FECALYSIS

Table of contents
MACROSCOPIC
EXAM DIARRHEA
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topic of the section here topic of the section here

DIFFERENTIAL
MICROSCOPIC FEATURES FOR
EXAM DIARRHEA
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Introduction

- STOOL NORMALLY CONTAINS

1. BACTERIA
2. CELLULOSE
3. AND OTHER UNDIGESTED FOODSTUFFS
4. GASTROINTESTINAL SECRETIONS
5. BILE PIGMENT
6. CELL WALLS
7. ELECTROLYTES
8. WATER
- NO BLOOD
- 100- 200 g per day
- Intestinal gas (flatus) and odor = due to
metabolism of bacterial GI normal flora
- Small intestine = primary site for final breakdown
and absorption of fats, proteins and carbohydrates
- Large intestine = absorbs water (3L of water)
- Digestive enzyme - trypsin, chymotrypsin,
aminopeptidase, lipase
 01
MACROSCOPIC
EXAM
 MACROSCOPIC
● BROWN - normal
● BLACK - melena; upper GI bleeding, iron, charcoal,
bismuth
● RED - hematochezia: lower GI, rifampin, beets
● PALE YELLOW, WHITE GRAY - bile duct obstruction,
barium sulfate
● GREEN - vegetable, biliverdin (alcoholic)
● BULKY/ FROTHY - steatorrhea
● BUTTER-LIKE - cystic fibrosis
● RIBBON-LIKE - intestinal constriction
● RICE WATER - cholera
● PEA SOUP - typhoid
● SCYBALOUS/ GOAT DROPPING - CONSTIPATION
● MUCOID - dysentery, malignancy
02
MICROSCOPIC
EXAM
1. FAT DETERMINATION
- MICROSCOPIC:
SCREENING

FECAL FAT
DETERMINATION:
DEFINITIVE
A. QUALITATIVE
B. SUDAN III: MOST
ROUTINELY USED
C. SUDAN IV
D. OIL RED O
 NEUTRAL FAT STAIN SPLIT FAT STAIN
- Maldigestion - Malabsorption
- All fat in stool
- REAGENT : 95% ETHYL
- REAGENT: 36% acetic acid -
ALCOHOL emulsifier
- STEATORRHEA : >60 - STEATORRHEA: 100 droplets
ORANGE DROPLETS/HPF that are 6-75 um in size
- Stain for TAG - Stain for total fat content
- PROCEDURE: STOOL + 36%
- PROCEDURE : emulsified ACETIC ACID + SUDAN III +
stool +95% ETOH + SUDAN HEAT
III
 NEUTRAL FAT SPLIT FAT INTERPRETATION
- NORMAL - INCREASED - MALABSORPTION
- INCREASED - NORMAL - MALDIGESTION
STEATORRHEA
= PRESENCE OF INCREASE OF FATS IN STOOL (>6G/DAY)
- FECAL CHARACTERISTICS: greasy; foul odor;
spongy consistency
- FECAL VOLUME : increased
- CAUSES:
1. Pancreatic insufficiency
2. Malabsorption
3. Maldigestion
4. Absence of bile
MALABSORPTION
- Inadequate intestinal absorption of
processed foodstuffs despite normal
digestive ability

MALDIGESTION
- An inability to convert foodstuffs in
GIT into readily absorbable
substances
B. QUANTITATIVE
VAN DE KRAMER

- 3 DAY STOOL
- GOLD STANDARD TEST FOR
FECAL FAT
- TITRATED WITH NAOH
D-XYLOSE TEST
- Test that is useful to differentiate malabsorption
and maldigestion
- D- Xylose is a pentose sugar that does not need to
be digested but does need to be absorbed to be
present in the urine
- The xylose absorption test involves the patient’s
ingestion of a dose of xylose, followed by the
collection of a 2hr blood sample and a 5hr urine
specimen
FECAL LEUKOCYTES
- Presence of >3 neutrophils/ hpf indicates invasive condition
- Presence of at least 1 neutrophil per OIF is significant

METHODS:
● WET PREPARATION : METHYLENE BLUE
● LACTOFERRIN LATEX AGGLUTINATION : >2.5 mL blood /
150 g stool
- Positive in diarrhea w WBC: S. salmonella, Shigella,
Campylobacter, Yersinia, and enteroinvasive E. coli
● DRIED PREPARATIONS : Wright’s and Giemsa
MUSCLE FIBER
- Patient must include meat in diet
- Emulsified stool + 10% eosin
- Presence of more than 10 undigested muscle fibers are
associated with biliary obstruction, cystic fibrosis, and
gastrocolic fistulas

