© 2018 Kurt Pfeifer.

Inflammatory Bowel Disease (IBD)

ASSESSMENT

Data Gathering

History

Symptoms

Exam

  • Disease severity

  • Past medication management

  • Past prednisone use

  • History of liver disease

  • Past abdominal surgeries

  • Abdominal pain

  • N/V

  • GI bleeding

  • Bowel habits

  • Abdominal tenderness

  • Ascites

  • Spider angiomata

  • Palmer erythema

  • Asterixis

  • Edema

  • Altered mentation

  • 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

  • Complete metabolic panel (including hepatic function panel) and CBC within 4 months (sooner if any recent clinical change)

  • 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

  • Active IBD and non-urgent surgery

Medication Management

  • Discuss with patient's IBD provider how immunomodulator therapy should be managed through surgery

    • Limited evidence suggests that non-biologic therapies can be continued uninterrupted​

  • Provide aggressive VTE prophylaxis due to increased VTE risk​ in IBD patients

COUNSELING & COMMUNICATION

  • Collaborate with patients' IBD providers