MIDTERM - FECAL ANALYSIS Flashcards
1
Q
In the minds of most laboratory personnel, fecal specimen analysis
fits into the category of a “___.”
A
necessary evil
2
Q
Routine fecal examination includes ___
A
macroscopic,
microscopic, and chemical analyses
3
Q
the fecal routine analysis such as macroscopic, microscopic, and chemical analysis, it will provide an early detection for what diseases and conditions?
A
gastrointestinal bleeding, liver and biliary duct disorders, maldigestion and malabsorption disorders, pancreatic diseases, inflammation, and causes of diarrhea and steatorrhea
4
Q
`The normal fecal specimen contains _
A
bacteria, cellulose, undigested foodstuffs, GI secretions, bile pigments, cells from the intestinal walls, electrolytes, and water
5
Q
. Approximately ___ g of feces
is excreted in a 24-hour period
A
100 to 200
6
Q
___ produces
the strong odor associated with feces and intestinal gas (flatus)
A
Bacterial metabolism
7
Q
It is the waste residue of indigestible materials of an
animal’s digestive tract expelled through the anus during
defecation
A
feces or stool
8
Q
Lactose intolerance leads to __
A
excessive gas production
9
Q
Produces strong odor and flatus
A
bacterial metabolism
10
Q
_____, especially oligosaccharides, that are resistant to digestion pass through the upper intestine unchanged but are metabolized by bacteria in the lower intestine, producing large
amounts of flatus
A
Carbohydrates
11
Q
Excessive gas production also occurs in ___ people when the intestinal bacteria metabolize the
lactose from consumed milk or lactose-containing substances.
A
lactose-intolerant
12
Q
Although digestion of ingested proteins, carbohydrates, and fats takes place throughout the alimentary tract, the ____ is the primary site for the final breakdown and reabsorption of these compounds
A
small intestine
13
Q
Digestive enzymes secreted into the
small intestine by the pancreas include ___,___, ____ , and __
A
trypsin, chymotrypsin,
amino peptidase, and lipase
14
Q
__ provided by the liver aid
in the digestion of fats
A
Bile salts
15
Q
Excess undigested or unreabsorbed materials then appear
in the feces, and the patient exhibits symptoms of __.
A
maldigestion
and malabsorption
16
Q
9000 ml of fluid including saliva, gastric, liver, pancreatic secretions enter the digestive tract each day but only ___ ml are excreted
A
150 ml
17
Q
how many ml of water from 9000 ml intake reaches the small and large intestine
A
500 to 1500 ml
18
Q
up to how many ml of water do colon can reabsorbed?
A
3000 ml of water
19
Q
pancreas secreted up to how many ml of secrtions?
A
1000 ml
20
Q
intestinal secretions composed of water and electrolytes is about how many ml
A
2000 ml
21
Q
bile from liver is about how many ml?
A
1000 ml
22
Q
saliva is about how many ml?
A
1500 ml
23
Q
how many ml of water do food and intake water contributes in 9000 ml
A
2000 ml
24
Q
gastric secretions is about how many ml ?
A
1500 ml
25
mucous secretions in the GI tract is about?
200 ml
26
The large intestine is capable of absorbing approximately ___mL of water
3000
27
When the amount of water reaching the large intestine exceeds this amount (3000 ml), it is excreted with the solid fecal material, producing ____
diarrhea
28
____, on the other hand, provides time for additional water to be reabsorbed from the fecal material, producing small,
hard stools.
Constipation
29
____ is defined as an increase in daily stool weight above 200 g, increased liquidity of stools, and frequency of more than
three times per day.
Diarrhea
30
Diarrhea classification can be based on four
factors what are they?
illness duration,
mechanism,
severity,
stool characteristics
31
Diarrhea lasting less than 4 weeks is defined as ___
acute
32
Diarrhea lasting more than 4 weeks is defined as ___
chronic
33
The major mechanisms of diarrhea are ___, ___, and ___
secretory, osmotic, and intestinal hypermotility
34
The major mechanisms of diarrhea are secretory, osmotic, and intestinal hypermotility.
