Fecalysis Flashcards
1
Q
Around __________ of fecal material is passed each day.
A
100-200g
2
Q
Primary site for the final breakdown and reabsorption of ingested proteins, carbohydrates, and fats
A
Small intestine
3
Q
Digestive enzymes are secreted by the __________ into the small intestine
A
Pancreas
4
Q
Bile salts are provided by the ____________ and aids in the digestion of fats
A
LIVER
5
Q
Digestive enzymes secreted by Pancreas
A
Trypsin
Chymotrypsin
Amino Peptidase
Lipase
6
Q
site of water & electrolyte reabsorption; capable of absorbing ~3000 mL (3 L) of water
A
Large Intestine
7
Q
How many liters of water does large intestine can absorb?
A
3L
8
Q
When the amount of water reaching large intestine exceeds that amount
A
Diarrhea
9
Q
When the fecal material stays a long time in the large intestine, it provides time for additional water to be reabsorbed producing small, hard stools.
A
Constipation
10
Q
How many hours is needed for feces to be excreted
A
18-24 hours to be excreted
11
Q
Brown color of stool is due to
A
Urobilin/Stercobilin/Mesobilin
12
Q
What is the consistency of normal stool
A
Firm,Formed
13
Q
What is the form of a normal stool
A
Tubular, Cylindrical
14
Q
Normal odor of stool
A
Foul to Offensive
15
Q
Wha is the normal ph of stool
A
7.0-8.0
16
Q
Chemical Examination.
Total fat, quantitative (72-hour specimen) Reference Interval
A
<6g/day and 20% of stool
17
Q
Chemical Examination.
Osmolality Reference Interval
A
285-430mOsm/kg H2O
18
Q
Chemical Examination.
Potassium Reference Interval
A
30-140mEq/L
19
Q
Chemical Examination.
Sodium Reference Interval
A
40-110 mEq/L
20
Q
Diarrhea duration of Illness
<4 weeks
A
Acute Diarrhea
21
Q
Diarrhea duration of Illness
>4 weeks
A
Chronic Diarrhea
22
Q
What are the mechanisms of Diarrhea
A
Osmotic
Secretory
Intestinal Hypermotility
23
Q
Microscopic Examination.
In qualitative assessment of stool what is the reference value for NEUTRAL FAT?
A
Few/HPF
24
Q
Microscopic Examination.
In qualitative assessment of stool, what is the reference value for TOTAL FAT?
A
<100 fat globules (<4um)/HPF
25
Microscopic Examination.
In qualitative assessment of stool, what is the reference value for Leukocyte?
Not present
26
Microscopic Examination.
In qualitative assessment of stool, what is the reference value for Meat and Vegetable Fibers?
Few
27
Color.
Upper gastro intestinal bleeding, iron, charcoal, bismuth
Black
28
Color.
Lower GI bleeding beets, food coloring, rifampin
Red
29
Color.
Bile duct obstruction, barium sulfate
Pale Yellow
White
Gray
30
Color.
Biliverdin, oral antibiotics, green vegetables
Green
31
Color.
Porphyria
Violet/Purple
32
Color/Apperance.
Bile duct obstruction, pancreatic disorders, steatorrhea
Bulky/Frothy
33
Clinical Significance.
Bulky/Frothy appearance
Bile duct obstruction
Pancreatic Disorders
Steatorrhea
34
Color/Appearance.
Cystic Fibrosis
Butter-like
35
Clinical Significance.
Mucus. blood streaked mucus
Colitis
Dysentery
Malignancy
Constipation
36
Clinical Significance.
Ribbon-like
Bowel obstruction
Intestinal narrowing
37
Clinical Significance.
Rice watery
Cholera
38
Clinical Significance.
Pea-soup
Typhoid
39
Clinical Significance.
Hard-small/Scybalous
Constipation
40
Termed as the increased fats in stool
(>6 g/day)
Steatorrhea
41
Mushy, foul-smelling, gray stool that float.
Fat
42
Screening test for fecal fat
Microscopic examination of feces for fat globules
43
Definitive test for fecal fat
Fecal fat determination
44
Resistant to digestion, pass through upper intestine unchanged but are metabolized by bacteria in lower intestine.
Oligosaccharides
45
Approximately ___________ of ingested saliva, gas secretions, liver secretions, pancreatic secretions, and intestinal secretions enter digestive tract
900mL/0.9L
46
How many mL of water is excreted?
150mL
47
Qualitative Fecal Fat Determination.
