FECALYSIS

Table of contents
MACROSCOPIC
EXAM DIARRHEA
01 You can describe the topic 03 You can describe the topic
of the section here of the section here

DIFFERENTIAL
MICROSCOPIC FEATURES FOR
EXAM DIARRHEA
02 You can describe the topic 04 You can describe the topic
of the section here of the section here
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
- REAGENT : 95% ETHYL - All fat in stool
- 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 - MALABSORPTIO
- INCREASED - NORMAL N
- 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
3. 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

LAB TEST OSMOTIC SECRETORY

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