Gastroenterology
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| iFOBT | immunochemical; specific for human globin; fewer false pos
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| FOBT guidelines | CLIA waived; 3 serial stools; avoid red meat & >250 mg vitamin C x 3 days; avoid ASA >325 mg x 7 days
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| FOBT timing | s/b after 3 days; at least 3-5 min; within 14 days
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| FOBT other sources of false pos | EtOH, anticoag, steroids, CTx, iodine prep
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| Fecal WBC: | methylene blue; PMNs (poss macrophages); invasive organisms & IB disorders; >1 g spec clean dry container (Cary Blair); not done on pts in hosp >3 days
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| Fecal WBC: present for : | shigella, campy, EIEC (poss salmonella, vibrio, yersinia, C diff)
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| Poss false negs in fecal WBC | E. histolytica; CMV
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| Predominant causative enterotoxin for pseudomem colitis | C diff toxin A; recent Abx tx; do ELISA test; may need serial stools
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| C diff toxin assay specimen criteria | specimen >5 ml (fridge if >1 hr); pt 5 soft/liquid stools /24 hr; submit 3 specimens on 3 different days
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| Gold std for pseudomem colitis | tissue cx (rarely done; usu do toxin assays); if done, need bx and anaerobic cx
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| 3 most commonly screened bac pathogens | Salmonella, Shigella & Campylobacter (4 other important patho: Vibrio, Aeromonas, Yersinia & E. coli O157:H7; all cx except E Coli: testing stool for toxin)
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| Bac stool cx specimen | fresh/unpreserved <2 hr; or preserved (Cary-Blair) <96 hr; not in pts hosp > 3 days
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| O&P specimen | parapak; if fresh: <2hr (liquid) or <4hr (formed); 1 spec/pt/wk or 1/hosp; reject if immunocompetent >6 yo or hosp >3 days
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| Acid fast stain for: | crypto and cyclospora
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| IFA: for: | Giardia (uses monoclonal Ab); also avail for Crypto
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| Rotavirus | F/O trans; Jan-May; kids 6 mo-2 yr; 1-3 d incub, lasts 5-8 d; EIA: 1 mL stool, fridge if delay
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| PCR for Norovirus | ONLY performed for epidemiologic reasons
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| Fecal fat | screen for malabsorption dz; gold std: Quant: high-fat diet x2d before & during collection (72 hrs); normal <7g/24hrs; Qual: Sudan stain (high-fat diet): Pos = multiple fat drops seen (40x obj)
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| Tests for C diff: | Cytotoxin B in stool is definitive (takes 24h); rapid ELISA for enterotoxin A & B faster but less sensitive
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| Positive FOBT should always be followed by: | colonoscopy (and no more FOBTs needed) Negative FOBT tests: should be:
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| comma shaped GNR, sensitive to low pH | V cholera; stims adenyl cyclase to overproduce cAMP
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| Shigella dx studies | fecal WBC & RBCs, +stool cx; sigmoidoscopy: inflamed engorged mucosa, punctate lesions, ulcers
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Created by:
Abarnard
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