Case 1.2

Risk stratifying the patient by degree of illness can be useful in initial workup of any patient.

Identifying mimickers of an IBD flare is vital in initial workup. Furthermore, administering steroids in the setting of an active C. diff infection without other clear evidence of IBD flare would be contraindicated.

Identifying mimickers of an IBD flare is vital in initial workup.

Identifying mimickers of an IBD flare is vital in initial workup.

Identifying mimickers of an IBD flare is vital in initial workup.

Given evidence of systemic infection with his persistent symptoms, fatigue and weight loss, evaluating for bacteremia is reasonable.

This test is not necessary both because it can be falsely positive in the setting of active bloody stools and because inflammation can be assessed more directly with endoscopy.

PPD should be placed on admission in a patient with acute severe ulcerative colitis with no documented negative TB test in the prior six months as active TB infection is a contraindication to some rescue therapies.

Hepatitis B serologies should be sent in patients with no documented prior testing as immunosuppression can lead to reactivation of hepatitis B.

Full colonoscopy is often avoided in the setting of severe colitis because of increased perforation risk.

Upper Endoscopy is not indicated in a patient with no symptoms of upper gastrointestinal disease.

At a minimum, abdominal plain film can show an obstructive bowel gas pattern or evidence of distal colonic distension concerning for toxic megacolon

While not necessary, in a patient in whom complications are suspected due to systemic symptoms, abnormal vital signs, labs, or exam, cross sectional imaging is more sensitive than plain film.

Normally, a flexible sigmoidoscopy is all that is needed to assess for disease severity in an acute flare of ulcerative colitis and can allow for biopsies to rule out infections like CMV.