InvestigationsPotential resultsClinical management plan: abnormal results
FundoscopyRaised ICPThis is an emergency
Discuss immediately with supervising clinician and the oncology or neurology team.
Trial of PPIInflammatory (acid related)Reassess after 2–4 weeks as clinically indicated.
Blood screen+morning cortisol levelMetabolic abnormalityDiscuss immediately with supervising clinician and consider referral to endocrinology within 24 h.
Liver/biliary abnormalityDiscuss with supervising clinician within 24 h.
Suggestive of infectionTreat with antibiotics within level of confidence or discuss with microbiologists and supervising clinician.
Urine analysisMetabolic abnormality, eg, glucosuria, ketonuriaDiscuss immediately with supervising clinician.
InfectionTreat with antibiotics within level of confidence or discuss with microbiologists and supervising clinician within 24 h.
OGD
± assessment for Helicobacter pylori		Inflammatory/ulcerative disease

  1. PPI and helicobacter eradication therapy.

  2. Sucralfate.

  3. Promotility agents.

  4. Discuss with supervising clinician need for future repeat endoscopy.

Gastric dysmotilityConsider a prokinetic medication (page 20) (eg, domperidone, metoclopramide, erythromycin).
Glucose hydrogen (methane) breath testSIBOTreatment for SIBO (page 17).
Hepatic and pancreatic ultrasoundBiliary/hepatic/pancreatic aetiologyDiscuss with gastroenterologist or hepatology team.
If acute jaundice/cholangitis: this is an emergency.
CXR/CT/MRI
(including CNS)		Local or distal infectionTreat with antibiotics within level of confidence or discuss with microbiologists and supervising clinician.
Central nervous system pathologyThis is an emergency
Discuss immediately with supervising clinician and the oncology or neurology team.
Bowel obstructionThis is an emergency
Discuss immediately with a GI surgeon.
If all tests are negative, but symptoms persist

  1. Consider contributing psychological factors.

  2. Consider referral for psychological support if there is a possible underlying eating disorder.

  3. Consider a routine referral to a gastroenterologist for further management.

  • GI, gastrointestinal; OGD, oesophago-gastroduodenoscopy; PPI, ; SIBO, small intestinal bacterial overgrowth.