Exercise 2-B

Chemical Examination of Stool

I. Introduction
Laboratory examination of stool would not go on without undergoing the chemical phase of fecalysis. This phase would
try to measure chemical components that may or may not be normally present in the stool of a normal/healthy individual.
Chemical phase of Urinalysis would include testing fecal occult blood, pH, Fecal Fat etc.
Another technique in the chemical phase would allow laboratory technicians to differentiate fetal blood and maternal
blood.
II. Method
Stool Specimen

Occult blood

Fecal Fat

pH

Infant stool or Vomitus

APT Test

III. Results & Interpretation

1. Patient: Alfredo D. Ebba IV
Age: 18 yrs old
Sex: Male
Fecal-Occult Blood Test: Negative
Interpretation: Normal
2. Patient: Gracielle Anne C. De Guzman
Age: 18 yrs old
Sex: Female
Fecal-Occult Blood Test: Positive
Interpretation: Abormal ( may be due to bleeding or substances like aspirin)

3. Patient: Alfredo D. Ebba IV

Age: 20 yrs old
Sex: Female

Fecal-Occult Blood Test: Negative

Interpretation: Normal
IV. Discussion
a. Fecal Occult Blood Test
- is a chemical screening test for the detection of occult (hidden) blood.
- bleeding in excess of 2.5mL/ 150 g of stool is considered pathologic and may not show no
visible signs of bleeding, thats why FOBT is necessary
Normal Value: Negative
Clinical Significance:
- Carcinoma of colon
- Ulcerative colitis
- Adenoma
- Diaphramatic hernia
- Gastric carcinoma
- Diverticulitis
- Ulcers
b. pH
- Normal stools are slightly acidic, slightly alkaline or neutral.

Normal Value: 5.8 - 7.5

Clinical Significance:
Acidic - Carbohydrate malabsorption,Fat malabsorption or Disaccharidase deficiency.
Alkaline - Villous adenoma ,Colitis or Antibiotic use
c. Fecal Fat

- is used as a confirmatory test for steatorrhea.

- requires the collection of at least a 3-day specimen.
- patient must also maintain a regulated intake of fat (100 g/day)
Normal Value: 1-6 g/day
Clinical Significance: Malabsorption syndromes, Steatorrhea.
d. Trypsin
- enzyme supplied to the GIT by the pancreas that is essential for digestion
- decrease in amount is associated with disorders such as chronic pancreatitis and cystic fibrosis.
- Emulsified specimen is placed on x-ray paper determines ability to digest gelatin.
- Inability to digest gelatin indicates lack of trypsin
e. Carbohydrate
- Addition of clinitest tablet to emulsified stool detects presence of reducing substances
- Reaction of 0.5g/dL reducing substances suggests carbodhydrate intolerance.

V. Questions for Research

1. State the principle of the general fecal occult blood determination

The test is basically based on the detection of the pesudoperoxidase activity of hemoglobin. The reaction
uses the pseudoperoxidase activity of hemoglobin reacting with hydrogen peroxide to oxidize a colorless
compound to a colored compound.
2. What are the different indicators that are used in the detection of fecal occult blood?
Indicators used in detecting occult blood include benzidine, ortho-toluidine and gum guaiac.
VI. Update
Title: Participant uptake of the fecal immunochemical test decreases with the two-sample regimen compared
with one-sample FIT
Authors: David M. Mosen , Elizabeth G. Lilesa, Adrianne C. Feldsteina, Nancy Perrin, Anna G. Rosalesa,
Erin Keast and David H. Smith
Date Published: July 29 2014
Background: Fecal immunochemical tests (FITs) are recommended to screen average-risk adults for
colorectal cancer (CRC). Little research has examined whether a two-sample FIT affects participant uptake,
compared with a one-sample FIT. Examining participant uptake is important, as evidence suggests that a twosample FIT may increase the sensitivity to detect CRC.
Conclusion: This unique, rigorous randomized controlled trial found that the 2-FIT regimen decreases
completion of FIT. Further research is needed to understand whether decreases in participant uptake are
offset by increased gains in test sensitivity.
VII. References
Strasinger, Urinalysis and Body Fluids, 5th Ed., 2008
www.microscopy.ahs.chula.ac.th/newmicros/lecture/images/stool
http://www.aarogya.com/conditions-and-diseases/diagnostic-tests/4175-physical-a-chemical-examination.html