Established Inflammatory Bowel Disease (IBD)

The Department will periodically contact patients waiting for an outpatient clinic appointment via SMS, with a link to an electronic form.  This is part of routine waitlist auditing to ensure patient details are up to date.  If you receive this SMS, please update your details.

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply to 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 Tasmanian Health Pathways website.

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 ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

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

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 ≥6x/day
  • Weight loss ≥5% of body weight in previous 6 months
  • Significant abnormalities in investigations i.e Hb <100 g/l, significant elevation of CRP or faecal calprotectin >200 mcg/g

Semi-urgent / category 2

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

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

GESA Guideline:Inflammatory Bowel Disease (2013)

Emergency:

Proceed to Emergency Department (ED).
LGH ED Reception  – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED* – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED* – Phone: (03) 6493 6351 Fax: (03) 6464 1926
RHH ED Reception – Phone: (03) 6166 6100  Fax: (03) 6173 0489

Advice for medical practitioners can be given by the Medical Officer In Charge (MOIC) - see HealthPathways Tasmania for contact information.
*MCH and NWRH MOICs request GPs call them prior to referring a patient to ensure the patient is being sent appropriately to a safe destination.

Urgent:

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:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment