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<< Management of Inflammatory Bowel Disease Flares in the Emergency Department (Pharmacology CME)

Risk Management Pitfalls for Inflammatory Bowel Disease Flares

1. “He came in with painful bumps on his shins, anemia, and some joint pain; how was I to know it was IBD?”

The painful shin bumps may be erythema nodosum, a dermatologic manifestation of IBD. Anemia, which may be multifactorial, often coexists with IBD. Finally, musculoskeletal manifestations are perhaps the most common of the extraintestinal manifestations of IBD. These findings and many others often coexist with, and flare with, IBD disease activity.

2. “I give antibiotics to every IBD patient with a disease flare.”

Consider checking with your patient’s gastroenterologist, but try to save the antibiotics to treat those with a high likelihood of, or proof of, a bacterial infection. Infectious colitis, toxic megacolon, bowel perforation, intra-abdominal abscess and other infections (pyelonephritis, cholecystitis) are indications for antibiotics. Admittedly, it can be difficult to distinguish a “flaring” patient from an infected one, since both may have temperature elevations and laboratory findings indicating possible infection. Flare due to infection or coexisting with infection is possible as well.

3. “I can’t CT everyone with abdominal pain and bloody stools.”

That’s a true statement, nor should you obtain a CT on every IBD patient with abdominal pain and bloody stools. However, certain IBD patients need imaging, and CT may the most expeditious way to get the information you need to care for these individuals. Consider CT (or alternate imaging, if feasible) in IBD patients for whom there is a concern for IBD-related surgical emergencies or other abdominopelvic but non- IBD-related diagnoses: for example, patients with severe pain and signs of sepsis.

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