Ensuring a proper diagnosis involves a variety of tools by the clinician. An efficient abdominal exam, along with a rectal exam aids in diagnosis. Typically patients will have tenderness to palpation on exam. Rebound tenderness or guarding may present with perforation of the ulcer with air leaking into the abdomen. In these patients, their exam may be far more acute with abdominal rigidity and need for immediate surgical intervention. Additionally, a rectal exam may reveal stool present in the rectal vault, pointing to the fact that constipation has been or is still present. These patients may even have blood on their rectal exam, due to passing small amounts of stool around the ulcer and adjacent fecaloma. Patients may have unstable vital signs if they have been having rectal bleeding, have developed<unk>  colitis, and/or have had a perforation of the ulcer. These vital sign changes may be an acute fever, elevated heart rate, and/or decreased blood pressure. Laboratory evaluation may not be as specific in pointing to a diagnosis. Patients may have non-specific leukocytosis with elevated acute phase reactants. However, these are neither specific nor sensitive so the clinician must take into account all aspects of the patient's illness to reach the diagnosis. If a patient presents with severe symptoms it may be useful to order blood cultures and preoperative labs such as type and screen and coagulation testing. Imaging studies have been shown to be a key aspect in diagnosing patients with<unk> s and<unk>  colitis. Patient status on presentation is important to take into consideration when deciding what imaging study to order. Patients who are acutely ill and showing signs of perforation will need an upright Chest x-ray to determine if there is free air in the peritoneum. The imaging study of choice is an CT scan of the abdomen with IV contrast, considering the patient's renal function is adequate. Findings that can be seen are fecal impaction with dilation of the rectosigmoid junction commonly, but any part of the colon can be dilated. Additionally, fecalomas may be seen as masses in the colon. In the case of ulceration, the part of the colon adjacent to the fecaloma will be thickened. This thickening of the bowel will help differentiate from<unk>  colitis and<unk>  from fecal impaction as the colon is typically not thickened in cases of fecal impaction.
Stercoral ulcer
Mouth ulcer
Callous ulcer
Lipschütz ulcer
Genital ulcer
Tropical ulcer
Skin fissure
Cushing ulcer