Investigations | Potential results | Clinical management plan |
---|---|---|
Actions from history, medication and dietary assessment | ||
History findings | Constipation | See management of constipation (p. 26). |
Dumping syndrome | See p. 20 (postprandial symptoms). | |
Medication findings |
| Consider stopping or alternative medications. |
Dietary findings |
|
|
First line | ||
Routine and additional blood tests | Abnormal results | Follow treatment for abnormal blood results (p. 2). |
In women, also check Ca 125 | Raised | Refer to gynaecology requesting an appointment within 2 weeks. |
AXR | Faecal loading | See management of constipation (p. 26). |
Ileus/obstruction | This is an emergency. Discuss immediately with GI surgeon and arrange urgent CT scan. | |
| Discuss with supervising clinician within 24 hours. | |
Second line | ||
OGD and SI aspirate and SI biopsies (p. 25) | SIBO | Management of SIBO (p. 27). |
Inadequate gastric emptying | Prokinetics (p. 26).Consider formal gastric emptying studies. | |
Coeliac disease | Refer to coeliac clinic/dietitians/gastroenterology. | |
Glucose hydrogen methane breath test | SIBO | Management of SIBO (p. 27). |
Stool sample for faecal elastase | EPI | Management of EPI (p. 26). |
Carbohydrate challenge | Carbohydrate intolerance/malabsorption | Management of carbohydrate malabsorption (p. 26). |
CT/MRI abdomen and pelvis | Intra-abdominal pathology, eg, ascites | Discuss with supervising clinician within 24 hours. |
Malignancy/tumour recurrence | Refer to appropriate MDT requesting an appointment within 2 weeks. | |
Third line | ||
US biliary tree and Doppler | Suggestive of gallstones, tumour recurrence | Discuss with supervising clinician and refer as clinically appropriate to a GI surgeon/gastroenterologist/oncology team. |
Malignancy/tumour recurrence | Refer to appropriate MDT requesting an appointment within 2 weeks. | |
Ascites | Discuss with supervising clinician within 24 hours. | |
MRI small bowel/enteroclysis/enterogram | Small bowel disease | Discuss with supervising clinician and refer as clinically appropriate to a GI surgeon/gastroenterologist/oncology team. |
Fourth line | ||
If normal investigations | Refer to dietitian for a trial of low FODMAPs diet. | |
Fifth line | ||
If no response to intervention |
Referral for gastroenterology for small bowel motility studies. | |
Reassure. |
AXR, abdominal X-ray; CT, computerised tomography; EPI, exocrine pancreatic insufficiency; FODMAPs, fermentable oligo-di-monosaccharides and polyols; GI, gastrointestinal; MDT, multidisciplinary team; MRI, magnetic resonance imaging; NSAID, non-steroidal anti-inflammatory drug; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); SI, small intestine; SIBO, small intestinal bacterial overgrowth; US, ultrasound.