Inflammatory Bowel Disease: Flare Up Ulcerative Colitis

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Ulcerative Colitis Flare Up

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Inflammatory Bowel Disease: Flare Up Ulcerative Colitis
-DDx includes: Escherichia coli 0157:H7, Clostridium difficile, microscopic, lymphocytic, and collagenous colitis. irritable bowel disease, and celiac disease.
-Likely ulcerative colitis flare due to hx of ulcerative colitis, bloody diarrhea w/wo mucus, tenesmus, and left quadrant abdominal pain. 
-CBC, iron panel, ESR, CRP, b12, folate, vitamin D, lactoferrin, fecal calprotectin, p-anca, anti-saccharomyces cerevisiae antibodies, and stool o&p studies.
-Obtain abdominal imaging to r/o free air, bowel obstruction, rectal fistula, abscess or toxic megacolon.
-If severe pain, fever, abdominal distension, rebound pain, chills +/- lethargy will STAT page Gastroenterology and surgeon due to concerns of toxic megacolon.
-Monitor for development of primary sclerosing cholangitis.
-Digital rectal exam, if concern for rectal abscess, rectal fistula or prolapse.
-Will treat flare in step wise. Severity Index for Ulcerative Colitis. Patient disease is XXXX.
-Will initiate aminosalicylates sulfasalazine/mesalamine for mild disease.
-Will initiate po/ IV steroids, if not responding to aminosalicylates or disease is moderate to severe. Steroid taper prior to discharge and switch to non-steroid maintenance.
-Consulted GI for co-management and initiation of cyclosporine or anti-TNF, if refractory. Reviewed Uptodate on choice of immunomodulator. Discuss with gastroenterologist.
-If decompensates or sx refractory or concerns of megacolon, will emergently consult surgery for evaluation and possible colectomy/ resection/ endoscopic dilation.
-Screening/surveillance for colorectal cancer. Appointment made for discharge f/u with GI and PCP.

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