Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (156 page)

   Nonspecific inflammatory or granulomatous disease of the small intestine

   Laboratory Findings

Core laboratory
: Serum cholesterol usually normal. Serum total protein, albumin, γ-globulin, and calcium are decreased. Serum α- and β-globulins normal. Proteinuria absent.

Hematology
: Mild anemia. Eosinophilia (occasionally).

Stool findings
: Steatorrhea with abnormal tests of lipid absorption.

Other
: Increased permeability of the GI tract to large molecular substances shown by IV iodine-131-polyvinylpyrrolidone (
¹³¹
I-PVP) test (see Malabsorption).

COLITIS, COLLAGENOUS

   Definition

Syndrome of chronic nonbloody diarrhea. The incidence is approximately 3/1,000 in such patients. Diagnosis is established by biopsy of the colon in patients thought to have irritable bowel syndrome.

   Laboratory Findings

Hematology
: ESR is increased, and anemia and hypoalbuminemia occur in some patients. Eosinophil count is increased in some patients.

COLITIS, PSEUDOMEMBRANOUS

   See
Clostridium difficile
in Chapter
11
, Infectious Diseases.

GALLSTONE ILEUS

   Laboratory findings caused by preceding chronic cholecystitis and cholelithiasis

   Laboratory findings caused by acute obstruction of the terminal ileum (accounts for 1–2% of patients)

GASTROENTERITIS, EOSINOPHILIC

   Definition

Diagnosis requires histologic evidence of predominant eosinophilic (>20 eosinophils/HPF) infiltration of the GI tract in the absence of parasitic infection or extraintestinal disease.

   Laboratory Findings

Hematology
: Eosinophilia in 80% of cases.

Other
: Eosinophilic ascites with predominant disease of serosal layer. IgE may be increased, especially in children.

Suggested Readings

Bonis PAL, LaMont JT. Approach to the adult with chronic diarrhea in developed countries.
www.uptodate.com
, May 2009.

Khan F, Sachs H, Pechet L, et al.
Guide to Diagnostic Testing
. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.

Wanke C. Approach to the adult with acute diarrhea in developed countries.
www.uptodate.com
, May 2009.

GASTROINTESTINAL BLEEDING

UPPER GASTROINTESTINAL BLEEDING (ADULT)

   Definition

Upper GI bleeding is defined as emanating from a source above the ligament of Treitz. This is the most common medical emergency for gastroenterologists. The mortality is approximately 8%, and it is not usually due to exsanguination but rather due to the adverse effect on comorbid conditions.

   Who Should Be Suspected?