The laboratory tests used to
differentiate these mechanisms are ___
--fecal electrolytes (fecal sodium, fecal potassium),
--fecal osmolality,
--and stool pH
35
The normal total fecal osmolarity is close to the serum osmolality
_____mOsm/kg
290 mOsm/kg
36
normal fecal sodium is ___ mmol/L
30 mmol/L
37
normal fecal potassium is ___ mmol/L.
75 mmol/L
38
The fecal sodium and fecal potassium
results are used to calculate the ____
fecal osmotic gap.
39
describe the difference between the osmotic gap and electrolytes of osmotic diarrhea and secretory diarrhea
osmotic diarrhea > 50 mOsm/kg
electrolytes negligible
secretory diarrhea <50 mOsm/kg
electrolytes increased
40
A fecal fluid pH of less than ___ indicates a malabsorption of sugars, causing
an osmotic diarrhea
5.6
41
___ diarrhea is caused by increased secretion of water.
Secretory
42
what are the causes of increase production or secretion of water and electrolytes in secretory diarrhea
Bacterial, viral, and protozoan infections
43
what is the mechanism of secretory diarrhea
Usually caused by an organism that produces a toxin that
stimulates adenylase cyclase enzyme that leads to crampy
diarrhea & secretion of intestinal fluid
44
the mechanism of secretory diarrhea Usually caused by an organism that produces a toxin that
stimulates ___ that leads to crampy
diarrhea & secretion of intestinal fluid
adenylase cyclase enzyme
45
secretory diarrhea stools are characterized as
watery and voluminous with no RBC,
WBC, and mucus
46
causative agents of secretory diarrhea
o Vibrio Cholerae
o ETEC (Travelers’s bacterial Diarrhea)
o Giardia lamblia
47
Other causes of secretory diarrhea are
drugs, stimulant laxatives,
hormones, inflammatory bowel disease (Crohn disease, ulcerative colitis, lymphocytic colitis, diverticulitis), endocrine disorders (hyperthyroidism, Zollinger-Ellison syndrome, VIPoma),
neoplasms, and collagen vascular disease.
48
increase production of water caused by bacterial, viral, and protozoan infections, will override the __ of large intestine resulting to secretory diarrhea
reabsorptive ability of the large intestine,
49
Process specimens for osmolality testing
immediately. Specimens that are stored for hours may
have a markedly increased osmolality due to the increased
degradation of carbohydrates.
true or false
true
50
is caused by poor absorption that exerts osmotic pressure across the intestinal mucosa.
osmotic diarrhea
51
Incomplete break
down or reabsorption of food presents increased fecal material to
the large intestine, resulting in water and electrolyte retention in
the large intestine
osmotic diarrhea
52
what is the mechanism of osmotic diarrhea
Usually caused by inefficient reabsorption of an osmotic substance due to an enzyme deficiency
53
___(impaired food digestion) and
___(impaired nutrient absorption by the intestine) contribute to osmotic diarrhea
Maldigestion ; malabsorption
54
explain the relationship of the osmolality and the concentration of the electrolyte in terms of the unabsorbable solutes
increases the stool osmolality
concentration of electrolytes is lower
resulting in an increased osmotic gap
55
osmotic diarrhea stools are characterized by
Stool samples are watery and Gaseous with no WBC, RBC, and
mucus
56
causes of osmotic diarrhea based on the ppt
o Lactose intolerance
o Pancreatic insufficiency
57
Differential features for Diarrhea
osmotic diarrhea has _____ in terms of osmotic gap
> 50 Osm/kh
58
Differential features for Diarrhea
osmotic diarrhea has ____ in terms of stool Na
<60 mmol/L
59
Differential features for Diarrhea
osmotic diarrhea has __ in terms of stool output
<200 g
60
Differential features for Diarrhea
osmotic diarrhea has ___ in terms of pH
<5.3
61
Differential features for Diarrhea
osmotic diarrhea is ___ in terms of reducing substance
positive
62
Differential features for Diarrhea
secretory diarrhea has __ in terms of osmotic gap
<50 Osm/Kg
63
Differential features for Diarrhea
secretory diarrhea has __ in terms of stool Na
>90 mmol/L
64
Differential features for Diarrhea
secretory diarrhea has ____ in terms of stool output in 24 hr
>200 g
65
Differential features for Diarrhea
secretory diarrhea is ___ in terms of reducing substance
negative
66
Causes of osmotic diarrhea include ___
disaccharidase deficiency (lactose intolerance),
malabsorption (celiac sprue),
poorly absorbed sugars (lactose, sorbitol, mannitol), laxatives, magnesium-containing
antacids, amebiasis, and antibiotic administration
67
what are the 4 common test for secretory diarrhea
Stool cultures
Ova and parasite
examinations
Rotavirus immunoassay
Fecal leukocytes
68
osmotic diarrhea common fecal test
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
69
higher pH will cause __ (osmotic or secretory?)
