Laboratory findings in patients with ulcerative colitis are nonspecific; they may include leukocytosis, anemia, thrombocytosis, decreased serum albumin, and abnormal liver function studies. Therefore, the diagnosis of ulcerative colitis rests on the following: a history of abdominal cramps and diarrhea, mucoid stools, stool examination negative for ova and parasites, stool cultures negative for enteric pathogens, and confirmation by sigmoidoscopic or colonoscopic examination. The results of the latter examination are abnormal in 95 percent of the patients with ulcerative colitis. The observed pathologic changes vary depending on the severity and duration of the disease. Granularity, friability, ulceration of the mucosa, and, in more advanced cases, pseudopolyposis are quite characteristic.
Sigmoidoscopy may be done in the office or the ED to confirm the clinical suspicion, but the appearance is not specific. Biopsy may help differentiate acute colitis from chronic colitis and diseases caused by specific etiology, such as amebiasis (see "Pathology," above). Barium enema examination may be useful in differentiating it from Crohn's disease and defining the extent of involvement of the colon. Colonoscopy, however, is the most sensitive method for making the diagnosis and defining the extent and severity of the disease. In addition, colonoscopy is extremely useful in the evaluation of the patient for the development of dysplasia or colon cancer. Barium enema examination should be done with caution or postponed in moderately ill patients. Rigid or fiberoptic proctosigmoidoscopy can be used, however, even in the severely ill patient, provided that it is done gently and without the administration of any enemas or laxatives.
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