Complications of IBD

● Severe GI bleeding → occurs in 10% of UC patients; usual GIB management

● Fulminant Colitis → 10+ stools per day; often bloody, pain, fever, anorexia

● Toxic Megacolon → colonic diameter >  6cm; cecal diameter > 9cm

 Clinical → ill-appearing, hypotensive, tachycardic, abd pain/ distension, peritonitis

 Management -> Resuscitate, IVF, symptom control, correct electrolytes

 Consider obstruction series for free air and bowel edema

 Broad spectrum antibiotics and early surgical consult

Avoid anticholinergics, antimotility agents and opioids; NGT not helpful

● Perforation → often secondary to toxic megacolon; resuscitate + abx + surgery consult

● Anorectal Abscess → Crohn’s > UC; Tx with Cipro + Flagyl; consult colorectal surgery

● Fistula → MRI preferred for dx; Tx = abx + immunomodulators v. surgery

● Strictures → presents like obstruction; consult GI/surgery for definitive management

Other IBD Considerations:

● Fissure → can lead to fistula or abscess so Cipro + Flagyl if no improvement in 5 days

● If ileocecal area removed or diseased → higher risk for biliary disease bc of bile salt malabsorption

● IBD patients are hypercoagulable and more at risk for DVT/ PE during acute flare

● Extraintestinal maninfestations:

○ Ocular → uveitis, episcleritis

○ MSK → arthritis, osteoporosis secondary malabsorption, osteonecrosis secondary to steroids

○ Aphthous ulcers

○ Cutaneous →Erythema nodosum, pyoderma gangrenosum (don’t debride or I&D)

○ Sclerosing cholangitis