#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)
  • Lipase
  • 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.