STOOL COLOR CHANGES

What may be black and white and red all over? The answer is not the newspaper but the pathologic changes in the stool. A black stool is usually melena , but do not be fooled by iron ingestion or the bismuth in a commonly used antacid. A white or light colored stool is most commonly found following the ingestion of a barium test meal, but the clay-colored stool of obstructive jaundice suggests the most important disease to be considered. The stool is light yellow to foamy in celiac disease. In mucous colitis, a large cast of white mucus (sometimes 6–10 in [15.2–25.4 cm] long) may be described as a white “stool.” A red stool signifies blood from the lower bowel in most cases, but ingestion of red beets is not an uncommon cause. The riddle mentioned above forms a key to remembering the causes of aberrations in stool color. Another method is to apply biochemistry. The normal color of the stool is due to the pigment urobilinogen. Color changes may result from a decrease in or absence of this pigment (obstructive jaundice), from an increase (hemolytic anemia), or the addition of another pigment (hemoglobin in melena), and finally, from the addition of another substance such as mucus in mucous colitis, fat in celiac disease, and bismuth in antacid ingestion.

Approach to the Diagnosis

The workup for changes in stool color includes most of the tests for either melena or jaundice . The workup of celiac disease can be found in Appendix A.

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Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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