Inflammatory Bowel Disease (IBD) - Diagnosis and Management ...
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Inflammatory Bowel Disease (IBD) - Diagnosis and Management Summary

When to Suspect IBD? (Crohn’s disease = CD, Ulcerative Colitis = UC)

 • Epidemiology: Onset 15-40y, bimodal in CD w/ 2nd peak 50-80y. Genetic predisposition (up to 25% variance per GWAS studies; ↑ incidence in Jews, Caucasians) + environment (↑risk w/ Western diet, abx exposure, NSAID use, smoking ↑ risk for CD & ↓ risk for UC)

 • GI manifestations: Abd pain, diarrhea, bloody stools (UC>CD), incontinence/soiling, tenesmus, N/V, oral ulcers, perianal dz (CD)

 • Extra-intestinal manifestations: Rheum (seronegative arthritis, sacroilitis), cutaneous (erythema nodosum, pyoderma gangrenosum), ophthalmic (uveitis, iritis, episcleritis), heme (DVT, AIHA), GI (PSC, B12 def), GU (Ca-Ox or UA stones), pulm (bronchiectasis, ILD)

 • CD: Skip lesions, fibrosis/strictures, fistulae, transmural inflammation, noncaseating granulomas, cobblestoning

 • UC: Continuous colonic mucosal inflammation spreading proximally from rectum, crypt abscesses, pseudopolyps

 • Complications: Toxic megacolon (5% of UC), obstruction (2/2 strictures), abscesses, fistulae (CD), malabsorption, 2o amyloid, ↑risk CRC

Inpatient Work-up and Management:

 • H&P: baseline pain, BRBPR, #BM/consistency, #BM at night, surgical hx, date of onset, presenting sx, dz extent (fistulizing, stricturing, for CD), new meds (OTCs, NSAIDs, abx), smoking, nutrition/TPN, travel, extra-intest. sxs, current/past IBD meds → compliance/efficacy

 • Labs: CBC, Chem 10, LFTs (↑ALP→?PSC), ESR/CRP, Mg, fecal calprotectin/lactoferrin,  

 • Stool Cx, O&P, C. diff, Fe/TIBC/B12 (if anemic) 

 • Imaging: if physical exam suggests peritonitis/obstruction/mass (abscess) → KUB upright or CT A/P. Consider MRE to eval sm intestine.

Mild:

 • <4 stools (bloody or not), afebrile, nl ESR 

 • Ambulatory, tolerates PO/no dehydration, no pain/toxicity

Moderate:

 •  4-6 BM, bloody BM, low fever, ↑pain, mild anemia 

 • Failed 1st line tx, low fever, N/V, wt loss, pain, anemia

Severe:

 • >6 BMs, Hb <10.5, fever, HR>90, wt loss, ESR >30 

 • Failed advanced tx, toxic, abscess, obstruction, peritonitis, cachexia



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