Investigations in a Flare of Inflammatory Bowel Disease
| Element | Comment |
|---|---|
| Full blood count | Patients on immunomodulators can become neutropenic, and therefore susceptible to infections. A full blood count may also reveal anaemia or a raised white cell count indicating infection or steroid use. |
| C-reactive protein (CRP) | Ten percent of patients with inflammatory bowel disease do not develop a raised CRP even during active disease. In these patients it is often useful to look at the platelet count as a marker of inflammation. |
| Electrolytes, urea and creatinine | Dehydration is unusual in flare-ups of inflammatory bowel disease unless there is underlying obstruction or the patient has presented late. |
| Amylase | In patients with abdominal pain pancreatitis is an important differential. Both steroids and azathioprine can cause pancreatitis. |
| Plain radiographs | Plain abdominal films may show loops of inflamed bowel, proximal constipation, obstruction or toxic dilatation of the colon. Chest X-ray may show concurrent chest infection or air under the diaphragm suggesting perforation. |
| Stool culture | Always send at least three stool cultures were possible. Even in patients with known colitis infection can trigger an exacerbation. In patients with previous hospital admissions or recent antibiotic use always consider Clostridium infection. CMV colitis can also occur in immunosuppressed patients. |