FECAL ANALYSIS (LECTURE)  Bleeding in excess of 2.

5 ml per 150 g of stool is

considered pathologic
Transcribed by: DAPNolasco | December 2022
 Principle: Pseudoperoxidase activity of Hgb
 Positive result: BLUE (any shades of blue)
Feces contains bacteria (commonly found in feces), cellulose,
and other undigested foodstuffs, GI secretion, bile The hgb present in stool because there is bleeding will cause the
pigments, cells, electrolytes and water hydrogen peroxide to be broken down into water and oxygen.
Deliberation of oxygen causes the BLUE color.
Human feces contains:

75% water Precautions:

25% solids 
Patients must be on a meat-free diet for atleast three
days leading to false positive reaction especially red
FECES meat
 Normal 24 hour stool is 100-200 grams 
Vitamin C may cause false negative results
 Bacteria constitute 1/3 of the total dry weight 
Turnips, broccoli, cauliflower, fish, meat, bananas, apples,
 Approximately 150 ml of fluid is excreted in the feces sardines, aspirin (promotes GI bleeding) causes false
 Normal color: BROWN due to substances called urobilin positive.
and stercobilin
 The reason for the feces odor is the presence of INDOLE, Other tests for occult blood testing
SCATHOLE, and BUTYRIC ACID
 produces blue color if positive
Benzidine and
Variation in Color  MOST SENSITIVE
O-toluidine
Lower GIT bleeding (bleeding in the large
Bright Red
intestine such as colon cancer or hemorrhoids),  MOST PREFFERED
beets (only to susceptible individuals), food Guaiac
 LEAST SENSITIVE
coloring, Rifampin Orthodianisidine Other reagents
Upper GIT bleeding (there is an ulceration
Occultest,
Black involving the stomach | dengue), iron ingestion Commercial screening test; rapid
(physiological lang), bismuth (antacid), charcoal Hemoccult,
tests
Presence of biliverdin, oral antibiotics, green Hemoquant
Green
vegetable intake
Pale Bile duct obstruction, ingestion of Barium sulfate APT DOWNEY TEST
Yellow/Gray

Alkali denaturation test

We measure if the hgb or the blood is able to be
Consistency Variations denatured using an alkali solution
Dysentery (caused by bacterial infection

Used in infants to test if there is bleeding in GI tract or
by Shigella dysenteriae), colitis (spasm of dahil nacontaminate lang ng blood from the mother
Mucus/RBCs gastro-intestinal of our GIT tract pero

Differentiates fetal and maternal blood in an infant’s
walang inflammation), malignancies, stool or vomitus
and constipation

Reagent: 1% NaOH which is added to hgb containing
Rice-watery Cholera (caused by Vibrio cholerae) emulsion
stool

Principle: alkali denaturation of hgb
Flattened/ Spastic colitis, cancer, ulcer, tumors o Fetal/Hgb F: resistant to alkali solutions; no change
Ribbon like in color
Bile duct obstruction, pancreatic o Maternal/adult hgb: not resistant to alkali
Bulky/frothy solutions; there is change in color
disorders, abundant fats
Butter/ Increased production of thick mucus in
How is it done?
grease like patients with cystic fibrosis 
Stool + water  centrifuge mo then add mo na yung 1%
Scybalous Constipation
NaOH sa supernatant
/goat 
Results:
droppings
o Solutions remain pink – fetal hgb is present (HbF)
Pea-soup Typhoid fever (Salmonella typhi)
o Solutions turned yellow/brown – maternal hgb
stool 
Contraindications:
o Mothers with thalassemia major
DIRECT FECAL SMEAR
o Can accept bloody stool sx.
 Macroscopically: o Do not accept black or tarry stool since Hgb in
o Check for the color this stool is already denatured and therefore it will
o Check for the consistency (formed, semi-formed, not react with 1% NaOH
mucoid, watery)
DIARRHEA
After that, poke a portion of the stool several times using an Characterized by:
applicator stick then transfer and spread it to the slide with 
Increased daily stool weight
NSS, then cover it with cover slide 
Increased liquidity (basag)