Emulsified stool + 95% Ethanol + Sudan III
Neutral Fat Stain
48
Are readily stained by SUDAN III and appear as large orange-red droplets, often located near the edge of the coverslip
Neutral Fat Stain
49
>60 droplets/HPF for Neutral Fat Stain
Steatorrhea
50
Stool + 36% acetic acid + SUDAN III + heat
Split Fat Stain
51
___________ and ___________ do not stain directly with Sudan III,
so, a second slide must be examined after the specimen has been mixed with acetic acid and heated
Soaps and Fatty acids
52
An increased amount of total fat on the second slide with normal fat content on the first slide is an indication of ______________ , whereas ______________ is indicated by increased neutral fat on the first slide
malabsorption, maldigestion
53
Split Fat Stain.
100 small droplets, less than 4 μm/hpf
NORMAL
54
Split Fat Stain.
100 droplets (1-8 um)
Slightly Increased
55
Split Fat Stain.
100 droplets (6-75 um)
Increased
56
Stained by SUDAN III after heating and as the specimen cools forms crystals that can be identified microscopically
Cholesterol
57
Can occur in combination with diarrhea and can result from malabsorption or maldigestion
Steatorrhea
58
Gold standard for fecal fat determination
Titration with NaOH
Van de Kamer Titration
59
Specimen for Van de Kamer Titration
3 day stool/ 72-hour stool
60
Normal Value or fecal fat for Van de Kamer Titration
1-6 g fats/day
61
Value for px with Steatorrhea in Van de Kamer Titration
>6g fats/day
62
Measures all fecal fat at 1400nm-2600 nm, but time consuming, uses corrosive & flammable solvents
Gravimetric, Near Infrared Reflectance Spectroscopy (NIRS)
63
The homogenized specimen is microwaved-dried and analyzed.
Hydrogen Nuclear Magnetic Resonance Spectroscopy (NMRS)
64
Rapid test to estimate/ monitor the amount of fat excretion/screen pediatric patients
Acid Steatocrit
65
Specimen for Gravimetric, Nuclear Infrared Reflectance Spectroscopy (NIRS)
48-72 hour stool
66
Acid Steatocrit
Normal
Adults
Infants
Steatorrhea
Adults
Infants
Normal
Adult: <31%
Infants: <10%
Steatorrhea
Adult: >31%
Infants: .20%
67
Abnormal excretion of muscle fibers in feces
Creatorrhea
68
Emulsified stool + 10% alc. Eosin= examine for 5 minutes
Muscle Fiber Examination
69
Microscopic Examination of Muscle Fiber should
Quantitate the number of red-stained undigested fibers
70
Conditions in increased >10 undigested Muscle Fibers
Maldigestion
Hypermotility
Pancreatic Disease
71
Fecal Leukocyte.
>/=3 Neutrophil/HPF
Invasive Condition
72
Stool + Loeffler’s methylene blue
Faster but may be more difficult to interpret
Wet Preparation
73
Stool + Wright’s/ Gram stain
Direct Preparation
74
Provide permanent slides for evaluation
Gram stain
75
Detection of fecal leukocyte in refrigerated and frozen specimen
Lactoferrin Latex Agglutination
76
Diarrhea + Neutrophil
Bacterial dysentery caused by invasive pathogens:
Salmonella
Shigella
Campylobacter
Yersinia and
Enteroinvasive E. coli
77
Diarrhea + w/o Neutrophil
Toxin producing bacteria:
Staphylococcus aureus
Vibrio spp.
Virus
Parasite
78
Fecal White Blood Cell Absent Conditions
Amoebic colitis
Viral gastroenteritis
Malabsorption
79
Fecal White blood cell
Leukocyte present
Celiac disease
Tropical spruce
Microscopic colitis
80
Fecal White Blood Cell
Neutrophil Present
Ulcerative colitis
Crohn's disease
Bacillary dysentery
Pseudomembranous colitis
Ulcerative diverticulitis
Intestinal tuberculosis
Abcessess or Fistula
81
Screening Test for Colorectal Cancer
Fecal Occult Blood Test
82
Pathologic Significance for FOBT
>2.5mL of blood/150g of stool
83
Chromogen of choice for FOBT
Gum guaiac
84
Principle of FOBT
Pseudoperoxidase Activity of Hemoglobin
85
Sample for FOBT
Center of Stool
86
Bright red stool in feces
Hematochezia
87
Black, tarry stool
Melena
88
Most sensitive chromogen in FOBT
Benzidine
89
Sensitive chromogen in FOBT
O-Toluidine
90
3 DAYS
Red Meat
Melon
Brocolli'
Cauliflower
Horseradish
Turnip
False Positive
91
7 DAYS
Aspirin
Nonsteroidal anti-inflammatory drugs (NSAIDs)
False Positive
92
Exemption for NSAIDs
Acataminophen
93
3 DAYS
Vitamins C
Iron supplement containing Vit. C
False Negative
94
More specific for lower GI bleeding than are guaiac-based tests
Immunochemical Fecal Occult Blood Test
95
Example of iFOBT
Hemocult-ICT
96
more sensitive to upper GI bleeding
fluorometric assays, this test includes porphyrins from intestinally converted hemoglobin.
