Fecal analysis is used to detect gastrointestinal bleeding, liver and biliary disorders, malabsorption syndromes, and infections. It involves macroscopic and microscopic examination of feces as well as chemical analyses. Specific tests are used to detect occult blood, fat malabsorption, inflammation, and pancreatic insufficiency. Accurate specimen collection is important for meaningful analysis and diagnosis.
Fecal analysis is used to detect gastrointestinal bleeding, liver and biliary disorders, malabsorption syndromes, and infections. It involves macroscopic and microscopic examination of feces as well as chemical analyses. Specific tests are used to detect occult blood, fat malabsorption, inflammation, and pancreatic insufficiency. Accurate specimen collection is important for meaningful analysis and diagnosis.
Fecal analysis is used to detect gastrointestinal bleeding, liver and biliary disorders, malabsorption syndromes, and infections. It involves macroscopic and microscopic examination of feces as well as chemical analyses. Specific tests are used to detect occult blood, fat malabsorption, inflammation, and pancreatic insufficiency. Accurate specimen collection is important for meaningful analysis and diagnosis.
Fecal analysis is used to detect gastrointestinal bleeding, liver and biliary disorders, malabsorption syndromes, and infections. It involves macroscopic and microscopic examination of feces as well as chemical analyses. Specific tests are used to detect occult blood, fat malabsorption, inflammation, and pancreatic insufficiency. Accurate specimen collection is important for meaningful analysis and diagnosis.
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Fecal Analysis Mucus/blood-streaked mucus
o Colitis (Inflammation of the intestinal wall)
Used in the detection of gastrointestinal (GI) bleeding, liver and o Dysentry Malignancy biliary duct disorders, malabsorption syndromes, and infections. o Constipation Routine fecal examination: Clay-colored, pale o Macroscopic o Bile-duct obstruction/obstructive jaundice o Microscopic Microscopic Examination o chemical analyses: of Feces early detection of gastrointestinal (GI) bleeding Fecal leukocytes liver and biliary duct disorders Determine cause of diarrhea maldigestion/malabsorption syndromes Neutrophils: inflammation Bacterial intestinal wall infections or ulcerative colitis, abscesses causes of diarrhea and steatorrhea. No neutrophils: Toxin-producing bacteria, viruses, and Fluid regulation in the gastrointestinal parasites tract. Common Fecal Test for Diarrhea
Qualitative fecal fat:
Detects fat malabsorption disorders by staining fecal fats with Sudan III or oil red O; increased fecal fat (>60 Specimen Collection droplets/hpf) suggestive of steatorrhea Collection of a fecal specimen, frequently called a stool Muscle fibers: Look for undigested striated muscle fibers, specimen, which may is not an easy task for patients. Detailed instructions and o indicate pancreatic insufficiency seen in cystic fibrosis appropriate containers should be provided. Methylene Blue Stain Procedure Patients should be instructed to collect the specimen in a clean for Fecal Leukocytes container, such as a bedpan or disposable container, and transfer o Place mucus or a drop of liquid stool on a slide. the specimen to the laboratory container o Add two drops Löffler methylene blue. usually collected in plastic or glass containers with screw- o Mix with a wooden applicator stick. capped tops similar to those used for urine specimens. o Allow to stand 2–3 minutes. For quantitative testing, such as for fecal fats, timed specimens o Examine for neutrophils under high power. are required(the most representative sample is a 3-day Muscle Fiber Procedure collection) o Emulsify a small amount of stool in two drops of 10% Macroscopic Screening eosin in alcohol. Color o Coverslip and let stand 3 minutes. Black (tarry) stool: o Examine under high power for 5 minutes. o Upper GI bleeding o Count the number of undigested fibers. o iron therapy Chemical Testing of Feces o Charcoal Occult blood o Bismuth (antacids) Used for early detection of colorectal cancer; old name, guaiac Red stool: test o Lower GI bleeding Occult blood most frequently performed fecal analysis o Beets and Food coloring Several chemicals used that vary in sensitivity o Rifampin o Ortho-toluidine: Pseudoperoxidase activity of hemoglobin Pale Yellow, White, Gray (Hb) o Bile-duct obstruction reacts with H2O2 to oxidize a colorless reagent to a o Barium sulfate colored product. Hb —» H2O2 —> ortho-toluidine —» blue oxidized Green indicator o Biliverdin-oral antibiotics o Gum guaiac: Least sensitive, most common o Green Vegetables Occult Blood Testing Interference Bulky/Frothy False-Positive o Bile-duct obstruction o Aspirin and anti-inflammatory medications o Pancreatic disorders o Horseradish Ribbon-like o Melons o Intestinal constriction/ Bowel obstruction o Menstrual and hemorrhoid contamination o Raw broccoli, cauliflower, radishes, turnips o Red meat False-Negative o Iron supplements containing vitamin C o Vitamin C 250 mg/d Immunological: Use of an antihemoglobin to react with the patient's hemoglobin has the advantage of not requiring any special diet before sample collection. There is the possibility, however, of hemoglobin degradation (and nondetection by antibody), if the gastrointestinal bleed is in the upper intestine DNA test detects K-ras mutation, which is associated with colorectal cancer. APT Test (Fetal Hemoglobin) Grossly bloody stools and vomitus are sometimes seen in neonates as the result of swallowing maternal blood during delivery. o Should it be necessary to distinguish between the presence of fetal blood or maternal blood in an infant’s stool or vomitus, the APT test may be requested. The APT test distinguishes not only between fetal hemoglobin and hemoglobin A but also between maternal hemoglobins AS, CS, and SS, and fetal hemoglobin. The presence of maternal thalassemia major would produce erroneous results owing the high concentration of hemoglobin F. Stool specimens should be tested when fresh. They may appear bloody bu should not be black and tarry, because this would indicate already denatured hemoglobin APT Test Procedure o Emulsify specimen in water. o Centrifuge. o Divide pink supernatant into two tubes. o Add 1% sodium hydroxide to one tube. o Wait 2 minutes. o Compare color with that in the control tube. o Prepare controls using cord blood and adult blood. Trypsin Emulsified specimen placed on x-ray paper determines ability to digest gelatin Inability to digest gelatin indicates lack of trypsin Clinitest Addition of Clinitest tablet to emulsified stool detects presence of reducing substances Reaction of 0.5 g/dL reducing substances suggests carbohydrate intolerance Fecal chymotrypsin It is more resistant to intestinal degradation and is a more sensitive indicator of less severe cases of pancreatic insufficiency. remains stable in fecal specimens for up to 10 days at room temperature. Chymotrypsin is capable of gelatin hydrolysis but is most frequently measured by spectrophotometric method. Elastase I Elastase I is an isoenzyme of the enzyme elastase and is the enzyme form produced by the pancreas. It is present in high concentrations in pancreatic secretions and is strongly resistant to degradation. It accounts for about 6% of all secreted pancreated enzymes. Elastase I can be measured by immunoassay using the ELISA kit