secretory
70
presence of reducing substance in secretory
negative
71
___ describes conditions of enhanced motility (hypermotility) or slow motility (constipation)
Altered motility
72
hypermotility and slow motility are both can be seen in ___
irritable bowel syndrome
73
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
74
IBS can be triggered by___
food, chemicals, emotional stress, and
exercise.
75
is the excessive movement of in
testinal contents through the GI tract that can cause diarrhea
because normal absorption of intestinal contents and nutrients
cannot occur.
intestinal hypermotility
76
___ describes hypermotility of the stomach and the shortened gastric emptying
half-time, which causes the small intestine to fill too quickly
with undigested food from the stomach
Rapid gastric emptying (RGE) dumping syndrome
77
Healthy people have a gastric emptying half-time range of ___minutes
35 to 100
78
A gastric emptying time of less than
35 minutes is considered ___
RGE or rapid gastric emptying dumping syndrome
79
Normal gastric emptying is controlled by ___
fundic tone, duodenal feedback,
and GI hormones
80
RGE can be divided into early dumping and late dumping
depending upon how soon after a meal the symptoms occur.
___symptoms begin 10 to 30 minutes following meal ingestion.
early dumping syndrome
81
a classification of late RGE which occurs ___after a meal and is characterized by weakness, sweating, and dizziness
2 to 3 hrs
82
___ is often a complication of
dumping syndrome
Hypoglycemia
83
The main causes of dumping syndrome
include ___.
gastrectomy, gastric bypass surgery, post vagotomy status, Zollinger-Ellison syndrome, duodenal ulcer disease, and
diabetes mellitus
84
Detection of ___ is useful in diagnosing pancreatic insufficiency and small-bowel disorders that cause malabsorption
steatorrhea (fecal fat)
85
it is the Absence of bile salts that assist pancreatic lipase in the breakdown and subsequent reabsorption of dietary fat (primarily triglycerides) produces an increase in stool fat that exceeds 6 g per day.
steatorrhea
86
steatorrhea has an increase of stool fat amounting __ g more per day
exceeds 6g per day
87
pancreatic disorders, including
- cystic fibrosis,
-chronic pancreatitis, and
- carcinoma,
that DECREASE THE PRODUCTION OF PANCREATIC ENZYME, are the conditions associated with steatorrhea
true or false
true
88
Steatorrhea may be present in both
maldigestion and malabsorption conditions and can be distinguished by the what test?
D-xylose test
89
___ is a sugar that does not
need to be digested but does need to be absorbed to be present
in the urine.
D-Xylose
90
If urine D-xylose is low, the resulting steatorrhea indicates a ___
malabsorption condition
91
A normal D-xylose test indicates __
pancreatitis
92
Faeces / feces is the plural of latin term “faex”
meaning ___.
residue
93
__ is the newborn's first feces.
Meconium
94
___ or ___ is the study of feces.
Scatology or Coprology
95
Usually caused by an organism that produces a toxin that stimulates adenylate cyclase enzyme
that leads to crampy diarrhea & secretion of
intestinal fluid
Secretory Diarrhea
96
secretory diarrhea stools are characterized as watery and voluminous with no rbc, wbc & mucus
true or false
true
97
Causative agent of secretory diarrhea
○ Vibrio cholerae
○ ETEC (traveler’s bacterial diarrhea)
○ Giardia lamblia
98
Invasive Diarrhea is mostly caused by
bacteria
99
Invasive organisms destroys the mucosal lining of the intestines producing pus, blood and mucus in stool.
invasive diarrhea
100
Stool may contain wbc, rbc, & specks of mucus; and sometimes the organism.
