Acholic stool

Physicians and patients should be vigilant for the appearance of signs or symptoms of hepatitis, such as fatigue, malaise, anorexia, nausea, jaundice, bilirubinuria, acholic stools, liver tenderness, or hepatomegaly. Consider the diagnosis of hepatotoxicity in this setting, even if liver function tests are initially normal or alternative diagnoses are possible. 

Biliary steatorrhoea is characterized by higher stool weight (>200 g) and increased excretion of fat (>7 g/ day). This condition correlates with the degree of severity of cholestasis. Stools are soft and smell unpleasant. Steatorrhoea is accompanied by additional diarrhoea. All these changes in the stools lead to a loss of liquid, electrolytes, fat-soluble vitamins and important trace elements. Intestinal bile deficiency causes the characteristic acholic stools, (s. tab. 12.6) (s. fig. 13.8)... 

BA can be viewed as two different entities, the embryonic and the postnatal form. Approximately 10%-35% of patients will be afflicted by cholestasis from the first hours of life, and the association of this cholestasis with different congenital malformations in these patients will constitute the embryonic or fetal form. On the other hand, a gradual increase in bilirubin levels with a clinically evident jaundice after the sixth week of life will characterize the postnatal form. Acholic stools and hepatomegaly are other common manifestations (Suchy 2003 Rosenthal 1999). 

Icteric hepatitis is generally accompanied by dark urine, acholic (light-colored) stools, and worsening of systemic symptoms. 

Fig. 13.8 Acholic fatty stool in recurrent intrahepatic cholestasis...

In approx. 90% of all patients, acute viral hepatitis A is subclinical, i.e. it frequently goes undetected. The end of the prodromal and the beginning of the clinical phase is indicated by a brown colouration of the urine. Urobili-nogenuria persists for a longer period of time than bili-rubinuria. Mild proteinuria and microhaematuria can develop. Stools are usually acholic. With the occurrence of jaundice (60-70% children, 80-90% adults), most of the subjective symptoms of the prodromal stage subside. 

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