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CLINICAL MICROSCOPY NOTES © Ma’am Judea //zjpc

FECES  Turnips, broccoli, cauliflower, fish in general, meat in general, bananas, apples,sardines,
 Normal 24 hour stool is 100-200g aspirin/aspilet (promotes GIT bleeding) can cause FALSE POSITIVE
 Bacteria constitute ONE-THIRDS of total dry weight
 Approximately 150mL of fluid is excreted in the feces APT TEST:
 Used to differentiate fetal and maternal blood in an infant’s stool (or vomitus)
A. CONSISTENCY VARIATIONS  Reagent: 1% sodium hydroxide added to haemoglobin-containing emulsion
 RICE WATER STOOL=Cholera  PRINCIPLE:
 MUCUS AND RBC in STOOL=dysentery, colitis, malignancies, constipation  HbF is resistant to alkali solutions
 PEA-SOUP STOOL= Typhoid Fever  ADULT haemoglobin= not resistant to alkali solution
 Butter or grease-like= increased production of thick mucus in patients with cystic fibrosis  RESULTS:
 Scybalous or “goat dropping”= constipation  Solution remains PINK= HbF is present
 Flattened or ribbon-like= spastic colitis, cancer, ulcer, tumor  Solution turned yellow-brown= HbA is present
 Bulky or frothy= bile duct obstruction, pancreatic disorders, abundant fats  CONTRAINDICATIONS: Mothers with Thalassemia major (due to high concentration of fetal
B. COLOR haemoglobin)
 RED STOOL= lower GIT bleeding, beets and food coloring NOTE: Do not use black or tarry stool since haemoglobin in this stool is already denatured
 BLACK STOOL= upper GIT bleeding, iron ingestion, bismuth (antacids), charcoal
 GREEN STOOL= presence of biliverdin, oral antibiotics or green vegetable intake DIARRHEA
 PALE YELLOW, CLAY, GRAY=bile duct obstruction or ingestion of barium sulphate  Characterized by any of the following:
a. Increased in daily stool weight
OCCULT BLOOD TESTING: b. Increased liquidity
 “hidden blood”; screening test for COLORECTAL CANCER c. Increased frequency (more than 3x a day)
 Intestinal bleeding in excess of 2.5 mL per 150g of stool is considered pathologic  Causes of diarrhea:
 PRINCIPLE: pseudoperoxidase activity of haemoglobin A. SECRETORY
 Positive result: BLUE  Increased solute secretion by the intestine
 Patient must be on meat-free diet for at least three days  Causes: toxin-producing organism (eg. Salmonella, Shigella)
 Benzidine and O-toluidine=produce blue color if positive; MOST SENSITIVE B. OSMOTIC
 GUAIAC-least sensitive but the most preferred  Increased amount of osmotically active solutes remain in the lumen; ingestion of an
 Other test: ORTHODIANISIDINE osmotically active solute
 Causes: Giardia lamdlia, Strongyloides stercoralis, increased carbohydrates in stool,
 Vitamin C may cause FALSE NEGATIVE results
maldigestion
C. INTESTINAL HYPERMOTILITY

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CLINICAL MICROSCOPY NOTES © Ma’am Judea //zjpc

 Increased intestinal movement


 Causes: laxatives, emotion/stress

FECAL FAT TESTING:


 For the diagnosis of STEATORRHEA

QUALITATIVE:
 Microscopic examination of direct smear stained with Sudan III
-For: NEURAL FATS or TRIGLYCERIDE
 Microscopic examination of smear heated with acetic acid and Sudan III
-For: SOAPS and FATTY ACIDS

QUANTITATIVE:
 Specimen: 3-day stool sample
 Method: VAN DE KAMER TITRATION or GRAVIMETRIC METHODS

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