invasive diarrhea
101
Patient is experiencing tenesmus.
invasive diarrhea
102
a frequent urge to go to the bathroom without
being able to defecate
tenesmus
103
invasive diarrhea is caused by
○ Shigella dysenteriae
○ Entamoeba histolytica
○ ETEC
○ Campylobacter jejuni
○ Yersinia enterolitica
104
Usually caused by inefficient reabsorption of an
osmotic substance due to an enzyme deficiency
osmotic diarrhea
105
Stool samples are watery & gaseous with NO wbc, rbc & mucus
osmotic diarrhea
106
Technologist must be aware of contaminants such as
o Urine
o Water
o Paper
107
MACROSCOPIC EXAMINATION of fecal
color
consistency
form
108
Normal color is
brownn
109
the one responsible for the color of the stool
Urobilinogen is converted to urobilin and
stercobilin
110
Pale color signifies ___ (acholic stool)
biliary obstruction
111
Bleeding can turn the stool into what colors
red and black
112
upper git infection causes the stool to turn
black
113
lower git infection causes the stool to turn
red (hematochezia)
114
Black/Tarry colored stool causes
- UGIT
- Iron therapy
- Charcoal
Intake
- Bismuth
intake
115
red colored stool causes
- LGIT
- Beets intake
- Rifampin
intake
116
Pale Yellow,
White, Gray colored stool causes
- Bile duct
obstruction
- Barium
intake
117
how many days it takes for the blood to appear in the stool if it came from esophagus, stomach, or duodenum
takes approx 3 days
that is why UGIT blood has colored black or tarry stool and not red, the blood was unable to retain its original color (red) due to long time of being inside the GIT
118
green colored stool causes
biliverdin/oral antibiotics
green vegetables
119
bulky/frothy stool appearance is caused by
bile duct obstruction
pancreatic disorders
120
ribbon like appearance of stool; is caused by
intestinal constriction
121
mucus or blood streak stool is caused by
colitis
dysentery
malignancy
constipation
122
macroscopic examination: consistency
what are the things we need to take note in terms of it?
form, hardness, and watery state
123
normal form of stool
cylindrical
124
ribbon like form of a stool signifies __
intestinal constriction on the structure such as tumor blockage
125
small round/scybalous form of a stool signifies __
constipation
126
bulky and frothy form of a stool signifies __
steatorrhea
( bile duct obstruction and pancreatic disorders)
127
mucoid form of a stool signifies __
colitis, constipation
128
possible causes of stool form bulky frothy
bile duct obstruction
pancreatic insufficiency
129
possible causes of stool form ribbon like
interstitial constriction due to malignancy (color cancer)
130
possible causes of stool form mucus and blood-streaked stool
-amoebic colitis
-dysentery
- malignancy
131
describe the type of stool base on the form
type 1-7
separate hard lumps, like nuts (hard to pass)
type 1
132
describe the type of stool base on the form
type 1-7
sausage-shaped but lumpy
type 2
133
describe the type of stool base on the form
type 1-7
like a sausage but with cracks on its surface
type 3
134
describe the type of stool base on the form
type 1-7
like a sausage or snake, smooth and soft
type 4
135
describe the type of stool base on the form
type 1-7
soft blobs with clear-cut edges (passed easily)
type 5
136
fluffy pieces with ragged edges, a mushy stool
type 6
137
describe the type of stool base on the form
type 1-7
watery, no solid pieces, entirely liquid
type 7
138
__- and ___ are the substances that produce normal
odor formed by intestinal bacterial fermentation and
putrefaction.
indole and skatole
139
A foul odor is caused by the degradation of ____
undigested protein and excessive carbohydrate intake.
140
A sickly sweet odor is produced by ___
undigested lactose.
141
a chemical test that is done for Hidden blood, not seen by microscopic examination
Fecal Occult Blood
142
a blood that is Normally found in small amount,___ of
stool.
2.5ml/ 150 grams
143
Screening test for colorectal cancer & git bleeding
Fecal occult blood
144
what is the principle of the fecal occult blood
Based on the pseudoperoxidase activity of
hemoglobin molecule reacting with the
chromogen
145
is commonly used because it is not too
sensitive (avoids high false positive)
gum guaiac
146
is the most sensitive chromogen
benzidine
147
the positive result for O-toluidine
blue chromogen
148
Pale stools are also associated with
diagnostic procedures that use ___
barium sulfate.
