BLOODY DIARRHEA : INVESTIGATIONS

 INVESTIGATIONS :

FULL BLOOD COUNT:

Anemia , may present acutely or may be present in chronic pathology such as incompletely treated IBD / Inflammatory Bowel Disease\

Microcytic hypochromic anemia will beseen in Irean deficiency anemia and  may be suggestive of blood loss.

Megaloblastic anemia is seen in malabsorption syndrome and Alcohol excess.

A raised white cell count suggest bacterial sepsis.

Also Look for Liver function  tests : Serum Bilirubin, ALT and ALPAse / Alkaline Phosphatase.

Electrolytes and Renal function Tests should also be assessed.

Serum albumin levels should be checked.

Less than 30 g/L suggests severe IBD and malnutrition.

Inflammatory markers include CRP and White cell count and should be checked.

Stool should be sent for Microscopic examination , Culture and Sensitivity.

Stool cultures for Clostridium difficile toxins is important as well.

Blood cultures and sensitivity should also be sent  depending upon clinical picture of thepatient.

X-rays / Radiology :

An erect X-ray of abdomen to include both hemi-diaphragms is important to exclude GI perforation.

A supine X ray should be taken to exclude Toxic megacolon of gut.And to look for mucosal islands and small bowle dilatation.

These are suggestive of adverse prognostic signs in IBD / Inflammatory Bowel Disease

Sigmoidoscopy :

This should be performed after an X ray has been performed.

This is because introduction of air during the procdure can produce a picture very similar to Toxic megacolon / dilatation of the gut.

Normal rectal mucose excludes active ulcerative colitis

Inflammed rectal mucose can be seen in any form of severe diarrhea.

The mucosal appearance of Clostridium difficile toxin varies.

Afherent yellow white plaques / pseudo membranes is characteristic.

A rectal biopsy if indicated should be taken well below the peritoneal reflection ie within 10 cm of the anal margin.