An adolescent with cystic fibrosis describes stool; which description indicates ongoing malabsorption?

• A. Soft with little odor
• B. Large and foul-smelling
• C. Loose with bits of food
• D. Hard with streaks of blood

Answer: (B)

In cystic fibrosis, pancreatic enzyme deficiency prevents proper digestion of fats, so fat stays in the stool. That fat malabsorption produces steatorrhea, which is characterized by stools that are very bulky, greasy or oily, and have a strong, foul odor. Often they are large and may float in the toilet due to their high fat content. This description signals ongoing malabsorption and the need for pancreatic enzyme replacement therapy and nutritional management.

Stool that is soft with little odor would not reflect fat malabsorption. Loose stools with bits of food can occur with diarrhea but don’t specifically indicate malabsorption of fats. Stools that are hard with streaks of blood suggest constipation or possible GI bleed rather than fat malabsorption.