Acholic stool in absence of jaundice?

[rpkall]

Hey all;

Thought I might get some ideas over here in the GI forum for this one. I'm an MS2 trying to wrap my mind around the presentation of patients with liver/biliary disease, and I was just wondering if it's possible for patients to present with acholic stool phenomena (clay colored feces) in the absence of other signs and symptoms of disease (i.e., no fever, jaundice, pruritis, normal PE, etc). Or is the acholic stool something that always happens "downstream" of cholestasis such that you'll *always* see physical evidence of bilirubin in the blood FIRST before you see evidence of lack of bilirubin in the stool?

I've been poking around StatRef, Harrison's and Current Gastroenterology, and couldn't find this issue of "isolated acholic stool" presentation explored at all. It always mentions jaundice first and stool change later.

I appreciate any info on this you all could provide (or a direction to a source that has the answer?).

Thanks!

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[SuperLin]

T-tube drainge conducted in those with CBD stricture will present with acholic stool in absence of other symptoms

 

[rpkall]

Thanks for the response! I had to look up what that stuff was--you learn something new every day. I guess this whole acholic stool can't happen in an isolated presentation in an otherwise "normal" appearing patient (i.e., no hx of transplant, stricture, intervention)...