- Secretory ● Osmotic ● Intestinal hypermotility

FECALYSIS Flashcards by Queenie Mae

Faeces/feces is plural of latin term “FAEX” meaning __.

RESIDUE

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It is the waste residue of indigestible materials of an animal’s digestive tract expelled through the anus during defecation.

Feces

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IS newborn’s first feces.

MECONIUM

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● is the study of feces.

SCATOLOGY OR COPROLOGY

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● while __ is the analysis of fecal/stool

fecalysis

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○ Produces strong odor and flatus
○ major factor of bacterial metabolism causes odor and flatus
○ __ leads to excessive gas production

Bacterial metabolism
-Lactose intolerance

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○ Major site for final breakdown and reabsorption of
compounds
○ by taking down the food through the process
○ mga hindi nareabsorb, not needed na on the body
napupunta sa__

Small intestine
large intestine

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Digestive enzymes
○ ,,,,_
○ these enzymes are needed for the digestion of our foods

Trypsin, chymotrypsin, lipase, and amino
peptidase and lipase

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Increase daily stool (above 200G)
● Increased liquidity and frequency of more than three times
per day

DIARRHEA

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MAJOR MECHANISM

Secretory
● Osmotic
● Intestinal hypermotility

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baterial, viral, and protozoan infections
produce increased SECRETION OF WATER AND ELECTROLYTES, which override the reabsorptive ability
of the large intestine.

Secretory

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Mechanism
○ Usually caused by an organism that produces a toxin that stimulates adenylase cyclase enzyme that leads to crampy diarrhea & secretion of intestinal fluid

SECRETORY DIARRHEA

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SECRETORY DIARRHEA
CAUSATIVE AGENT

○ Vibrio cholerae
○ ETEC (Traveler’s bacterial diarrhea)
○ Giardia lamblia

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Stool are characterized as watery and voluminous with no
RBC, WBC & mucus

SECRETORY DIARRHEA

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● Mostly caused by bacteria

INVASIVE DIARRHEA

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MECHANISM
○ Invasive organisms destroy the mucosal lining of
the intestines producing pus, blood, and mucus in
stool.

INVASIVE DIARRHEA

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Stool may contain WBC, RBC, & specks of mucus; and
sometimes the organism
- ● Patient is experiencing tenesmus

INVASIVE DIARRHEA

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INVASIVE DIARRHEA CAUSED BY

○ Shigella dysenteriae
○ Entamoeba histolytica
- EIEC
○ Campylobacter jejuni
○ Yersinia enterocolitica

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→ incomplete breakdown of reabsorption of
food presents increased fecal material to the large
intestine, resulting in the retention of water and
electrolytes in the large intestine

OSMOTIC

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not causes by the parasite/microorganism but the lactose
intolerance
● deficient sa digestive enzyme

OSMOTIC DIARRHEA

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MECHANISM
○ Usually caused by inefficient reabsorption of an
osmotic substance due to an enzyme deficiency
● Stool samples are watery & gaseous with no WBC, RBC,
& Mucus

OSMOTIC DIARRHEA

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OSMOTIC DIARRHEA
CAUSES

○ Lactose intolerance
○ Pancreatic insufficiency

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DIFFERENTIAL FEATURES FOR DIARRHEA
Laboratory Test
Osmotic gap
Stool Na
Stool output in 24
hours
pH
Reducing
substances

Osmotic Diarrhea
>50 OSM/kg
<60 mmol/L
<200 g
<5.3
Positive

Secretory Diarrhea
<50 Osm/kg
>90 mmol/L
>200 g
>5.6
Negative

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COMMON FECAL TESTS FOR DIARRHEA
Secretory

Stool cultures
Ova and parasite examinations
Rotavirus immunoassay
Fecal leukocytes

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COMMON FECAL TESTS FOR DIARRHEA Osmotic

Microscopic fecal fats Muscle fiber detection Qualitative fecal fats Trypsin screening Microscopic fecal fats Muscle fiber detection Quantitative fecal fats Clinitest D-xylose tolerance test Lactose tolerance test Fecal electrolytes Stool pH Fecal osmolality

describes conditions of enhanced motility (hypermotility or slow motility (constipation))

