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Introduction

Increased destruction of red blood cells, as in hemolytic anemia, increases the amount of urobilinogen excreted in stool. Liver disease, in general, reduces the flow of bilirubin to the intestine and thereby decreases the fecal excretion of urobilinogen. In addition, complete obstruction of the bile duct reduces urobilinogen to very low levels.

This test investigates hemolytic diseases and hepatic obstructive conditions. Determination of stool urobilinogen is an estimation of the total excretion of bile pigments, which are the breakdown products of hemoglobin.

Normal Findings

  1. 50–300 mg/24 hr or 100–400 Ehrlich units/100 g

  2. Newborns to 6 months: negative

Procedure

  1. Collect a 48-hour specimen following the procedure for Collection and Transport of 24-, 48-, 72-, and 96-Hour Stool Specimens. Observe standard precautions.

  2. Protect the specimen from light. Send to the laboratory as soon as possible.

Clinical Implications

  1. Increased values are associated with hemolytic anemias.

  2. Decreased values are associated with the following conditions:

    1. Complete biliary obstruction (clay-colored feces result)

    2. Severe liver disease (e.g., infectious hepatitis)

    3. Oral antibiotic therapy that alters intestinal bacterial flora

    4. Aplastic anemia, which results in decreased hemoglobin turnover

Interventions

Pretest Patient Care

  1. Explain purpose of test, procedure for stool collection, and interfering factors.

  2. Ensure that the patient does not receive oral antibiotic therapy for 1 week before test.

  3. Advise the patient to avoid barium procedures and laxatives for 1 week before stool specimen collection.

  4. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel the patient regarding abnormal findings; explain the need for further testing. Monitor patient for liver disease, biliary obstruction, and diarrhea.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors

see Appendix E for drugs that affect test outcomes.