Management of Inflammatory Bowel Disease Flares in the Emergency Department -
Publication Date: November 2017 (Volume 19, Number 11)
Michael D. Burg, MD
Associate Clinical Professor of Emergency Medicine, University of California San Francisco-Fresno; Emergency Medicine Residency Program, Community Regional Medical Center, Fresno, CA
Steven T. Riccoboni, MD
Clinical Instructor of Emergency Medicine, Department of Emergency Medicine, University of California San Francisco-Fresno, Fresno, CA
Andrew Lee, MD
Associate Vice Chair of Operations, Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
Chad Roline, MD
Emergency Physician, North Memorial Health, Robbinsdale, MN
Because of the chronic relapsing nature of inflammatory bowel disease (IBD), emergency clinicians frequently manage patients with acute flares and complications. IBD patients present with an often-broad range of nonspecific signs and symptoms, and it is essential to differentiate a mild flare from a life-threatening intra-abdominal process. Recognizing extraintestinal manifestations and the presence of infection are critical. This issue reviews the literature on management of IBD flares in the emergency department, including laboratory testing, imaging, and identification of surgical emergencies, emphasizing the importance of coordination of care with specialists on treatment plans and offering patients resources for ongoing support.
Excerpt From This Issue
At the start of your shift, you log on and click into your first ED chart of the day and sigh, “Not again.” It’s the chart of one of your “frequent flyers,” a young woman who has come to the ED several times in the past few months with a variety of nonurgent complaints. Itching eyes is one. “I seem to be tired all the time,” is another. “I have fevers sometimes.” “My muscles ache. My joints hurt sometimes.” Her workups are always unrevealing. She carries multiple diagnoses, many nonspecific: anemia, possible depression, medication-seeking behavior, myalgias, possible malingering, etc. Today’s chief complaint is abdominal pain. “It's going to be a heck of a day, if this is the start of it,” you think, but remembering how bias can cloud decision-making, you take a deep breath and enter the exam room...