Investigations | Potential results | Clinical management plan |
---|---|---|
Actions from history, medication and dietary assessment | ||
History findings | Symptoms of heartburn/acid reflux: |
|
If within 2 weeks after surgery | Discuss with the surgical team within 24 hours. | |
Chemotherapy related | Contact team to change antiemetics urgently. | |
Persistent vomiting | This is an emergency. Contact the on-call medical team. | |
Nutritional compromise | Refer for dietetic advice. | |
First line | ||
Fundoscopy | Raised ICP | This is an emergency. Discuss immediately with the supervising clinician. |
Routine and additional blood tests | Metabolic abnormality | Discuss immediately with the supervising clinician. |
Liver/biliary abnormality | Discuss with the supervising clinician within 24 hours. | |
Suggestive of infection | Treat with antibiotics within level of confidence or discuss with a microbiologist/supervising clinician. | |
Urine analysis | Metabolic abnormality, eg, glucosuria, ketonuria | Discuss immediately with the supervising clinician. |
Infection | Treat with antibiotics within level of confidence or discuss with a microbiologist/supervising clinician within 24 hours. | |
AXR (if with pain) | Small bowel obstruction | This is an emergency. Discuss immediately with a GI surgeon and arrange urgent CT scan. |
Faecal loading | See management of constipation (p. 26). | |
Second line | ||
OGD and SI aspirate (p. 25) | Upper GI inflammation/ulceration | See management of acid or bile related inflammation (p. 25). Assess Helicobacter pylori and treat if positive. Discuss with the supervising clinician the need for future repeat endoscopy. |
Gastric dysmotility | Consider prokinetic (p. 26). | |
Pyloric stricture | Consider dilatation (p. 25) with careful biopsy only after agreement from the appropriate MDT. | |
SIBO | Management of SIBO (p. 27). | |
Glucose hydrogen methane breath test | SIBO | Management of SIBO (p. 27). |
US liver and pancreas | Biliary/hepatic/pancreatic aetiology | See jaundice (p. 18). |
CT/MRI/PET (head/chest/ abdomen/ pelvis) | Malignancy/tumour recurrence/lymphadenopathy | Discuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks. |
Consider also
| These are emergencies. Refer to the upper GI surgical team. | |
Mesenteric ischaemia | This is an emergency. Discuss with the on-call surgical team immediately. | |
Ascites | Discuss with the supervising clinician and the oncology team within 24 hours. | |
Third line | ||
If normal investigations/no response to intervention |
|
AXR, abdominal X-ray; CT, computerised tomography; GI, gastrointestinal; ICP, intracranial pressure; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PET, positron emission tomography; SI, small intestine; SIBO, small intestinal bacterial overgrowth; US, ultrasound.