FECALYSIS

• Most of the laboratory personnel categorize fecal analysis as “necessary evil”.

• The normal fecal specimen contains bacteria, cellulose, undigested foodstuffs, GI
secretions, bile pigments, cells from the intestinal walls, electrolytes, and water.

• Bacterial metabolism produces the strong odor

associated with feces and intestinal gas (flatus).
• Digestive enzymes secreted into the small intestine by the
pancreas include trypsin, chymotrypsin, amino peptidase, and
lipase. Bile salts provided by the liver aid in the digestion of
fats.
• Constipation : producing small, hard stools.
DIARRHEA & STEATORRHEA
 •Diarrhea
• Increase in daily stool weight above 200 g .
• Increase liquidity of stools and frequency of more than 3 times per day.
Acute diarrhea : < 4 weeks
Chronic diarrhea : >4 weeks
3 major mechanism:
1. Secretory diarrhea – increase solute secreted by the intestine
2. Osmotic diarrhea – increase amount of osmotically active solutes in the lumen
3. Intestinal hypermotility – secretory and osmotic diarrhea
• Steatorrhea
• Fat in stool (NV = 1-6 g/day)
• Useful in diagnosing pancreatic insufficiency and small bowel disorders
that cause malabsorption.
• Malabsorption causes
bacterial overgrowth
intestinal resection • Quantitative Fecal fat test
Celiac disease – most common = confirmatory test for steatorrhea
Whipple disease  3 day specimen
Giardia lamblia Intake of fat = 100 g per day before or during
• Rotten egg odor the collection period
• D- Xylose Test
Specimen Collection
• Patients should be instructed to collect the specimen in a clean
container, such as bedpan and disposable container.
• The specimen must not be contaminated with urine or toilet
water, which may contain chemical disinfectants or deodorizers
that can interfere with chemical testing.
• Random specimens suitable for qualitative testing for blood and
microscopic examination for leukocytes, muscle fibers, and fecal fats are
usually collected in plastic or glass containers with screw tops.
• For quantitative testing such as fecal fats, timed specimens are
required.
 PHYSICAL EXAMINATION
 MICROSCOPIC EXAMINATION
 Fecal Leukocytes primarily neutrophils that affect the intestinal mucosa such as
ulcerative colitis and bacterial dysentery.
Fecal leukocytes (+) : Salmonella, Shigella, Campylobacter,
Yersinia, and enteroinvasive E.coli.
Fecal leukocytes (-) : Toxin mediated and viral or parasitic diarrhea ,
S. aureus & Vibrio spp.
• Methylene blue – for wet preparation
faster procedure than Wright’s and Gram stain but may be difficult to
interpret

• Lactoferrin Latex agglutination test – sensitive in refrigerated and frozen specimens

 Muscle Fibers test for undigested muscle fibers can be helpful in diagnosis of
pancreatic insufficiency.
Creatorrhea – undigested muscle fibers in feces
Stain: Eosin
a. Completely digested : no striations
b. Partially digested : striation in one direction
c. Undigested : striations in both directions
Note: >10 undigested muscle fibers : bile duct obstruction, cystic and Gastrocolic fistulas
 Qualitative Fecal Fat test
 Sudan III = most routinely used
 Sudan IV
 Oil red O
Split fat stain – free fatty acids and fatty acids from hydrolysis of soaps and neutral fats
NV: 100 droplets (<4um)
Slightly increased : 100 droplets (1-8 um)
Increased: 100 droplets (6-75 um)
CHEMICAL EXAMINATION
Occult Blood “Hidden blood”
- detecting for colorectal cancer
significant : > 2.5 ml blood per 150 g stool
Fecal occult blood testing (FOBT) – most frequently done test
Annual test is recommended for early detection of colon cancer

Guaiac – Based Fecal Occult Blood Tests (gFOBT)

Guaiac – least sensitive but the most preferred
Benzidine O-toluidine – most sensitive

Principle: Pseudo peroxidase activity of Hgb

(+) color: blue
 CHEMICAL EXAMINATION
APT test (Fetal Hemoglobin)
distinguish fetal blood and maternal blood in an infant’s stool
specimen: infant stool / vomitus
Reagent: 1% NaOH added to the pink hemoglobin containing supernant
Hemoglobin F : alkali-resistant (+) pink
Maternal Hemoglobin : not alkai-resistant (-) yellow brown
Other tests:
- Immunochemical Fecal Occult Blood Test
- Porphyrin-Based Fecal Occult Blood Test

 Fecal Enzymes
1. Trypsin
2. Chymotrypsin
3. Elastase I
 Fecal Carbohydrates
Normal stool pH: 7.0 -8.0
pH: 5.5 = CHO disorders (lactose intolerance)