Established Inflammatory Bowel Disease (IBD)

This condition is treated in the Gastroenterology clinic.

Pre-referral work-up

History

All referrals should comply to the referral standards and include in particular:

History:

• Crohn's
• Ulcerative colitis
• Indeterminate colitis
• Site: proctitis, left colon, pancolitis, small bowel
• Details of any previous endoscopies (date, result)
• Complications e.g. fistula
• Extra intestinal manifestations e.g. arthritis, iritis, erythema nodosum

Tests

Pathology:

LFT

FBC

U&E

iron studies

CRP

Stool M/C/S and PCR including Clostridium difficile (Category 1 referrals only)

Stool calprotectin

Imaging:

Any relevant

Investigations:

Nil

Interim/GP management

To refer a patient with this condition, please see the Gastroenterology clinic page for the full referral process and templates.

For more information please see the HealthPathways Tasmania website.

GESA Guideline: Inflammatory Bowel Disease (2013)

Clinic appointments

🚩 Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency

🚩 Potentially life-threatening symptoms suggestive of:

• acute upper GI tract bleeding
• acute severe lower GI tract bleeding
• oesophageal foreign bodies/food bolus
• bowel obstruction
• abdominal sepsis

🚩 Acute Severe Colitis - see note

🚩 Severe vomiting and/or diarrhoea with dehydration
🚩 Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
🚩 Biliary sepsis (to be referred to a centre with ERCP service)

Note: Acute severe colitis as defined by the Truelove and Witts criteria - all patients with greater than or equal to 6 bloody bowel motions per 24 hours plus at least one of the following:

• temperature at presentation of over 37.8°C,
• pulse rate at presentation of over 90 bpm,
• haemoglobin at presentation of under 105 gm/l, CRP over 30mg/dl at presentation (or ESR over 30 mm/hr)

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Urgent (Category 1)

Previously diagnosed or suspected inflammatory bowel disease with any of the following concerning features:

• Rectal bleeding
• Symptoms of bowel obstruction
• Fever and/or abdominal / perineal mass
• Significant diarrhoea greater than or equal to6x/day
• Weight loss greater than or equal to5% of body weight in previous 6 months
• Significant abnormalities in investigations i.e Hb under 100 g/l, significant elevation of CRP or faecal calprotectin over 200 mcg/g

We will endeavour to see these patients within four weeks

Urgent referrals should be accompanied by a phone call to the clinic and the relevant doctor for urgent assessment, or patient should be directed immediately to the Emergency Department.

Semi-urgent (Category 2)

• Stable previously diagnosed inflammatory bowel disease without concerning features (as above)
• Suspected/un-diagnosed IBD without concerning features (as above)

Availability

North

Launceston General Hospital
Level 3 - Specialist Clinics

Phone: 1300 977 694
Fax: 03 6777 5227

North West

All North West referrals are managed via  Mersey Community Hospital
Phone: 03 6478 5222
Fax: 03 6441 5942

South

Wellington Clinics (Level 10)
Phone: 03 6166 0000
Fax: 03 6234 3982