
Inflammatory Bowel Disease (IBD)
ASSESSMENT
Data Gathering
History
Symptoms
Exam
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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
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Abdominal pain
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N/V
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GI bleeding
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Bowel habits
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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
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