing
112
Bulky, frothy, greasy, spongy stool
Steatorrhea
113
Translucent gelatinous mucus clinging to the surface of formed stool
-Spastic constipation
-mucous colitis
114
BLOODY mucus clinging to fecal mass
- Neoplasms
- Inflammatory process of the rectal canal
115
Mucus associated with pus and blood
- Ulcerative colitis
- bacillary dysentery
- ulcerating diverticulitis
- intestinal tuberculosis
116
Copious quantity of mucus
Villous adenoma of colon
117
fecal analysis normal quantity
100 to 200g/day
118
fecal analysis normal color
light to dark brown
119
fecal analysis normal consistency
soft to well-formed
120
fecal analysis for odor
foul to offensive
121
fecal analysis for pH
7.0 to 8.0
122
aid in preliminaryinvestigation of the cause of diarrhea (*secretory diarrhea)
NEUTROPHILS
123
3 neutrophils/HPF (or any per OIF) – INVASIVE BACTERIA:
Salmonella
Shigella
Campylobacter
Yersinia
124
Absence of neutrophils – TOXIN-PRODUCING BACTERIA: (only toxins are causing inflammation)
S. aureus
Vibrio spp.
Viruses
Parasites
125
wet preparation
stained with methylene blue
126
dried preparation
stained with wright's or gram stain
127
secondary granules; iron binding protein in immune system *competes with bacteria for iron
lactoferrin
128
can be helpful in diagnosis and monitoring of patients with pancreatic insufficiency (i.e., in cystic fibrosis), biliary obstruction and gastrocolic fistulas
Muscle Fibers
129
lacks digestive enzymes tobreak down muscle fiber making it unable to bereabsorbed, thus appearing in stool.
Pancreatic insufficiency
130
increased muscle fibers in stool
Creatorrhea
131
Frequently ordered in conjunction with microscopic exam for fecal fats *for accurate determination of malabsorptionor maldigestion
Muscle Fibers
132
Presence of >_______ undigested muscle fibers is reported as increased
Muscle Fibers
133
enhances muscle fiber striations
10% alcoholic eosin
134
what is the results in emulsify a small amount of stool in 10% alcoholic eosin and examine the slide for exactly 5 minutes
- undigested fibers
- clearly defined, in two directions
135
results of only undigested fibers are
- partially digested fibers
- striations one direction
136
results of patients should be instructed to include red meat in their diet prior to collecting the specimen
specimens should be examined within 24 hours of collection
- digested fibers
- no visible striations
137
most routinely used staining with dyes
Sudan III
138
Observed microscopically by staining with dyes:
Sudan III
Sudan IV
Oil red O
139
Qualitative Fecal Fats is used to screen specimens microscopically for
STEATORRHEA
140
Fecal Fat Testing for Microscopic Exam
QUALITATIVE Fecal Fat
141
Fecal Fat Testing for Chemical Exam
QUANTITATIVE Fecal Fat
142
readily or directly stained by sudan III
appear as large orange-red droplets
often located near the edge of the coverslip
neutral fat (triglycerides)
143
how many droplets per HPF for steatorrhea
>60 droplets/HPF
144
acidification; hydrolysis of fatty acids
acetic acid
145
better take up of stain and both applied on the second slide
heat
146
split fat stain increased/steatorrhea
100 (6 to 75 um) per HPF
147
split fat stain normal
>100 (<4um) per HPF
148
split fat stain slightly increased
100 (1 to 8um) per HPF
149
dom not stain directly with sudan III, a second slide must be examined after the specimen has been mixed with acetic acid and heat
fatty acids salts (soaps) & fatty acids
150
increased amount of total fat on the second slide with normal fat content on the first slide
malabsorption
151
increased neutral fat on the first slide
maldigestion
152
stained by sudan III after heating and as specimen cools, forms crystals that can be identified microscopically
cholesterol
153
Used as a confirmatory test for steatorrhea / GOLD STANDARD FOR FECAL FAT
Quantitative Fecal Fat Testing
154
Requirementn for Quantitative Fecal Fat Testing
3-day specimen
Regulated intake of fat
Refrigerate
155
Normal blood IN STOOL
2.5 mL of blood
156
Any bleeding in excess of ____________ of stool is pathologic and no visible signs may present thus FOBT testing is necessary
2.5 mL/150g
157
large amounts of fecal blood (50-100mL/day)that turned the stool black and tarry
Melena
158
Most frequently performed chemical fecal analysis
Occult (Hidden) Blood or Fecal Occult Blood Testing (FOBT)
159
Mass screening procedure for the early detection of COLORECTAL CANCER
Occult (Hidden) Blood or Fecal Occult Blood Testing (FOBT)
160
early indication that you have colorectal cancer is that there is
bleeding but without any visible signs.
161
Decreased production of Fecal Enzymes (pancreatic insufficiency) is associated with disorders such as ___________ and __________
chronic pancreatitis and cystic fibrosis
162
Fecal enzymes analyzed:
trypsin, chymotrypsin, elastase I
163
distinguishes between the presence of fetal blood or maternal blood in an infant's stool or vomitus
APT TEST FOR FETAL HEMOGLOBIN
164
are resistant to lying with Sodium hydroxide and will remain pink, while blood cells with adult hemoglobin (Hg A) lyse changing from pink to yellow brown
blood cells with infant blood (Hg)
165
HbF is present
REMAINS PINK
166
HbA is present
YELLOW-BROWN
AUBF
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