Fecalysis • Principle:

Feces / Stool - Based on the pseudoperoxidase activity of hemoglobin

•Solid/ semi-solid body waste discharged from the large molecule reacting with chromogen.
intestine through the anus during defecation. Different Types of Indicator Chromogens
Components of a Normal Stool •Gum Guaiac - prevent false positive
• Bacteria - Good bacteria (bacillus fragilis or normal flora - •Benzidine - most sensitive chromogen
found in the lining of the intestine) •Ortho toluidine - for positive result of chromogen
• Undigested food stuff •Positive Result: BLUE CHROMOGEN
• Bile pigments (Urobilin/ Stercobilin - produces normal color of Dietary Restrictions 3 days before the examination (FOBT)
stool, pigments) • Red Meat • Horse radish • Melons • Raw broccoli
• Water and electrolytes • Cauliflower • Turnip • Vitamin C
• Enzymes • Aspirin and NSAIDS - restriction of 7 days prior specimen
a. Trypsin responsible for protein digestion collection.
b. Chymotrypsin Bristol Stool Chart
c. Aminopeptidase Type 1. Separate hard lumps, like nuts (hard to pass). Severe
d. Lipase - responsible for fat digestion constipation
e. Amylase - responsible for carbohydrate digestion Type 2. Sausage-shaped but lumpy. Mild constipation
Macroscopic Examination of a Normal Stool Specimen Type 3. Like a sausage but w/ cracks on its surface. Normal
• Volume: 100-200 grams/day Type 4. Like a sausage or snake, smooth and soft. Normal
• Color: Light to Dark Brown Type 5. Soft blobs w/ clear-cut edges (passed easily). Lacks
• Odor: Offensive (due to Indole and Skatole) of fiber
• Form and Consistency: Soft and well formed Type 6. Fluffy pieces w/ ragged edges, a musty stool. Mild
• Reaction: diarrhea
a. Alkaline: Increase protein diet Type 7. Watery no solid pieces. Entirely liquid. Severe
b. Acidic: Increase vegetable, CHO, and fats in the diet Diarrhea
Abnormal Variation in Color:
•Black- upper gastrointestinal bleeding, intake iron, etc. BARIUM SULFATE - ihahalo sa water, then issubject si patient
•Red- bleeding in lower GIT, intake of beets, food coloring, sa x-ray, USE TO TEST INTESTINAL OBSTRUCTION
Rifampin and Pyridium compounds. BILIVERDIN - pag hindi dinigest ng intestine yung food
•Pale Yellow, White, Gray- Bile duct obstruction, Barium BED PAN - for quantitative testing w/ fecal fats collected in 3
intake days
•Green- Presence of biliverdin, Oral antibiotics, Green
Vegetables
Abnormal Variation in Consistency
•Soft and watery - Diarrhea
•Hard and Scybalous (like goat droppings) - Spastic
constipation
•Bulky frothy stool - Bile duct obstruction, Pancreatic
disorders, abundant fats
•Ribbon-like stool - Intestinal constriction due to malignancy
(colon cancer)
•Mucus and blood-streaked stool - Amoebic colitis,
Dysentery, Malignancy
•Rice watery stool - cholera
Fecal Sample Collection
•Detailed instructions and appropriate containers should be
provided.
•Containers for collection of fecal (stool) samples:
-Random samples used for cultures, ova and parasites
(O&P), microscopic examination for cells, fats and fibers,
and detection of blood are collected in cardboard
containers with wax-coated interiors or plastic containers
with wide openings and screwcapped tops similar to those
used for urine samples.
•The stool collected should only be about thumb size/ pea
size of forming or soft specimen and 5-6 spoonful of
watery specimen.
• For specimen with no preservatives, tighten the lid to
prevent leakage and refrigerate the sample if will not be
transported immediately.
• Patients should understand that the specimen must not be
contaminated with urine, toilet water, fibers, gauze threads,
and tissue papers.
Preservation of Stool
• Refrigeration
• Chemical Preservative
- Sodium Acetate - Formalin
- Merthiolate Iodine Formaldehyde - NSS w/ glycerine
- Polyvinyl Acohol
Preparation of Direct Fecal Smear
•1 drop of Normal Saline Solution/ 1% Lugol’s Iodine
Solution on a glass slide. Place a small portion of stool
specimen to the drop of solution. Make a smooth emulsion in
the drop of saline/ iodine by rotary motion using the applicator
stick.
a. Formed stool: portion of stool from area to include inside
and outside of the specimen
b. Stool with mucus: small portion of mucus and mix
c. Watery stool: if mucus is not present, small portion of stool
• Cover the saline/ iodine with cover slip
Chemical Examination of Stool Specimen:
Fecal Occult Blood Testing (FOBT)
• Hidden Blood, not seen by microscopic examination.
• Normally found in small amount, 2.5mL/ 150 grams of stool
• Screening test for colorectal cancer and GIT bleeding.