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
Food poisoning not due to
infections usually does not cause blood in the stool. Evaluation of the body's
other systems (cardiovascular,
neurological, etc.) may
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
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.
Stool samples will likely be collected for culture,
searching for bacterial and
parasitic infections as the cause of colitis.
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.