Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences 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.
Diagnosis of colitis and its causes always begins with
the taking of the patient's history. The information the patient provides helps
the physician guide the direction for diagnosis and treatment.
In patients with abdominal pain
and diarrhea, it is important to find out when the symptoms began, how long
they have lasted, whether they come and go, and what makes them better or worse.
Questions may be asked about travel because infections may arise while
traveling, particularly in undeveloped countries. Patients often ask if the
cause of symptoms is food poisoning, but that is often a difficult question to answer immediately.
If the patient has blood with bowel movements (which in general, is not
normal) further questions may be explored to screen for
colon cancer or
polyps.
Food poisoning not due to
bacterial
infections usually does not cause blood in the stool. Evaluation of the body's
other systems (cardiovascular,
neurological, etc.) may
be necesseary.
Physical examination
Once the history is taken, physical examination will be helpful in
determining potential causes of the symptoms.
Signs of more severe disease with
dehydration may include orthostatic changes in
blood pressure and
pulse rate (decreases in the former and increases in the latter upon standing).
In patients who are low on fluid or blood, blood pressure and pulse may be
normal when they lie flat but may change with standing; the blood pressure falls
and the pulse rate rises.
Temperature often is checked for fever.
Examination of the abdomen will disclose areas of tenderness and potentially
abnormal masses if tumors or Crohn's disease are present.
The exam also may
include a rectal examination to test the stool for blood and to feel for
abnormal rectal masses.
In patients where ischemic colitis is a consideration,
the healthcare practitioner may examine the heart and listen for sounds of
abnormal, restricted blood flow (bruits) in arteries located in the neck, groin,
and abdomen as signs of coexisting
vascular disease.
In patients where there is clinical suspicion of
viral infection, no further
testing may be needed. However, in a patient who appears ill, dehydrated, or has
significant pain, fever or blood in the stool, more evaluation may be required.
An elevated white blood cell count may be present as the body's
response to infection. However, an elevated white blood cell count does not
necessarily mean infection, since the white cell count may be elevated as part of
the body's general response to any type of inflammation.
Blood chemistries may be measured looking for changes in
electrolyte
concentrations in the body, especially abnormal sodium and potassium levels that
would suggest serious diarrhea or loss of fluid. Kidney function may be checked
by measuring the BUN (blood urea nitrogen) and
creatinine levels; this may be an
important clue that patients are dehydrated. As well, certain bacterial causes
of diarrhea may also cause kidney failure.
Stool samples will likely be collected for culture,
searching for bacterial and
parasitic infections as the cause of colitis.
Imaging
Colonoscopy is a test in which a gastroenterologist uses
a thin, flexible tube with a fiberoptic camera attached it to look at the inside
of the colon searching for the cause of the symptoms. The appearance of the
colonic lining often allows the doctor to make the diagnosis and also provides
the opportunity to look for tumors and polyps. Biopsies - small bits of
tissue - an be removed from the mucosal lining during colonoscopy and then
evaluated under the microscope to make or confirm a diagnosis of the presence or cause of colitis.
Computerized tomography and
barium enemas are tests that
are performed by a radiologist to explore the cause of colitis but often are ordered as part
of the evaluation of abdominal pain or diarrhea.
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.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
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.
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Clostridium difficile (C. difficile) is a bacterium, and is one of the most common causes of infection of the colon. C. difficile spores are found frequently in hospitals, nursing homes, extended care facilities, and nurseries for newborn infants. They can be found on bedpans, furniture, toilet seats, linens, telephones, stethoscopes, fingernails, rings, floors, infants' rooms, and diaper pails. They even can be carried by pets. Antibiotic-associated (C. difficile) colitis is an infection of the colon caused by C. difficile that occurs primarily among individuals who have been using antibiotics. Treatment for C. difficile colitis hydration, replenishment of electrolyte deficiencies, discontinuing the antibiotic that caused the colitis, and using antibiotics to eradicate the C. difficile bacterium.
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.
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.
Food poisoning is common, but can also be life threatening. The most common form of food poisoning is caused by bacteria and include symptoms such as fever, abdominal pain, diarrhea, nausea and vomiting.
A colon polyp is a benign tumor of the large intestine. Benign polyps do not invade nearby tissue or spread to other parts of the body. Benign polyps can easily be removed during colonoscopy and are not life threatening. If benign polyps are not removed from the large intestine, they can become malignant over time.
Salmonella bacteria are known to cause salmonellosis, typhoid fever, and paratyphoid fever in humans. Salmonella infection is usually caused by ingesting large amounts of the bacteria in contaminated food or water.
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
There are many types of E. Coli (Escherichia coli ). Pathogenic E. coli can cause urinary tract and bladder infections, or lead to sepsis. E coli O157:H7 (EHEC) causes bloody diarrhea and colitis. Complications of E. coli infection include hemorrhagic diarrhea, hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura. Symptoms include severe abdominal pain and bloody diarrhea. E coli O157:H7 commonly is due to eating raw or undercooked hamburger or raw milk or dairy products.
Travelers' diarrhea is generally contracted by eating contaminated food or drinking contaminated water. Food is the primary source of travelers' diarrhea. Enterotoxigenic E. coli is the cause of up to 70% of all cases of travelers' diarrhea. There are five unique classes of E. coli that causes gastroenteritis. Other bacteria responsible for travelers' diarrhea include
Campylobacter, jejuni, shigella, and salmonella. Viruses such as rotavirus and Norwalk virus (norovirus) and giardia lamblia a parasite may cause travelers' diarrhea. Prevention is careful eating and drinking of water.
Microscopic colitis (lymphocytic colitis and collagenous colitis) is a disease of inflammation of the colon. Microscopic colitis is only visible when the colon's lining is examined under a microscope. The cause of microscopic colitis is not known. Symptoms of microscopic colitis are chronic watery diarrhea and abdominal pain or cramps. Microscopic colitis is diagnosed through biopsies of several areas of the colon. There is no standardized treatment for microscopic colitis; however, eliminating NSAIDs, and treatment medications such as Imodium, Lomotil, Petpo-Bismol, Entocort EC, and mesalamine (Asacol) have been helpful in some individuals.
Vascular disease includes any condition that affects your circulatory system. Vascular disease ranges from diseases of your arteries, veins and lymph vessels to blood disorders that affect circulation.
Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include malaria, meningococcal meningitis, yellow fever, hepatitis A, typhoid fever, polio, and cholera.
Shigellosis is a disease caused by the Shigella bacteria. Bloody diarrhea, stomach cramps and fever are common symptoms. Mild infections usually resolve on their own. Antibiotics are used to treat more severe cases.
Cytomegalovirus (CMV) is a virus that is spread from person to person via spit, semen, vaginal secretions, urine, blood, sexual contact, breastfeeding, blood transfusions, organ transplants, and breast milk. Symptoms of CMV include fatigue, swollen glands, fever, and sore throat. You can take precautions to prevent CMV such as washing hands frequently and thoroughly, using condoms, if you work in day care centers wash hands thoroughly after contact with body secretions, and avoiding oral contact with objects covered in saliva. Individuals with HIV infection are at most risk of contracting CMV.
Enterovirulent Escherichia coli (E. coli) are strains of related bacteria that have a strong propensity to cause gastrointestinal tract infections. Examples of strains include: EHEC (enterohemorrhagic E. coli), ETEC (enterotoxigenic E. coli), EPEC (enteropathogenic E. coli), EIEC (enteroinvasive E. coli), EAEC (enteroadherent E. coli), and EAggEC (enteroaggregative E. coli). Symptoms may vary depending on the strain the individual contracts. Infection is spread generally through contaminated food or drink.
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