Stools, pale

Complains only of irritability and mild depression no nausea, vomiting, diarrhea, abdominal pain, or anorexia never had an episode of jaundice, pale stools, or tea-colored urine... 

Hepatic - Pretreatment serum transaminase (ALT and AST) tests are advised for all patients before taking terbinafine. Warn patients to immediately report to their physician any symptoms of persistent nausea, anorexia, fatigue, vomiting, right upper abdominal pain or jaundice, dark urine, or pale stools. Discontinue treatment in patients with these symptoms taking oral terbinafine, and immediately evaluate the patient s liver function. 

Notify the physician if dark urine, pale stool, rash with or without itching, or yellow skin or eyes develops... 

Report decreased appetite, dark urine, nausea, vomiting, pale stools, unusual fatigue, or yellow skin to the physician... 

Notify the physician if dark urine, cough, generalized fatigue, nausea, pale stools, severe or persistent abdominal pain, shortness of breath, unexplained sore throat or fever, vomiting, or yellowing of the eyes or skin occurs... 

Symptoms include nausea, vomiting, jaundice (yellowness of eyes, skin and urine), diarrhoea, pale stools, abdominal pain, malaise, fatigue, fever, chills, lack of appetite, sore throat, etc. 

Pale stool and dark urine Peripheral oedema... 

Pale stools are a sign of biliary obstruction. Normally, bile is secreted into the intestine, where the majority is converted to the faecal pigment stercobilin. If there is a biliary obstruction bile secretion is reduced and this conversion cannot take place, and so the stools do not have the usual coloration. Where there is complete obstruction, such as in biliary atresia, the stools may be white. 

Pale stools indicate partial or complete (if the stools are white) blockage of the bile ducts, such that reduced or no bile is excreted. This will affect the absorption of highly lipophilic drugs, e.g. fat-soluble vitamins, as no bile salts will be secreted into the duodenum to solubilise fats. It will also mean that drugs that are cleared exclusively by the bdiary system will have significantly reduced clearance. 

Pale stools MELD/PELD/ Child-Pugh N/A... 

A 35-year-old woman complained of nausea, fatigue, pruritus, dark urine, pale stools, and jaundice after taking a supplement containing chromium picohnate for weight loss (14). Infectious hepatitis was excluded and a liver biopsy was consistent with toxic liver damage. Hepatic chromium concentrations were more than 10 times normal. The chromium supplement was withdrawn and she received supportive treatment with a suspension containing natural products, colestyramine 1 g qds, and hydroxyzine 25 mg tds. She fully recovered in 3 months. 

An 87-year-old man took cinnarizine 75 mg/day for tinnitus and developed jaundice 7 weeks later, with dark urine and pale stools (6). He had taken no other drugs. Bile duct obstruction was ruled out and serological tests for viral hepatitis were negative. A liver biopsy 6 weeks later showed distinct centrilobular cholestasis and a shght lymphocytic infiltrate. He recovered completely and the hver tests were normal after another 3 months without cinnarizine. Rechallenge was not performed. 

The clinical course of HBV infection and the associated clinical features cannot be differentiated from other types of viral hepatitis based on symptoms. The duration of incubation is highly dependent on age and can vary between 6 and 24 weeks. Infants do not develop any symptoms and children between the ages of 1 and 5 years are asymptomatic in 85% to 95% of the cases. Symptomatic infections vary in severity and include fever, anorexia, nausea, vomiting, jaundice, dark urine, clay-colored or pale stools, and abdominal pain. Extrahepatic manifestations of HBV infection rarely occur and may include skin rash, arthralgias, and arthritis. Hepatic failure occurs rarely, with a case fatality rate of 0.4%. °... 

Typical signs and symptoms of hepatitis include jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools), anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea and vomiting, and fever, although the disease may range in severity from subclinical to fulminant. 

A 21-year-old man took levetiracetam for partial seizures for 1 month, and had a generalized seizure preceded by a 6-day history of pale stools, dark urine, and jaundice. The serum bihmbin was 591 pmol/1, alanine aminotransferase 1610 U/1, alkaline phosphatase 246 U/1, and the international normalized ratio (INR) 3.6. A liver biopsy showed massive confluent hepatocyte necrosis with no evidence of pre-existing liver disease. Levetiracetam was withdrawn but the Uver failure continued to deteriorate and he subsequently required hver transplantation. Postoperatively levetiracetam... 

A 45-year-old man, who had taken mesalazine 1.6 g/day for 8 years for ulcerative colitis, developed right upper abdominal pain, jaundice, and pale stools. He had a raised white cell count with eosinophilia, and raised bilirubin, alkaline phosphatase, and alanine aminotransferase. Abdominal ultrasonography showed a normal liver without ductal dilatation. A liver biopsy showed eosinophil infiltration in the sinusoids, parenchyma, and, in particular, the central veins and portal tracts, consistent with drug-induced hepatitis. Mesalazine was withdrawn and the blood tests improved or normalized over the next week. After 3 years, liver function tests and blood cell counts were normal. 

A 52-year-old woman presented with a 3-day history of anorexia and jaundice after receiving acupuncture twice a day for 7 weeks, performed bilaterally at the Zusanli (ST36) acupoint to a depth of 22 mm [125 ]. Electrical stimulation was performed, with the stimulation frequency fixed at 5 Hz for 20 minutes. Her aspartate aminotransferase and alanine aminotransferase activities and total bilirubin concentrations were 84 U/1, 109 U/1, and 216 mmol/1 respectively She developed pale stools, dark urine, pruritus, pedal edema, and diarrhea during the next 12 days. Her laboratory results continued to worsen. No specific therapy was provided for the severe cholestatic jaundice. Over the next 12 weeks, her symptoms and the laboratory results gradually improved. 

Patients with coeliac disease show the symptoms associated with malabsorption, often characterized by steatorrhoea (pale stools that float because of their high fat content) (22a). Malabsorption may have any number of causes, one of which is coeliac disease, a gluten-sensitive enteropathy. This disorder results in loss of villi, crypt hyperplasia and chronic inflammation of the small bowel mucosa. The immature cells of the small intestine are unable to absorb nutrients or to produce G1 hormones. This reduces pancreatic and bile secretion, which impedes fat absorption in the gut. Anaemia is caused by the folate and B12 deficiency due to impaired absorption (22b). Treatment of coeliac disease is by a gluten-free diet, steroids (to treat inflammation) and immunosuppressants (22c). People with unrecognized and untreated coeliac disease may have an increased risk of small bowel carcinoma. 

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