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Inflammatory Bowel Disease, Emergency Medicine

Shayle Miller Reviewed 06/2017
 


Basics

Description

  • Idiopathic, chronic inflammatory diseases of intestines, which can involve extraintestinal sites as well.

  • Differentiation between ulcerative colitis (UC) and Crohn's is not always cle...

Diagnosis

Signs and Symptoms

  • Crohn's disease can present with any clinical correlates of chronic inflammatory, fibrostenotic, or fistualizing illness.

  • UC may begin subtly or as catastrophic illness.

  • Cons...

Treatment

Pre-Hospital

Vital sign stabilization as per BLS 

Initial Stabilization/Therapy

  • IV 0.9% NS volume replacement if dehydrated

  • Transfusion if significant blood loss

Ed Treatment/Procedures

  • Nasogastri...

Follow-Up

Disposition

Admission Criteria

  • Surgical indication:

    • Massive, unresponsive hemorrhage

    • Perforation

    • Toxic dilation

    • Obstruction

  • Severe flare-up:

    • Electrolyte imbalance

    • Severe dehydration

    • Severe pain

    • High fe...

Pearls and Pitfalls

  • With severe flare, rule out toxic megacolon.

  • Consider Crohn's in children with growth/puberty delay.

  • Consider Crohn's with perianal disease.

  • Rule out C. difficile with flares; the inc...

Additional Reading

  • Ananthakrishnan  AN, Issa  M, Binion  DG. Clostridium difficile and inflammatory bowel disease. Gastroenterol Clin North Am.  2009;38(4):711–728.

  • Sandborn  WJ. New concepts in a...

Codes

ICD9

  • 555.9 Regional enteritis of unspecified site

  • 556.9 Ulcerative colitis, unspecified

  • 558.9 Other and unspecified noninfectious gastroenteritis and colitis

  • 555.2 Regional enteritis of small intest...

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