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Irritable Bowel Syndrome (IBS) Message Board


Irritable Bowel Syndrome (IBS) Board Index


Goofy,

Crohns is an Inflamatory Bowel Disease, so the bowel and colon need to be looked at directly with a colonoscopy or sigmoidoscopy.

The key symptoms of Crohns are:

-Chronic or nightly diarrhea

-Abdominal pain

-Obstructions of the bowel

-Weight loss

-Night sweats

-Intestinal inflammation

-Fibrosis

-Fistula

To confirm his or her diagnosis and rule out other conditions which can cause similar symptoms such as, other inflammatory bowel diseases, colitis, celiac disease, or irritable bowel syndrome, the doctor will probably perform a complete physical examination and order medical tests. These diagnostic tests can include:

[b]Physical Examination[/b]
If your physician suspects that you have Crohn’s disease, his or her examination may include a closer look at 2 areas of your body. In the first area, which is the right lower quadrant of the abdomen, he or she will try to determine if there is any tenderness or any inflammatory masses present. The second area is called the anorectal area. Your physician will look in this area for any signs of hemorrhoids, anal fissures, perianal abscesses, or thick, mound-like, tender areas, and in women, signs of fistulas located between the vagina and the rectum. In addition, some people with Crohn's disease have a very constricted rectal opening that is so narrow, a physician is unable to insert a finger.


[b]Blood Tests[/b]
Although a complete blood count test cannot provide a positive diagnosis of Crohn's disease, physicians usually order the test in suspected cases because it will reveal the following:


Anemia: May indicate that you are experiencing intestinal bleeding determined by the hemoglobin and hematocrit levels


White blood cell levels: When elevated, may indicate Crohn's disease, an infection, or an inflammatory condition


Differential: Shows the percentage of different kinds of white blood cells that comprise the total count and reveals the level of activity of inflammatory conditions or infection


Platelet count: Determines the number of clotting cells; when the level is raised above normal it may indicate an infection or active inflammation


Erythrocyte sedimentation rate (ESR): When elevated, may indicate inflammatory conditions or infection
A blood chemistry profile is a comprehensive test that is often ordered when Crohn's disease is suspected because it provides overall information about how well your body is functioning. This test reveals:


Nutritional information

State of general health

Electrolyte levels

Liver function

Kidney function

Your physician may also order a Schilling test, which determines if your body absorbs vitamin B-12 the way it should. If you are deficient in vitamin B-12, you may become anemic.


[b]Radiologic Examinations[/b]
Radiologic tests will enable your physician to see inside your body to determine if you have Crohn's disease. In addition to diagnosing Crohn's disease, these tests can help monitor your ongoing condition and response to treatment, as well as alerting your physician to any other health concerns. There are a number of different kinds of radiologic tests which include:


Barium enema: X-rays help your physician visualize the colon and the rectum. The terminal ileum, which is where the colon and the small bowel meet, usually can also be seen with this test. The test is very common and useful because it can help to diagnose Crohn's disease, monitor the progress of the disease, and uncover any complications that may exist, including strictures. It is also helpful in differentiating between Crohn's disease and ulcerative colitis.


Upper GI and small bowel follow-through: A barium-based drink is ingested and then X-rays, that look at the esophagus, stomach, duodenum, and small intestine, are used to determine the presence of ulcers and inflammation.


Enteroclysis: A tube is inserted into the nose and guided through the stomach to the duodenum, which is where the small intestine begins. A barium-based fluid is infused through the tube and then X-rays reveal any abnormalities that may be inside of the small intestine, including lesions, obstructions, inflammation, or strictures.


Computerized tomography scan (CT): A very precise X-ray used to detect abnormalities in the liver, kidneys, and intestine. A dye is ingested or administered intravenously or inserted through the rectum. CT scans of the pelvis and the abdomen also enable physicians to guide needles and to insert catheters that drain abscesses.