Porphyrin-Based FOBT
97
Example for pFOBT
HemoQuant
98
Red Meat will cause _______ in pFOBT
False positive
99
Bloody stools & vomitus are sometimes seen in neonates as a result of swallong maternal blood during delivery.
Differentiates fetal blood & maternal blood
APT TEST (Apt-Downey Test)
100
Alkali Resistant
HbF
101
Denatured by NaOH
HbA
102
Pink solution
Fetal blood
103
Yellow-brown supernatant
Maternal Blood
104
Emulsified stool + X-ray Paper
Clearing Film
+ Trypsin
105
Emulsified stool + X-ray Paper
No Clearing Film
Negative Trypsin
106
more sensitive indicator for less severe case of pancreatic insufficiency.
Chymotrypsin
107
Chymotrypsin remains stable in fecal specimens for up to ________ days at room temperature.
10
108
pancreas specific; provides a very sensitive indicator of exocrine pancreatic insufficiency
Elastase I
109
Most valuable in assessing cases of infant diarrhea
Fecal Carbohydrates
110
Test for reducing sugars
Clinitest
111
>0.5g/dL for Clinitest
Carbohydrate intolerant
112
Carbohydrate Fecal pH
<5.5
113
What is used to detect lactase
Mucosal Biopsy
114
3-4 L of mucus / 24hr seen in ____________ of the colon
villous adenoma
115
Stool weight of >200 g/day with increased liquidity and frequency of more than 3x/day
Diarrhea
116
Increased secretion of water and electrolytes, which override the reabsorptive ability of the large intestine
Secretory Diarrhea
117
Causes of Secretory Diarrhea
Enterotoxin producing organisms:
E. coli
Clostridium
V. cholerae
Salmonella
Shigella
Staphylococcus
Campylobacter
Protozoa
Parasite: Cytosporidium
Drugs, Stimulants, laxatives
Inflammatory bowel disease
118
Retention of water and electrolytes in the large intestine due to incomplete breakdown or reabsorption of food
Osmotic Diarrhea
119
Causes of Osmotic Diarrhea
Maldigestion
Malabsorption
Disaccharide Deficiency
laxative
Antacids
Amoebiasis
Antibiotic
120
Enhanced (hypermotility) or slow (constipation) motility
Altered Motility
121
Altered Motility causes
Irritable bowel syndrome
Rapid gastric emptying dumping syndrome
122
Fecal Osmotic gap formula
290 - [2x(Fecal Na+ + Fecal K+)]
123
Distinguish secretory vs. osmotic diarrhea
Fecal osmotic gap
124
EIA for toxins A and B
Stool C. difficile toxin assay
125
Pseudomembranous colitis
Stool C. difficile toxin assay
126
Radioimmunoassay
Serum Gastrin
127
Zollinger-Ellison syndrome
Serum Gastrin
128
Carbon 13 or 14 labelled Urea →CO2 + NH3 (HCO3 in blood)
Urea Breath Test
129
Urea Breath Test
H. pylori
130
25g pentose sugar Orally→urine after 5 hr
<3g enterogenous malabsorption
Xylose absorption Test
131
Culture w/ Axenic medium
PAS (+) duodenum biopsy (pathognomonic sign)
Whipple’s disease: Tropheryma whipplei
132
NOTE: assoc. vitamin K malabsorption
Whipple’s disease: Tropheryma whipplei
133
Used to diagnose Cystic Fibrosis
Sweat Test
134
Autosomal recessive metabolic disorder affecting the mucous secreting glands of the body (epithelial chloride channel protein).
Cystic Fibrosis
135
Increase ___________ and ____________ due to inability of the sweat glands to reabsorb them before the sweat is secreted
sodium and Chloride
136
Pilocarpine + Mild current
induce sweat production
137
Flame photometry, Ion exchange electrode
Sodium
138
Manual or automated titration
Chloride
139
60 mmol/L in 2 occassions
Diagnostic for Cystic fibrosis
140
50 to 60 mmol/L
suggestive for Cystic fibrosis
