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ULY CLINIC
ULY CLINIC
18 Septemba 2025, 13:23:52
Clay-colored stools
Clay-colored stools are pale, putty-like stools that typically result from hepatic, gallbladder, or pancreatic disorders. Normally, bile pigments give stool its characteristic brown color. Hepatocellular dysfunction or biliary obstruction interferes with bile pigment secretion, leading to clay-colored stools. These stools often accompany jaundice and dark “cola-colored” urine.
History and Physical Examination
History
Document onset of clay-colored stools.
Explore associated symptoms: abdominal pain, nausea, vomiting, fatigue, anorexia, weight loss, dark urine.
Assess digestive tolerance, e.g., difficulty with fatty or heavy meals.
Evaluate bleeding tendencies and previous biliary, hepatic, or pancreatic disorders.
Ask about biliary surgery, barium studies, antacid use, alcohol intake, and hepatotoxin exposure.
Physical Examination
General appearance and vital signs.
Inspect skin and eyes for jaundice.
Abdomen: inspect for distention and ascites, auscultate bowel sounds, percuss, and palpate for masses or tenderness.
Obtain urine and stool specimens for laboratory analysis.
Medical causes
Cause | Key Features | Associated Signs/Symptoms |
Bile duct cancer | Obstructive lesion | Jaundice, pruritus, anorexia, weight loss, upper abdominal pain, palpable mass, bleeding tendencies |
Biliary cirrhosis | Progressive cholestatic disorder | Pruritus (worse at night), weakness, fatigue, weight loss, abdominal pain, jaundice, hyperpigmentation, malabsorption (steatorrhea, nocturnal diarrhea), hepatomegaly, hematemesis, ascites, edema, xanthomas |
Sclerosing cholangitis | Chronic bile duct fibrosis | Clay-colored stools, intermittent jaundice, pruritus, right upper quadrant pain, fever, chills |
Cholelithiasis/Choledocholithiasis | Stones causing obstruction | Intermittent clay-colored stools, biliary colic (RUQ pain radiating to shoulder), nausea, vomiting, tachycardia, fever, jaundice |
Hepatic cancer | Tumor compressing bile flow | Weight loss, weakness, anorexia, firm hepatomegaly, jaundice, RUQ pain, ascites, dependent edema, fever, auscultatory bruits |
Hepatitis (viral) | Icteric phase onset | Clay-colored stools, jaundice within 1–5 days, dark urine, anorexia, tender hepatomegaly, RUQ pain, splenomegaly, cervical lymphadenopathy, pruritus, post-icteric fatigue |
Cholestatic nonviral hepatitis | Drug or toxin-induced | Similar to viral hepatitis: clay-colored stools, jaundice, fatigue, anorexia |
Pancreatic cancer | Common bile duct obstruction | Clay-colored stools, abdominal/back pain, jaundice, pruritus, nausea, vomiting, anorexia, weight loss, fatigue, splenomegaly, GI bleeding, periumbilical bruit |
Acute pancreatitis | Inflammatory disorder | Clay-colored stools, dark urine, jaundice, severe epigastric pain radiating to back, nausea, vomiting, fever, hypoactive bowel sounds, abdominal rigidity, crackles at lung bases, restlessness, tachycardia, mottled skin |
Other causes
Biliary surgery: May cause bile duct strictures, leading to clay-colored stools.
Special considerations
Prepare for diagnostic tests:
Liver function tests, serum bilirubin
Hepatitis panels
Abdominal ultrasound, CT scan
Endoscopy, ERCP
Stool analysis
Patient counseling
Explain the importance of dietary modifications.
Advise avoiding alcohol and hepatotoxic substances.
Emphasize rest and measures to reduce abdominal pain.
Pediatric pointers
Infants may develop clay-colored stools due to biliary atresia.
Geriatric pointers
Elderly patients with cholelithiasis have a higher risk of complications; early surgical intervention should be considered for persistent symptoms.
References
Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. American Academy of Pediatrics; 2012.
Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. Mosby Elsevier; 2008.
McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Mosby Elsevier; 2010.
Sommers MS, Brunner LS. Pocket Diseases. F.A. Davis; 2012.
Schiff ER, Maddrey WC, Sorrell MF. Schiff’s Diseases of the Liver. 12th ed. Wiley; 2017.
Boyer TD, Manns MP, Sanyal AJ. Zakim and Boyer’s Hepatology: A Textbook of Liver Disease. 8th ed. Elsevier; 2021.
McCance KL, Huether SE. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 8th ed. Elsevier; 2019.
Sleisenger MH, Fordtran JS. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Elsevier; 2021.
Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. American Academy of Pediatrics; 2012.