Day 3 - Inflammatory Bowel Disease

Acute in-hospital management of IBD Flare

Clinical Manifestations: Diarrhea, bloody stools, mucous stools, abdominal pain, systemic symptoms, hypovolemia, hypotension, tachycardia

History:

• Current treatment

  • including Prednisone, immunosuppression therapy, 5-ASA

• Last Scope and Findings

• Last imaging and findings

• Changes in BMs

• Systemic symptoms

Severity Assessment:

Mayo Score/Disease Activity Index for UC

Crohn’s Disease Activity Index

Investigations:

• Bloodwork: CBC, Electrolytes, Creatinine, CRP/ESR

• Imaging: Abdominal X-Ray/CT tomogram to rule out obstruction, toxic megacolon

• Stool Studies: C.Diff, Stool Culture, O+P, fecal calprotectin may be helpful

  • Infection is the most common culprit for IBD flare

General Treatment Considerations:

• Gastroenterology Consult

  • May require repeat endoscopy

  • Will provide guidance for Steroids, antibiotics, and chronic therapy

• Physical Exam:

  • Daily volume status, bowel movement re-assesment and abdominal exam to monitor for clinical improvement and/or development of toxic megacolon

• Medications:

  • IV Pulse Steroids once infection is ruled out

    • generally does not need to be done acutely

  • Antibiotics if evidence of:

    • Localized peritonitis (indicating microperforation), presence of intra-abdominal or rectal abscess, bowel perforation

  • Anemia treatment

    • Usually Iron deficient, consider Venofer 300mg IV infusion

  • DVT prophylaxis EVEN IF patient has bloody diarrhea

    • IBD patients are very pro-thrombotic especially during flare

  • Consider immunomodulators or surgery if non-steroid response (guided by GI)

• Nutrition Assessment

  • Bowel rest only recommended in patients who have toxic megacolon, bowel obstruction

  • Can continue normal PO intake

  • If unable to tolerate PO intake, parenteral nutrition (TPN) may be required

• Discharge

  • Connect with outpatient gastroenterologist