#EMConf: Inflammatory Bowel Disease in the ED!
EP Management Goals:
- Resuscitate/ stabilize patient and restore fluid balance and electrolytes
- Symptom control
- Identify IBD manifestations that are urgent/ emergent → 1. Obstruction 2. Toxic megacolon/ perforation 3. Life-threatening hemorrhage 4. Intra-abdominal abscess
HPI elements GI wants to know
1. # of stools
2. Hx of flares/ complications
3. Last colonoscopy
4. meds/ immunomodulators
5. Location of disease
Work up GI wants
- CBC + BMP
- LFT’s (ALK-P important as IBD can have liver involvement)
- ESR/CRP (these are trended during a flare as a marker of disease progression)
- Stool studies, especially C.Diff, as GI needs negative C.Diff before starting steroids.
- Low threshold for CT A/P; consider IV and PO contrast to help in obstruction and fistula dx
- IV fluids and symptomatic control
- Solu-Medrol 1 mg/kg q12h in discussion with GI; often wait for C.Diff results
- +/- Cipro + Flagyl in discussion with GI if concern for infectious colitis
- Ask GI regarding holding or continuing maintenance medications for IP team
- majority of patients require admission as they have usually had a trial of outpatient management, discharge only after discussion with GI.