Ultrasound, also called sonography: By using sound waves, this test examines the organs of the pelvis and abdomen without any radiation exposure. Gallstones and abscesses, which may indicate a complication of Crohn's disease, can be detected with ultrasound. In addition, this test can also determine if the right kidney is swollen due to an obstruction of the right ureter by an inflamed ileum.


Magnetic resonance imaging (MRI): By using radio waves and superconducting magnets that cause hydrogen molecules to vibrate within a person's body, the MRI, which does not use radiation exposure, can detect fistulas and abscesses that may be found in people with Crohn's disease.
Several of these tests involve the use of barium-based liquids. You should know that barium may cause constipation. Contact your physician if you experience problems from the tests.

[b]Stool Tests[/b]
Stool examinations are noninvasive tests that are performed to determine whether someone has Crohn's disease, ulcerative colitis, or a bacterial infection, which often have similar symptoms. Usually, you can collect your own stool samples using a special vial provided by your physician, which you then mail to a lab. Your physician may also collect stool samples from you during an office visit for a rectal examination or a sigmoidoscopy. Stool tests detect the following:

Occult blood and white blood cells (WBCs): Stool samples are tested for occult (microscopic amounts) blood and white blood cells. People with Crohn's disease often have both occult blood and WBCs present in their stool.


Culture and sensitivity (C&S): Bacterial infections such as: Salmonella, Shigella, Campylobacter, and Yersiniacen can produce similar symptoms to Crohn's disease, and stool samples can be tested for their presence.


Parasitic infections: Stool samples can be examined to detect evidence of parasite conditions such as, amebiasis or giardiasis.


Clostridium difficile: Antibiotic use can allow an organism called Clostridium difficile to proliferate, which is a common cause of diarrhea. The presence of a toxin from this organism can be detected in stool samples.
Urine Tests
A urinalysis is used to detect the presence of red and white blood cells, as well as bacteria, in your urine. When bacteria and white blood cell levels are raised, it usually indicates a urinary tract infection, which can be a complication of Crohn's disease. The presence of red blood cells in the urine may indicate fistulas located between the bladder and the intestines, as well as kidney or bladder stones.

[b]Endoscopic Examinations[/b]
Endoscopic examinations of the upper or lower gastrointestinal (GI) tract can confirm Crohn's disease, locate areas of the intestine that are affected by the disease, and obtain tissue samples needed for biopsies and further examination. Endoscopes are thin, flexible, lighted tubes that are linked to a computer and a video monitor. An endoscopic examination is performed by inserting an endoscope into the rectum, mouth, or a small abdominal incision. This provides a physician with a very detailed view of the intestinal tract. If your physician suspects Crohn’s disease, he or she may recommend one of the following endoscopic procedures:

Sigmoidoscopy: The most commonly performed endoscopic examination used to confirm a diagnosis of Crohn's disease. By using either a flexible or a rigid instrument, your physician can evaluate the rectum as well as the lower end of the colon for signs of inflammation. In patients with Crohn's disease, a sigmoidoscopy often reveals a colon wall marked by ulcerations, with areas of healthy tissue surrounding them. If needed, a biopsy can also be performed with a sigmoidoscopy.


Colonoscopy: An examination of the full length of the colon as well as the lower part of the small intestine. In this procedure, the patient is sedated, and an endoscope is inserted into the rectum and guided through the entire colon. A colonoscopy can reveal if there is evidence of Crohn's disease in a particular section of the colon and the extent to which the area is inflamed. Additionally, compared to an X-ray, a colonoscopy can provide a much more detailed, inside view of the intestine. Colonoscopies are also used to rule out cancer concerns in patients who have had Crohn's disease for a long time.


Upper endoscopy: An examination performed by placing an endoscope into the patient's mouth and guiding it through the stomach to the upper intestine. This procedure can detect ulceration and inflammation of all areas of the upper GI tract and may confirm a diagnosis of Crohn's disease.




[This message has been edited by andyM (edited 07-24-2003).]





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