Altered motility

A functional disorder in which the nerves and muscles of the bowel are extra sensitive, causing cramping, bloating, flatus, diarrhea, and constipation

irritable bowel syndrome (IBS)

Increase fat in stool (>6G/Day) ○ Absence of bile salts that assist pancreatic lipase in the breakdown and subsequent reabsorption of triglycerides

STEATORRHEA

STEATORRHEA CONDITIONS ASSOCIATED

○ Pancreatic disorders: ■ Cystic fibrosis ■ Chronic pancreatitis ■ Carcinoma that decrease the production of pancreatic enzymes

● distinguish steatorrhea in maldigestion and malabsorption condition

D-XYLOSE TEST:

is a sugar that does not need to be digested but does need to be absorbed to be present in the urine ● dapat hindi nakikita on the stool

d-xylose

● a normal d-xylose test indicates __ ● if positive the doctor will also request for the _ and _ to confirm for the association of it

pancreatitis lipase and amylase

MACROSCOPIC EXAMINATION

● Color ● Consistency ● Form

MACROSCOPIC SCREENING: Black/ Tarry

UGIT (melena) Iron therapy Charcoal intake Bismuth intake

MACROSCOPIC SCREENING: Red

LGIT (hematochezia) Beets intake Rifampin intake

MACROSCOPIC SCREENING: Pale Yellow, White, Gray

Bile Duct Obstruction Barium intake

MACROSCOPIC SCREENING: Green

Biliverdin Oral antibiotics Green vegetables

Normal color is __- Urobilinogen is converted to _and _

Brown urobilin stercobilin

Bulky frothy stool

Bile DUCT obstruction Pancreatic insufficiency

Ribbon-like stool

Intestinal constriction due to malignancy (colon cancer)

Mucus and blood-streaked stool

Amoebic colitis- Dysentery- Malignancy

BRISTOL STOOL CHART

TYPE 1 Separate hard lumps, like nuts (hard to pass) TYPE 2 Sausage shaped but lumpy TYPE 3 Like a sausage but with cracks on the surface TYPE 4 Like a sausage or snake, smooth and soft TYPE5 Soft blobs w/ clear cut edges TYPE 6 Fluffy pieces w/ ragged edges, a mushy stool TYPE 7 Watery, no solid pieces ENTIRELY LIQUID

Basically depends on the pH of the stool and _ and _ are the substances that produce normal odor formed by intestinal bacterial fermentation and putrefaction.

ODOR INDOLE and SKATOLE

A __ is caused by degradation of undigested protein and excessive carbohydrate intake.

foul odor

● _ is produced by undigested lactose (Milk).

Sickly sweet odor

Determination of Hidden blood, not seen by microscopic examination ● Usually requested by doctors once blood is present in feces

FECAL OCCULT BLOOD

● Normally found in small amount 2.5 mL / 150 grams of stool ● Screening test for _ and _

FECAL OCCULT BLOOD - colorectal cancer & GIT bleeding

●_ of stool is significant

> 2.5 mL / 150 grams

Based on the PSEUDOPEROXIDASE ACTIVITY of hemoglobin molecule CHROMOGEN.

FECAL OCCULT BLOOD

FECAL OCCULT BLOOD __ is commonly used because it is not too sensitive (avoids high false positive); has same principle with urine strip test for blood

Gumguiac

●is the most sensitive chromogen

Benzidine

FECAL OCCULT BLOOD POSITIVE RESULT:__

Blue Chromogen

False-POSITIVE FECAL OCCULT BLOOD

NSAIDS (medicine, antibiotics)-Contamination of menstrual blood-Hemorrhoids-Non-adherence to diet advice (dietary restrictions)

FECAL OCCULT BLOOD False-NEGATIVE

Vitamin C and Iron intake

Substances that may also exhibit pseudoperoxidase activity / reaction:

○ Hemoglobin ○ Myoglobin ○ Vegetables ○ Fruits

Dietary restrictions 3 days before the examination

○ Red meat ○ Horse radish ○ Melons ○ Raw Broccoli ○ Turnip ○ Vitamin C and Iron

→ specific for globin portion of human hemoglobin. Uses anti-human hemoglobin antibodies. ● It does not require dietary or drug restrictions (non-steroidal).

