From the Guidelines
The patient's presentation of back pain, hematuria, diarrhea, and blood in stool warrants a comprehensive diagnostic workup.
Initial Laboratory Tests
Initial laboratory tests should include a complete blood count (CBC), basic metabolic panel (BMP), and urinalysis with microscopy to evaluate for underlying infections, inflammatory conditions, or renal dysfunction 1.
Stool Studies
Additionally, stool studies such as stool culture, ova and parasite examination, and Clostridioides difficile toxin assay should be ordered to evaluate for infectious causes of diarrhea, as recommended by the Infectious Diseases Society of America 1.
Imaging Studies
Imaging studies, including a non-contrast computed tomography (CT) scan of the abdomen and pelvis, should also be considered to evaluate for potential renal or gastrointestinal pathology, such as kidney stones, urinary tract infections, or inflammatory bowel disease 1.
Further Evaluation
Further evaluation, including renal function tests and coagulation studies, may be necessary to assess the severity of the patient's condition and guide management, as suggested by the American College of Physicians 1.
Considerations
It is essential to consider the patient's medical history, physical examination findings, and laboratory results when interpreting the diagnostic workup and developing a management plan, as emphasized by the American College of Radiology 1.
From the Research
Diagnostic Approach
To approach the diagnosis of a 49-year-old male presenting with back pain, hematuria, diarrhea, and hematochezia, the following tests should be considered:
- Complete blood count (CBC) to evaluate for anemia or infection 2
- Basic metabolic panel (BMP) to assess for electrolyte imbalances or kidney dysfunction 2
- Coagulation panel to evaluate for bleeding disorders 2
- Liver tests to assess for liver dysfunction 2
- Type and crossmatch to prepare for potential blood transfusion 2
- Urinalysis to evaluate for hematuria and potential urinary tract infection or kidney stones
- Stool tests, including comprehensive stool analysis, to evaluate for infectious or inflammatory causes of diarrhea 3
- Imaging studies, such as MRI or CT, to evaluate for spinal or abdominal causes of pain and bleeding 4, 5
Specific Considerations
- For the patient's back pain, imaging studies such as MRI or CT may be considered to evaluate for spinal causes, such as disc herniation or spinal stenosis 4, 5
- For the patient's hematuria, urinalysis and imaging studies such as CT or ultrasound may be considered to evaluate for kidney stones or other urinary tract abnormalities
- For the patient's diarrhea, comprehensive stool analysis may be considered to evaluate for infectious or inflammatory causes 3
- For the patient's hematochezia, colonoscopy or other imaging studies may be considered to evaluate for colorectal causes, such as diverticulitis or colon cancer 2
Laboratory Tests
The following laboratory tests may be helpful in categorizing the patient's diarrhea:
- Stool culture to evaluate for infectious causes
- Stool ova and parasites to evaluate for parasitic infections
- Inflammatory marker tests, such as fecal calprotectin or lactoferrin, to evaluate for inflammatory bowel disease
- Malabsorption tests, such as fecal fat or carbohydrate absorption tests, to evaluate for malabsorptive causes 6