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Gastroenterology (Expert Forum)
Conflicting Diagnosis
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Conflicting Diagnosis
by Scrapbird, Jun 06, 2007 12:00AM
50 yo white female, confused about recent bout with gastroenteritis/diverticulitis/colitis.
Traveling May 27; suddenly overcome w severe abdominal pain, nausea, & vomiting. Next 6-7 hours stopped 12 times for diarrhea. Pain unrelenting. Stopped at ER 2 hours from home; admitted to hospital w dehydration, abdominal pain, & elevated white cell count. (13000) Diarrhea stopped. Given Cipro, Flagyl, and morphine. Stayed 3 days, until pain improved & white cell count 9000. Discussed w physician a recent colonoscopy that showed some diverticula; since pain mostly in upper & left side, he agreed it could be diverticulitis. Official diagnosis on discharge dehydration and gastroenteritis.
2 days later had bright red rectal bleeding; went to physician. Sent to ER. Did blood work, stool culture, rectal exam, abdominal x-ray, and CT scan; sent home. Discharge diagnosis was rectal bleeding and diverticulitis.
Went to doctor today; was told final diagnosis was not diverticulitis, as I had only a few diverticula in sigmoid colon. CT scan showed thickening of transverse colon; told it was most likely infectious colitis w bleeding.
I don’t know what to believe. I am a 7-year renal cell cancer survivor; is important to me to understand what is happening with my body. Feels as if no one knows. Is gastroenterology this inexact a science? I am feeling better, and I don’t know to what lengths I should go to follow up on this.
Traveling May 27; suddenly overcome w severe abdominal pain, nausea, & vomiting. Next 6-7 hours stopped 12 times for diarrhea. Pain unrelenting. Stopped at ER 2 hours from home; admitted to hospital w dehydration, abdominal pain, & elevated white cell count. (13000) Diarrhea stopped. Given Cipro, Flagyl, and morphine. Stayed 3 days, until pain improved & white cell count 9000. Discussed w physician a recent colonoscopy that showed some diverticula; since pain mostly in upper & left side, he agreed it could be diverticulitis. Official diagnosis on discharge dehydration and gastroenteritis.
2 days later had bright red rectal bleeding; went to physician. Sent to ER. Did blood work, stool culture, rectal exam, abdominal x-ray, and CT scan; sent home. Discharge diagnosis was rectal bleeding and diverticulitis.
Went to doctor today; was told final diagnosis was not diverticulitis, as I had only a few diverticula in sigmoid colon. CT scan showed thickening of transverse colon; told it was most likely infectious colitis w bleeding.
I don’t know what to believe. I am a 7-year renal cell cancer survivor; is important to me to understand what is happening with my body. Feels as if no one knows. Is gastroenterology this inexact a science? I am feeling better, and I don’t know to what lengths I should go to follow up on this.
Doctor's Answer
by Kevin Pho, MD, Jun 07, 2007 12:00AM
, Jun 07, 2007 12:00AM
You have had a pretty comprehensive evaluation with imaging, cultures and antibiotic therapy.
The colonoscopy and CT scan would rule out more of the common disorders. Biopsy of any suspected colitis would rule out inflammatory bowel disease. The antibiotics that you were given are appropriate to treat infectious colitis. Diverticulitis typically does not result in diarrhea.
If infection has been ruled out, obtaining malabsorption studies looking for fat malabsorption or blood tests for celiac disease can be done.
You could obtain a second GI opinion if the diagnosis is in question.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
The colonoscopy and CT scan would rule out more of the common disorders. Biopsy of any suspected colitis would rule out inflammatory bowel disease. The antibiotics that you were given are appropriate to treat infectious colitis. Diverticulitis typically does not result in diarrhea.
If infection has been ruled out, obtaining malabsorption studies looking for fat malabsorption or blood tests for celiac disease can be done.
You could obtain a second GI opinion if the diagnosis is in question.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
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