Include IBD in the differential diagnosis of any patient presenting with abdominal pain, abdominal distention, diarrhea (especially bloody diarrhea), perianal disease, or any of the many extraintestinal manifestations described in this review, especially those involving the skin, musculoskeletal system, or eyes. IBD’s extraintestinal manifestations can occur concurrently with gastrointestinal manifestations of IBD or they may precede them. Some undiagnosed IBD patients may present to the ED repeatedly, with wide-ranging nonspecific complaints (chronic intermittent abdominal pain, fatigue, etc) before they are appropriately referred, worked up, and definitively diagnosed.
Laboratory abnormalities (anemia, leukocytosis, thrombocytosis, hypoalbuminemia, elevated CRP and ESR) are common in IBD patients, especially in those with active disease, but normal laboratory values do not exclude the diagnosis of IBD. One cannot use laboratory tests alone to distinguish IBD flares from complications.
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