149
False-positive reaction for fobt
- NSAIDS
- Contamination of menstrual
blood
- Hemorrhoids
- Non adherence to diet advice
150
false negative for fobt reaction
vitamin c and iron intake
151
Substances that may also exhibit pseudoperoxidase
activity/ reaction:
○ Hemoglobin
○ Myoglobin
○ Vegetables
○ Fruits
152
Dietary restrictions 3 days before the examination
○ Red meat
○ Horseradish
○ Melons
○ Raw broccoli
○ Turnip
○ Vitamin C and iron
153
___ specific for globin portion of
human hemoglobin. uses anti-human hemoglobin
antibodies.
Hemoccult ICT (IFOBT)
Immunochemical Fecal Occult Blood
154
It does not require dietary or drug restrictions.
Immunochemical Fecal Occult Blood
155
It is more sensitive to lower gi bleeding that could be
an indicator of 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
156
offers a porphyrin-based fobt
fluorometric test for hemoglobin based on the
conversion of heme to fluorescent porphyrins. the test
Hemoquant
157
measures both intact hemoglobin and the hemoglobin
that has been converted to porphyrins.
Hemoquant
(Porphyrin-based Fecal Occult Blood)
158
Determines if infant’s stool or vomitus is fetal or
maternal in origin
chemical examination: apt test
159
principle of apt test
Principle:
○ “Fetal blood resist alkali denaturation (remains pink) while maternal blood is sensitive to alkali denaturation (yellow brown).”
160
procedure of apt test
Specimen in emulsified with water, centrifuged then added with 1% NAoH.
161
result of apt test
maternal blood is denature = ___
yellowish brown
162
result of apt test
fetal flood is unchange
pink
163
Confirmatory test for Steartorrhea
Quantitative Fecal Fat Testing
164
Collection of 3 day fecal specimen
Quantitative Fecal Fat Testing
165
Methods for quantitative fecal fat testing
Van de Kamer Titration (gold standard)
166
Rapid test for quantitative fecal fat testing
acid steatocrit
167
MICROSCOPIC EXAMINATION of fecal will check on
● WBCS
● Increased fecal fat
● Meat or muscle fibers
168
__ are positive for fecal wbc.
Invasive organisms
169
__ organisms are negative for fecal wbc.
Toxin producing
170
fecal wbc is assesed using __
Wet preparation with methylene blue, gram’s stain or wright’s stain
171
3 wbc/ hpf is significant for fecal wbc
true or false
true
172
test for fecal wbc
Lactoferrin latex agglutination test
173
Detects fecal wbc even on frozen specimen
Lactoferrin latex agglutination test
174
clinical significance of wbc in fecal test
▪ Ulcerative Colitis
▪ Dysentery (Bacterial)
▪ Ulcerative diverticulitis
▪ Intestinal TB
▪ Abscess
175
Signifies pancreatic insufficiency (acute and chronic pancreatitis, cystic fibrosis)
muscle fiber
176
Usually associated with bulky frothy stool with lots of fecal fat
muscle fiber (Signifies pancreatic insufficiency)
177
muscle fibers is predominant in patient's stool with
Gastrocolic fistula (abnormal connection of the
stomach and intestine)
178
describe the striations of digested meat fibers
no striations
179
describe the striation of a partially digested meat fibers
fibers has 1 stration
180
describe the striation of undigested fibers
has 2 striations or more than
181
Fecal WBCs are seen in __ and ___
bacterial dysentery and ulcerative colitis
182
Wet preparation for fecal wbc
methylene blue
gram stain
wright stain
183
how many wbc per hpf is considered significant in fecal wbc test?
3 WBC/HPF is significant
184
a microscopic screening that is Done in cases steatorrhea and Malabsorption syndromes
qualitative fecal fat
185
Types of fats:
o Neutral Fat (TAG)
o Fatty Acid; Salts or Soaps
o Fatty acid
o Cholesterol
186
Stain used in qualitative fecal fat
sudan 3 (Most commonly used),
4 or ORO
