ROUTINE STOOL EXAMINATION AND FOBT - Specimens contaminated with urine or

Lecture by Joshua Ramel toilet paper.

Unit Outcomes: - Containers with contaminated exteriors.
1. Know the basic concepts regarding feces - Specimens of insufficient quantity.
collection. - Specimens that have been improperly
2. Identify the tests that are performed in a transported.
feces specimen and the types of fecal II. ROUTINE STOOL EXAMINATION
specimen. A. Physical Examination
Routine stool examination – aka Fecalysis. Consistency
I. SPECIMEN COLLECTION - Degree of moisture in a stool specimen.
 Clean, dry, wide-mouthed containers. - Formed, semi-formed, soft, loose, or
 Sealed and sent to the lab immediately after watery.
collection.
 Preserved specimens can usually be kept at
room temperature.
 Large gallon containers for 24-, 48-, and 72-
hour stool collections for fecal fat and
urobilinogen (sometimes also for
parasitology); specimens normally
refrigerated throughout collection period.
Stool Containers
- Some usually have a built-in scoop in the
container. Consistency Possible Gross
- Ideally, use containers designed for stool colors appearance
collection, but they can use urine containers Hard Dark brown Conspicuously
too. fibrous
- Instructions given to patients: when Soft Black Fiber scanty to
defecating, the stool should not come in moderate
contact with the water (if they have Mushy Brown Colloidal
diarrhea, that’s inevitable so it’s fine) – aim (homogenous)
for the side of the inside of the toilet, and Loose Pale brown Scanty mucus
then scoop a small amount (pea-sized) to Diarrheic Clay Much mucus
the container. Watery, Yellow Mucus with
liquid scanty blood
Formed Red brown Other (e.g.,
blood, barium)
Semi formed Green, other
Color
- Normal color is brown.
- Black, red, or green color does not
necessarily mean you’re sick. Check table.
COLOR POSSIBLE CAUSE
Black Upper GIT bleeding
Iron therapy
Charcoal
Bismuth (antacids)
Reasons for rejecting stool specimen: Red Lower GIT bleeding
- Specimens in unlabeled containers Ingestion of beets and food
- Nonmatching labels and req. forms.
 coloring - Fecal Occult Blood Testing
Rifampin False positive:
Green Biliverdin - Aspirin and anti-inflammatory medications
Oral antibiotics - Red meat (like beef, goat)
Green vegetables - Horseradish
Pale yellow, gray, Bile duct obstruction - Raw broccoli, cauliflower, radishes, turnips
white Barium sulfate - Melons
Presence of Dysentery - Menstrual and hemorrhoid contamination
mucus, blood Malignancy False negative:
streak - Vit. C >250 mg/dL
Gross Abnormalities - Iron supplements containing vitamin C.
- Adult worms, proglottids (egg laying - Failure to wait specified time after sample is
segments of adult tapeworms), and applied to add the developer reagent.
parasitic indications (pus and mucus) C. Microscopic Examination
- Samples containing adult worms may be - To detect the presence of parasites in a
carefully washed through a wire screen. This stool specimen.
process allows for the retrieval and - It can also reveal artifact.
examination of the parasites for o Microscopic structures that are only
identification purposes. found in stool (like residues of what
B. Chemical Examination you ate).
- detection of occult blood (hidden blood). - It should be performed on a fresh specimen.
- no need for chemical test strip. Procedures:
Hema-screen Guiac Slide Test Kit 1. Direct wet preparations
- Colorimetric test. 2. Concentrated technique
1. Hema-screen slide 3. Permanently stained smear
2. Hema-screen developer Reporting:
(<6% H2O2) NOPS – no ova and/or parasite seen.
Results: NIPS – no intestinal parasite seen.
(+) any trace of blue coloration Artifacts, Pseudoparasites, and Confusers
(-) no blue coloration - WBCs, RBCs, macrophages, Charcot-Leyden
crystals, epithelial cells.
- eggs of anthropods, plant nematodes, and
other spurious parasites.

WBCs RBCs Í›
Test Card/Slide – piece of cardboard with two
Í›
absorbent types #1 and #2.
Reagent dropper – contains hydrogen peroxide
solution. You put the stool sample there and
use the dropper on the test card.
*Urobilinogen turns to stercobilinogen which gives
the stool its brown color.
Occult blood – marker for colorectal cancer.
macrophages Charcot-Leyden
crystals
Interference of FOBT
 Epithelial cells

Eggs of
parasites*
*Refer to the list above.
More shiz:
- fungal spores
o looks like RBC but it has small circles
beside it because it appears to be
dividing already.
- elements of plant origin
o vegetable fibers
- plant and animal hairs
o diet
- muscle fibers
o meaty diet
- fat globules
o small circles that are yellow and
shiny (like oily).
III. DIRECT FECAL SMEAR
Steps:
1. about 2 mg of stool (amount forming a low
cone at the tip of an applicator stick).
2. 0.85% NaCl solution (NSS) – one to two
drops on the stool and mix.
3. Cover with cover slip.
 Primarily useful in the detection of
motile protozoan trophozoites (pale and
transparent).
Weak iodine solution (Lugol’s and D’ Antoni) are
temporary stain to demonstrate nuclei.
Helminth eggs and larvae can be detected using
this preparation.
Cytoplasm: Golden yellow
Nucleus: Pale and refractile
Glycogen: Deep brown

Clear drop in the pic: NSS

Iodine solution: yellow

Lugol’s can help you see the

structures better.