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