Inflammatory Bowel Disease: Crohn’s/Ulcerative Colitis

Crohn’s/UC: (Crohn’s: tender RLQ; UC: LLQ) flare possibly secondary to stress/pain elsewhere (ex: kidney stone)

  • CT of abdomen and pelvis with contrast to look for abscess – May need to consult surgery if big abscess
  • Cover bowel (GI) flora (Diverticulitis/Crohn’s abscess):
    1. Ciprofloxacin and Flagyl. And/or Zosyn, Levoquin (levofloxacin), or Rocephin 1g IV qd [Levoquin and Flagyl] or Rocephin and Flagyl
      1. Levofloxacin 750mg/D5W 150ml IV qd
      2. Metronidazole (Flagyl) 500mg/NS 100ml IV q6-8hrs
  • Meropenum 1g IV q8hr
    1. Carbapenums: ultra-broad spectrum (Gram POS, Gram NEG, and ANaerobes)
      1. Imipenum: more Gram POS coverage
      2. Meropenum: more Gram NEG coverage (including Pseudomonas, Enterobacteria: E. coli, Klebsiella, Proteus, Serratia)

(ANaerobic pathogens are almost universally susceptible to: Metronidazole (Flagyl), Piperacillin (Zosyn), Ampicillin-sulbactam, Ticarcillin-clavulanic acid, Amoxacillin-clavulanic acid, and Imipenem. Generally are susceptible to Cefoxitin and Clindamycin.)

  • Keep NPO. FOBT.
  • Consult GI (ideally GI that has seen pt before, ex: Dr. Mark Young, Dr. Welch, Dr. Chakradhar M Reddy, MD)
  • Crohn’s meds:
    1. Azathioprine 50-100mg PO qd
    2. Mesalamine SR 500-1,000 mg PO SR 4X/day (q6hr)
      1. Mesalazine (mesalamine or 5-aminosalicylic acid) an anti-inflammatory drug
    3. Prednisone 20mg PO bid
  • Pain control:
    1. Lortab 10 PO q4-6hrs (scheduled)
    2. Morphine 4mg IV q3hr PRN for breakthrough pain.
  • Other:
    1. Protonix 40mg IV qd
    2. MIVF: D5/ ½ NS + KCl 20 mEq IV @ 125ml/hr
    3. Continue supportive care with IV fluids.
    4. Okay for clear liquid diet and advance as tolerated.
    5. No steroid therapy at this time.
    6. Would give the patient’s Cimzia dose early.
    7. Avoid narcotics. [contribute to ileus]
    8. We will start the patient on a probiotic.
    9. Will check a CT abdomen pelvis with IV and oral contrast.

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