CREATORRHEA - increased excretion of muscle fiber in feces

DIGESTED - fibers have no visible striations
PARTIALLY DIGESTED - fibers exhibit striations in only one
direction
UNDIGESTED FIBERS - fibers have visible striations running
both vertically and horizontally
APT TEST/ ALAKALI DENATURATION
TEST/ DOWNEY TEST
- Test for fetal hemoglobin
- Used for differentiating fetal blood from maternal blood
- Discovered by Leonard Apt
- Specimen: infant stool, vomitus, emesis, or gastric aspirate
REAGENT: 1% SODIUM HYDROXIDE
RESULT:
pink HbF supernatant
Brown HbA
APT TEST PROCEDURE
1. Emulsify specimen in water
2. Centrifuge
3. Divide pink supernatant into two tubes
4. Add 1% sodium hydroxide to one tube
5. Wait 2 minutes
6. Compare color with that in the control tube
7. Prepare controls using cord blood and adult blood
 FECAL OCCULT BLOOD TEST
- Screening for colorectal cancer
- Principle: any bleeding in excess of 2.5 mL/ 150 g of stool
- Chromogens:
1. Benzidine
2. Guaiac - least sensitive but preferred
(+) blue
1. O- toluidine
FALSE (+)
● RED MEAT
● MELON, BROCCOLI, CAULIFLOWER, HORSERADISH - 3 DAYS
● ASPIRIN AND OTHER ANTI-INFLAMMATORY DRUGS - 7 DAYS
FALSE (-)
● REDUCING AGENT
● ASCORBIC ACID
 FECAL ENZYMES
- Used in digesting proteins, carbohydrates, and fats
- Decreased production is associated with chronic pancreatitis, cystic
fibrosis.
TEST:
1. X- RAY FILM TEST - detects trypsin enzyme
- No trypsin = cystic fibrosis
- Present trypsin = digest the gelatin on the paper, leaving a clear area
1. CHYMOTRYPSIN - more resistant to intestinal degradation
- Stable at room temperature up to 10 days
- Measured by spectrophotometry
1. ELASTASE 1- produced by pancreas
- Sensitive and specific test for exocrine pancreatic insufficiency
- Measured by ELISA
FECAL CARBOHYDRATES
- Lactose tolerance assessment
- Normal stool pH : <7-8
- CARBS DISORDER : <5.5
- Clinitest: a test for reducing sugar
- A result of >0.5 g/dL indicates carbohydrate intolerance
DIARRHEA
DIARRHEA
- ACUTE : <4 WEEKS
- CHRONIC: >4 WEEKS

1. SECRETORY DIARRHEA
- Increased secretion of water and electrolytes which
override the reabsorption ability of the large intestine
- <50 mosm/kg

CAUSES: bacterial, viral, protozoan infections, drugs,

laxatives, hormones, inflammatory bowel disease, endocrine
disorders, neoplasma, collagen, vascular disease
2. OSMOTIC DIARRHEA
- Retentions of water and electrolytes in the large
intestine due to incomplete breakdown or reabsorption
of food
- >50 mosm/ kg

CAUSES: maldigestion, malabsorption, disaccharidase

deficiency, laxatives, antacids, amoebiasis, antibiotics
3. ALTERED MOTILITY
- Enhanced or slow motility
- >50 mosm/kg

CAUSES: gastric surgery, gastric bypass, post vagotomy,

duodenal ulcer, DM Zollinger Ellison
RAPID GASTRIC EMPTYING
- Dumping syndrome describes hypermotility of the stomach
and the shortened gastric emptying half-time, which causes
the small intestine to fill quickly with undigested food from
the stomach
- <35 minutes
DIFFERENTIAL FEATURES FOR
DIARRHEA

OSMOTIC SECRETORY
LAB TEST
OSMOTIC GAP >50 MOSM/KG <50 MOSM/KG

STOOL SODIUM <60 MMOL/L <90 MMOL/L

STOOL OUTPUT 24 HRS <200 g >200 g

PH <5.3 >5.6

REDUCING SUBSTANCES POSITIVE NEGATIVE

ACTIVITY
OBJECTIVE: TO BE ABLE TO IDENTIFY PARASITES AND
FECAL DEBRIS

REAGENTS:
● IODINE SOLUTION
● O.9% NSS
MATERIALS:
● APPLICATOR STICK
● SLIDES
● COVERSLIP
QUIZ
1. Color of stool sample with melena
2. Inadequate intestinal absorption of processed
foodstuffs despite normal digestive ability
3. Normal stool pH
4. Specimen of choice for D-xylose test
5. Normal value of fecal leukocytes