Hemoccult ICT (IFOBT)

It is more sensitive to lower GI bleeding that could be an indicator or colon cancer or other GI disease and can be used for patients who are taking aspirin and other anti-inflammatory medications

IMMUNOCHEMICAL FECAL OCCULT BLOOD TEST

__- offers a porphyrin-based FOBT fluorometric test for hemoglobin based on the conversion of heme to fluorescent porphyrins. The test measures both intact hemoglobin and the hemoglobin that has been converted to porphyrins.

PORPHYRIN-BASED FECAL OCCULT BLOOD TEST - HEMOQUANT

Measures both intact hemoglobin and the hemoglobin that has been converted to porphyrins. (Positive → Doctor will request clinical analysis.)

PORPHYRIN-BASED FECAL OCCULT BLOOD TEST

Determines if infant’s stool or vomitus is fetal or maternal in origin (greenish, reddish, streak of mucus)

APT TEST

PRINCIPLE ○ Fetal blood resist alkali denaturation (remains pink) while maternal blood is sensitive to alkali denaturation (yellow brown)

APT TEST

PROCEDURE ○ Specimen in emulsified with water, centrifuged then added with 1% NAOH

APT TEST

APT TEST RESULT ○ Maternal blood is denature = __ ○ Fetal flood is unchanged = _

yellowish brown pink

Determine Total Fecal Fat. ● Confirmatory test for steatorrhea ● Collection of 3-day fecal specimen ● METHOD: __ (Gold Standard) ● RAPID TEST: _

QUANTITATIVE FECAL FAT TESTING - Van de Kamer Titration - Acid Steatocrit

MICROSCOPIC EXAMINATION

● WBCs ● Increased Fecal Fat ● Meat or Muscle Fibers

(mostly neutrophils) are seen in bacterial dysentery and ulcerative colitis (Damage sa lining) ●__ are positive for it.

FECAL WBC - Invasive organism

● Toxin producing organisms are negative for __.

fecal WBC

○ Detects fecal WBC even on frozen specimen

LACTOFEBRIN LATEX AGGLUTINATION TEST

WBCS __ ■ Infection or inflammatory intestinal mucosal wall ■ Bacteria (salmonella, shigella, campylobacter, yersinia, and e.coli)

NEUTROPHILS

FECAL WBC CLINICAL SIGNIFICANCE

■ Ulcerative colitis ■ Dysentery (Bacterial) ■ Ulcerative diverticulitis ■ Intestinal TB ■ Abscess

Signifies pancreatic insufficiency (acute and chronic pancreatitis, cystic fibrosis) ○ Usually associated with bulky frothy stool with lots of fecal fat

MUSCLE FIBER

(abnormal connection of the stomach and intestine)

Gastrocolic fistula

PROCEDURE ○ Stool with 10% eosin ○ Examine slides for 5 minutes ○ Count the striated muscle fibers

MUSCLE FIBER

Digested meat fibers has _striations ● Partially digested fibers has_ striation ● Undigested fibers has _ striations (more than 10 per slide is significant)

MUSCLE FIBER no 1 2

Done in cases of STEATORRHEA and MALABSORPTION SYNDROMES

QUALITATIVE FECAL FAT

TYPE OF FATS:

○ Neutral fat (TAG) ○ Fatty acid salts or soaps ○ Fatty acid ○ Cholesterol

QUALITATIVE FECAL FAT Stain used are __(most commonly used), _ OR _

Sudan 3 Sudan 4 or ORO

○ Mix stool with Sudan 3 ○ Count thelarge orange-red droplets ○ > 60 droplets / HPF is significant

NEUTRAL FAT STAIN

○ Mix stool with acetic acid and heat. It measures soap and fatty acid ○ Count and take note of size of fat droplets (Presence of fat droplets is normal, the abnormal size is significant Normal is 100 small droplets < 4 um in diameter (6 to 75 um is significant)

SPLIT FAT STAIN MEASURES “TOTAL FECAL FAT”

○ Stool is mixed with Sudan 3 then heated. ○ Allow to cool and then look for cholesterol crystals (notched-end rhombic plates)

Cholesterol Fecal Fat

FECALYSIS Flashcards

(81 cards)