THE HISTORY AND PHYSICAL EXAMINATION IN IBD

The patient's history (the symptom pattern) is actually quite useful in trying to understand whether a patient has IBD and what type of IBD it might be. Your doctor or nurse will probably ask detailed questions about all the symptoms (pain, diarrhea, blood in the stool, nausea or vomiting):

• How long has this symptom been happening
• How often (daily, weekly, hourly)
• How bad is it, how sudden 
• What makes it worse, What makes it better
• Does it happen at the same time as the other symptoms
• Does It wake you at night
• And for abdominal pain, where is it? Does it move?  

The examiner will also want to know about allergies, recent medications, travel and exposure, allergies, other family members with similar problems 

The physical exam is generally less helpful for diagnosis, though several features are quite important, and usually, will be repeated at almost every visit, along with the questions. Those features include:

• Measuring the height and weight and calculate/ graphing the BMI as well.  (Your BMI or body mass index compares your weight to your height to see if you might be underweight or overweight).
• Examining for mouth sores
• Looking at the eyes, tongue and finger nails for adequate oxygen flow, anemia and jaundice
• Listening to the heart for a murmur from anemia
• Abdominal exam for swelling or tenderness (often over on the R side in Crohn's disease, near the appendix)
• Rectal exam to look outside for tags and / or fistulas (if present, these help to confirm the diagnosis of Crohn's disease and later to determine whether it is increasing or decreasing in size), since it is like an early warning sign of increased disease activity.
• Legs to look for swelling in the ankles
• And then a careful exam and history to look for the extra-intestinal manifestations that can occur with Crohn's disease and UC.