eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Colitis: Differential Diagnoses & Workup

Author: Jagvir Singh, MD, Director, Division of Pediatric Emergency Medicine, Lutheran General Hospital of Park Ridge
Contributor Information and Disclosures

Updated: Jun 17, 2009

Differential Diagnoses

Amebiasis
Malabsorption Syndromes
Anemia, Chronic
Protein-Losing Enteropathy
Appendicitis
Ulcerative Colitis
Growth Failure
Yersinia Enterocolitica Infection

Workup

Laboratory Studies

The following studies may be indicated in patients with colitis:

  • For newborns with necrotizing enterocolitis (NEC), obtain an ABG, WBC count, hemoglobin, platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT), electrolytes, and disseminated intravascular coagulation (DIC) profile as indicated.
  • A child with allergic colitis may have an elevated WBC count, low hemoglobin, often (but not invariably) an increase in eosinophils, and hypoalbuminemia (if a condition of protein-losing enteropathy coexists). In the search for fecal leucocytes, stools are positive for neutrophils and eosinophils.
  • In patients with pseudomembranous colitis, WBC counts are usually higher than 15,000/mcL. An etiologic diagnosis requires the identification for C difficile toxin in the stool.
  • When bacterial etiology (eg, Salmonella species, Shigella species, Campylobacter species, Yersinia species, E coli, C difficile) is suspected, stools need to be tested for cultures, and Gram and methylene blue staining of the stool is recommended. The WBC counts can be elevated or normal.
    • Most of the organisms may be cultured from the stool by using appropriate media, but enrichment techniques for Y enterocolitica may be required. Infectious agents, such as Clostridium perfringens, E coli, and S epidermidis species, have been recovered from stool cultures in patients with colitis. Nonetheless, in most cases, no pathogen is identified.
    • Failure to isolate pathogenic organisms may be because of possible clearance of the organisms at time of isolation, failure to identify an organism, lack of suitable culture techniques, or laboratories not routinely testing for all pathogens.
    • Enterohemorrhagic E Coli (EHEC), including O157:H7 and O26:H11, causes hemorrhagic colitis and systemic complications, including hemolytic uremic syndrome (HUS).
    • In typical infectious colitis, the lamina propria of the large intestine is infiltrated by polymorphonuclear leukocytes.
  • If a parasitic cause (E histolytica, B coli) is suspected, consider a stool examination, serology, or scrapings of mucosal ulcerations to identify the organism.
  • In a child with suspected inflammatory bowel disease (IBD), colonoscopy is the test of choice and never should be avoided if the patient's condition is stable enough to allow the test to be performed. If Crohn disease (CD) is being considered, an upper GI endoscopy and radiography with barium swallow and small bowel follow-through also need to be done.
  • Blood studies should include CBC count, serum electrolyte level, BUN level, creatinine level, C-reactive protein (CRP) level, and liver function test results (eg, transaminases, total protein, serum albumin, PT). CRP is elevated in as many as 90% of patients with CD and in more than 50% of those with ulcerative colitis (UC). Thrombocytosis and hypoalbuminemia correlate best with histologic inflammation of the colon in UC. Acute phase reactants are more likely to be elevated in patients with CD than in those with UC. If the differential diagnosis between Crohn colitis and UC is unclear, measuring serum levels of Anti-Saccharomyces cerevisiae antibody (ASCA) and perinuclear antineutrophilic cytoplasmic antibody (p-ANCA) antibody may be very useful: the former is found almost exclusively in Crohn colitis, whereas the latter are more indicative of UC. Stool blood and fecal leukocytes may indicate the presence of active inflammation.
  • Assessment of skeletal age is indicated in children with short stature.
  • In patients with Henoch-Schönlein purpura (HSP), findings from routine laboratory studies, including CBC count, electrolyte levels, serum protein levels, and C3 complement levels, are usually normal. The erythrocyte sedimentation rate (ESR) may be elevated. The diagnosis is based on clinical findings.

Imaging Studies

  • The diagnostic yield of plain film radiographs is relatively low. Nevertheless, the diagnosis of NEC can be assisted by a plain film radiograph of the abdomen, demonstrating pneumatosis intestinalis (ie, gas accumulation in the submucosa of the bowel wall) in 50-75% of patients, gas in the portal vein in severe cases, and pneumoperitoneum in patients with perforation of the bowel.
  • Plain film radiography also can be useful in establishing a diagnosis of toxic megacolon, bowel obstruction, or perforation, and they should be performed as initial studies.

More on Colitis

Overview: Colitis
Differential Diagnoses & Workup: Colitis
Treatment & Medication: Colitis
Follow-up: Colitis
Multimedia: Colitis
References
Further Reading
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References

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Keywords

colitis, inflammatory bowel disease, IBD, Crohn disease, CD, ulcerative colitis, UC, necrotizing enterocolitis, NEC, allergic colitis, pseudomembranous colitis, infectious colitis, parasitic colitis, ischemic colitis, bowel perforation, sepsis, diarrhea, uveitis, erythema nodosum, cholangitis, hepatitis, arthritis, abdominal distention, emesis, growth failure, weight loss, abdominal pain, iron deficiency anemia, juvenile rheumatoid arthritis, dysentery, disseminated intravascular coagulation, toxic megacolon, liver abscess, colonic perforation, proteinuria, hypertension, treatment, diagnosis

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Contributor Information and Disclosures

Author

Jagvir Singh, MD, Director, Division of Pediatric Emergency Medicine, Lutheran General Hospital of Park Ridge
Jagvir Singh, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Robert Baldassano, MD, Director, Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, Associate Professor, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania
Robert Baldassano, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Stefano Guandalini, MD, Director, University of Chicago Celiac Disease Program, Section Chief of Gastroenterology, Hepatology and Nutrition; Professor, Department of Pediatrics, University of Chicago Comer Children's Hospital
Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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