A 22-year-old college student presents to clinic with a history of intermittent diarrhea for the past 5 days after returning from Mexico. On further questioning, she has had previous episodes of diarrhea for the past 2 years, unrelated to travel. After a physical examination, what are appropriate tests that should be ordered to appropriately work up this patient?A. Stool wet-mount and stool culture
Stool wet-mount and culture can often diagnose infection. Sigmoidoscopy or colonoscopy can be helpful in diagnosing inflammatory bowel disease or ischemia. However, if the patient has abdominal tenderness, particularly with peritoneal signs, or any other evidence of perforation, endoscopy is contraindicated. For chronic diarrhea tests for malabsorption and metabolic investigations should be conducted along with colonoscopy. Biopsies should be taken even if the colonic mucosa appears grossly normal.