# IBD Flare
Severity of flares is generally based on a combination of #BMs/day, anemia, inflammatory markers, symptoms, complications
-- ABCs: ICU if evenidence of shock, dangerous electrolyte imbalances; stat consult to surgery if c/f complications, esp peritonitis
-- Chart Check: current treatment, previous flares, complications, infections, surgeries, last colo
-- HPI Intake: fevers, diarrhea, abd pain, weight loss, rashes, arthritis, evidence of peritonitis
-- Can't Miss: sepsis/shock, peritonitis
-- Admission Orders: NPO; CBC, BMP, LFTs, ESR/CRP, lactate, fecal calprotetin (if new dx - takes a while to come back), infectious workup
-- Initial Treatment to Consider: fluids, tylenol, dicylcomine, antibiotics, discuss steroids with GI consultants
-- History: *** #BM/day, previous flares, previous complications - bleeds, strictures, perf, infections; last colo, previous and current treatment, previous surgeries, GI Physician, smoking
-- Clinical: *** diarrhea, abdominal pain, tenesmus, weight loss, arthritis
-- Exam: *** signs of peritonitis, erythema nodosum, pyoderma gangrenosum, evidence of DVT/PE
-- Data: *** WBC, ESR, lactate
-- Etiology/DDx: *** infectious colitis, celiac, lactose intolerance, IBS, appendicitis, diverticulitis
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- Lab Workup: *** ESR/CRP, fecal calprotectin, iron studies, VitD, B12, folate; consider BCx, C Diff, stool culture, O+P
-- Before starting biologics - hep serologies, HIV screen, TB testing (Quant Gold, CXR)
-- Imaging: *** KUB, CTAP, endoscopy if needed (usually choose to avoid if acute flare) - to assess for complications (strictures, fistulae, abscess, obstruction, perforation)
-- Monitoring: *** trend abd exam q8-12
-- Surveillance: *** (colo due 8 years after dx, and then q1-3 years with biopsies)
-- IVF: ***
-- Steroids: *** inpatient flares usually get IV methylpred 20mg q8-12 → pred 40mg daily - discuss with GI consultants
-- Abx: *** cipro/flagyl if systemic illness, fevers, WBC, or complications evident on imaging
-- Pain: *** tylenol, dicyclomine; avoid NSAID, opioids, anti-motility agents)
-- avoid anti-diarrhea medicines like loperamide
-- Consult: *** GI - for biologic selection; colorectal surgery - consideration of colectomy; palliative, nutrition)
-- Diet: *** NPO, consider NGT; push diet with high fiber, fruits/veggies, decrease red meat
PDF coming soon!
The management of IBD is complex - GI and surgical consultants should be involved from the beginning. Though we tend to think of UC and Crohns in very stark buckets, in reality differentiating between the two (especially when first diagnosed) can be difficult. Classically, UC involves the rectum and colon and is continuous whereas Crohns can involve any part of GI tract from anus to mouth with skip lesions, though typically affects the terminal ileum and colon while sparring the rectum.
In general, the severity of flares is determined based on the number of BMs per day, andpresence of anemia, inflammatory markers, and other symptoms of colitis. Flares are most commonly treated with IV steroids, analgesia (avoid NSAIDs, opioids, anti-motility agents), antibiotics if there is a concern for an intra-abdominal infection, and other supportive care. Complications can include GI bleeding, strictures, fistulae, perforations, and intra-abdominal infections/abscesses. In severe cases, management will include initiating biologics or undergoing surgical management.