Inflammatory Bowel Disease (IBD)
ASSESSMENT
Data Gathering
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History
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Disease severity
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Past medication management
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Past prednisone use
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History of liver disease
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Past abdominal surgeries
Symptoms
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Abdominal pain
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N/V
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GI bleeding
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Bowel habits
Exam
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Abdominal tenderness
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Ascites
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Spider angiomata
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Palmer erythema
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Asterixis
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Edema
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Altered mentation
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Splenomegaly
Risk Stratification
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No perioperative risk stratification tools specific for IBD have been developed. Risk stratification primarily involves assuring the patient's IBD is fully understood (obtain previous records), stable, and optimally managed.
Diagnostic Studies
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Complete metabolic panel (including hepatic function panel) and CBC within 4 months (sooner if any recent clinical change)
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ECG within 6 months if non-low-risk surgery (author opinion based on evidence suggesting long-term CV risk associated with IBD is similar to other "coronary disease equivalents" such as CKD)
MANAGEMENT
Indications for Surgical Delay
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Active IBD and non-urgent surgery
Medication Management
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Discuss with patient's IBD provider how immunomodulator therapy should be managed through surgery
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Limited evidence suggests that non-biologic therapies can be continued uninterrupted
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Provide aggressive VTE prophylaxis due to increased VTE risk in IBD patients
COUNSELING & COMMUNICATION
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Collaborate with patients' IBD providers