Increased frequency (madalas; greater than 3x a day)
 Microscopically
o Check for parasites, RBCs, fat bodies, WBC Diarrhea lasting < 4 weeks: ACUTE
Diarrhea lasting > 4 weeks: CHRONIC (dehydration; fatal)
OCCULT BLOOD TESTING
Occult means hidden blood dahil they are too small to be Mechanisms of Diarrhea
observed but it is already clinically significant. It is used for
Mechanisms Description Causes
detection of bleeding in GI tract. It is a screening test for
Secretory Increased solute Toxin producing
Colorectal cancer.
secretion by the organisms
intestine
 Osmotic Increased amts of G.lamblia,
osmotically active S.stercoralis, Parasites, viruses, S.aureus. Vibrio spp does not cause
solutes remain in the increased CHO appearance of neutrophils in stool
lumen; ingestion of in stool,
an osmotically active maldigestion Lactoferrin latex agglutination test: detects lactoferin
solute which is a component of secondary granules whose
Intestinal Increased intestinal Laxatives, presence indicated presents invasive bacterial pathogen;
hypermotility movement emotion, stress positive result: agglutination or clumping

Malabsorption vs. Maldigestion Stains

Description Test  Wet prep: methylene blue
hindi Lactose Tolerance  Dried smears: wright’s or gram’s
natutunaw Test. measures the
yung pagkain or body’s ability to FECAL MUSCLE FIBERS
nabebreakdown break down lactose,  For dx of creatorrhea
due to lack of because when it  Increased amounts of striated fibers may be seen in
digestive breakdown it will be biliary obstruction and gastrocolic fistulas
enzymes converted to  Procedures:
glucose and o Emulsify stool in 2 drops of 10% eosin in alcohol
Maldigestion
galactose. Increased o Coverslip and let stand for 3 minutes
glucose means o Examine under HPO for 5 minutes
sufficient si lactose o Count undigested fibers
mo. However, if o Increased – greater than 10 indicates an increase
glucose ay mababa,
then it is insufficient Undigested muscle fibers – striations are running
dahil di siya vertically and horizontally
naconvert
natunaw si food D-Xylose Test. D- Partially digested – striation in one direction only
pero di mo rin xylose is normally
naabsorb yung easily absorbed by Digested – no visible striation
nutrients or di the intestines. It
nagagamit ng helps dx problems FECAL FAT TESTING
Malabsorption
katawan. that prevent the  Used for diagnosis of steatorrhea (increased amount of
Absorption of small intestine from fat in stool): > 6g of fat excreted in stool
nutrients absorbing nutrients  Normal value: 1-6 g/day
happens in in food.  Qualitative exam (microscopic exam):
small intestines o Direct smear stained with Sudan III for Neutral
Fats/TAG – Neutral fat stain
FECAL ENZYMES o Smear heated with acetic acid and Sudan III for
For assessment of pancreatic insufficiency. Here, we Soaps and Fatty acids – split fat stain
specifically test trypsin.  Quantitative exam:
o Specimen: 3-day stool collection (placed in paint
Trypsin (enzyme produced by the exocrine pancreas that can containers)
break downs/hydrolyzes dietary protein) o Method:
 Van de Kamer Titration (fecal fats
Enzymes involved: chymotrypsin and elastase I converted to fatty acids)
 Acid Steatocrit (rapid method)
Screening test for presence of trypsin

X-ray paper test
o If kulang ka sa trypsin, walang enough na enzyme na
napoproduce ang pancreas
o Results: color unchanged pag kulang si trypsin
: clearing – trypsin present; sufficient enzyme
produced by pancreas

Gelatin film Rapid Method

FECAL CARBOHYDRATES

Useful assessing infant diarrhea

Stool pH (normal stool pH 7-8; pH below 5.5 may
indicate carbohydrate disorders

Clinitest tablet: a copper reduction test

Px (+) w/clinitest  follow up test (D-xylose, lactose
tolerance test)

FECAL LEUKOCYTES
As few as 3 neutrophils is considered to be invasive.
Increase neutrophils is considered to be invasive
conditions:

Salmonella

Shigella

Campylobacter

Yersinia

Enteroinvasive E.coli (diarrhea with WBCs)