Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
A history of antibiotic use is important in the diagnosis of C. difficile
colitis. Patients taking antibiotics (or recently having taken antibiotics) who
develop abdominal pain, cramps and
diarrhea are usually tested for C. difficile
infection. However, doctors do not always wait for the appearance of diarrhea to
start testing for C. difficile since in rare instances C. difficile can cause
abdominal pain and tenderness without diarrhea.
Laboratory tests
Patients with C. difficile colitis often have elevated
white blood cell counts
in the blood, and, in severe colitis, the white blood cell counts can be very
high (20,000 to 40,000). Patients with C. difficile colitis also often have
white blood cells in their stool when a sample of stool is examined under a
microscope. Elevated white blood cell counts and white blood cells in the stool,
however, only demonstrate that there is colitis and not that the cause of the
colitis is C. difficile. More specific tests are necessary to determine whether
C. difficile is the cause of the colitis.
The most widely used test for diagnosing C. difficile colitis is a test that
detects toxins produced by C. difficile in a sample of stool. There are two
different toxins, toxin A and toxin B, both capable of causing colitis. Accurate
tests for both toxins are available commercially for use in all laboratories.
Unfortunately, like most tests in medicine, these tests for toxins are not
perfect; both false positive tests (finding toxins when there is no C.
difficile) and false negative tests (not finding toxins when C. difficile is
present) can occur. Therefore, other tests such as flexible sigmoidoscopy and
colonoscopy often are necessary to look for pseudomembranes that are
characteristic of C. difficile colitis.
Flexible sigmoidoscopy and
colonoscopy
Flexible sigmoidoscopy is an examination in which a doctor inserts a flexible
fiberoptic tube with a light and a camera on its end into the rectum and sigmoid
colon. (The sigmoid colon is the segment of the colon that is closest to the
rectum.) In most patients with C. difficile colitis, the doctor will find
pseudomembranes in the rectum and the sigmoid colon. However, some patients with
C. difficile colitis will have pseudomembranes only in the right colon (the
segment of the colon farthest from the rectum). Patients with pseudomembranes
confined to the right colon require colonoscopy in order to see the
pseudomembranes. (A colonoscope is a longer version of the flexible
sigmoidoscope that is long enough to reach the right colon.)
X-Rays
X-ray examinations and computed tomography (CT) examinations of the abdomen will
occasionally demonstrate thickening of the wall of the colon due to
inflammation, but these x-ray findings also are non-specific and only
demonstrate that colitis is present. They do not demonstrate the cause of the
colitis, for example, C. difficile.
Clostridium Difficile Colitis - How Was Diagnosis EstablishedQuestion: What kinds of treatments have been effective for your clostridium difficile colitis (antibiotic-associated colitis, c. difficile colitis)?
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
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