#IBD Flare Hx

-Crohns or UC: ***

-Diagnosed: ***

-IBD provider: ***

-Treatments tried with dates: *** (biologics, 5-ASAs, steroids)

-fever, weight loss, urgency, rectal bleeding, passage of mucus, tenesmus, and abdominal pain.

-small bowel obstruction (nausea/vomiting), anorexia, weight loss, fever, malnutrition

-diarrhea

-baseline abdominal pain, diarrhea, BRBPR, #BMs at night, new meds (NSAIDs, Abx, OTC), recent smoking or smoking cessation, current/prior IBD meds and compliance, nausea/vomiting

***Physical Exam: overall appearance, perianal disease, oral ulcers, erythema nodosum, pyoderma gangrenosum

>Ulcerative colitis: fever, weight loss, urgency, rectal bleeding, diarrhea, passage of mucus, tenesmus, and abdominal pain.

>UC Proctitis: tenesmus, urgency, and passage of mucus and blood per rectum

>UC extensive colitis usually have more diarrhea, weight loss, fever, clinically significant blood loss, and abdominal pain

>CD: abdominal pain more predominant

>CD ileum: small bowel obstruction, anorexia, loose or frequent stools, weight loss, fever, malnutrition

>CD colitis: diarrhea (sometimes with blood),

-Montreal Criteria: <4, 4-6, 6+ BM's/day, ESR, pain, weight loss, HgB

Abdominal pain (0-10):

BM a day:

Consistency:

% of stools have blood:

Urgency:

Nocturnal BM:

Weight change over last 6 mo:

Appetite (good/average/poor):

Fevers/chills:

Heartburn:

Nausea/vomiting:

Abdominal bloating/distention:

#IBD Work-up

-CRP/ESR

-send Celiac Disease serologies

-folate, iron, vitamin D, Vitamin B12 (replete Vitamin D if deficient)

Stool studies:

-Fecal calprotectin

-C Diff

-Microsporidia

-Bacterial Stool studies (Salmonella, Shigella, Campylobacter, Yersinia, E. Coli)

-Stool O&P

#IBD Flare Plan

-*** IV methylprednisolone 1mg/kg

-IV fluids, replete electrolytes

-Ciprofloxacin or Flagyl given Sx of fever and Hx of fistula/abscess, pouchitis, leukocytosis, bandemia

-continue DVT Ppx even if active bleeding

-send stool calprotectin

-send CRP/ESR--trend CRP daily afterwards

-send stool studies (C. Diff, stool bacterial cultures, stool O&P, microsporidia)

-if febrile, send blood cultures

-send CBC, CMP, folate, iron, vitamin D, Vitamin B12 (replete Vitamin D if deficient)

-send Celiac Disease serologies

-Avoid NSAIDs, opioids, antidiarrheals

***involve colorectal surgery early, re: active UC, make aware of patient in case symptoms don't respond to medical treatment and colectomy needed

***send anti-TNF pre-infection labs: HIV, t-spot, HAV total Ab, HBV sAg/sAb/cAb, HCV Ab

***send drug levels of anti-TNF

***NPO @ MN for Colonoscopy/Flex Sig on ***