Investigations | Potential results | Clinical management plan: abnormal results |
---|---|---|
1st Line | ||
Routine AND additional blood screen (pages 2–3) | Abnormal results | Follow treatment of abnormal blood results (pages 2–3). |
Abdominal X-ray | Severe faecal loading |
|
Dietary history | Inadequate fluid Inadequate/excessive fibre intake Excessive sorbitol Excessive caffeine |
|
Drug history/medications assessment | Consider stopping opiate drugs/metformin/statins/non-steroidal anti-inflammatory drugs. | |
2nd Line | ||
OGD and duodenal aspirate and/or glucose hydrogen methane breath test | SIBO | Treatment for SIBO (page 17). |
Stool for faecal elastase | EPI | Treatment for EPI (page 16). |
Dietary history ± challenge test for carbohydrate malabsorption | Carbohydrate intolerance | Treatment for carbohydrate malabsorption (pages 16–17). |
Ultrasound of biliary tree and abdomen and pelvis (and small bowel if no CT scan of abdomen and pelvis in the time symptoms have been present/last 3 months) | Suggestive of gallstones, inflammatory bowel disease, tumour recurrence, other | Discuss with supervising clinician and refer as clinically appropriate to a GI surgeon/gastroenterologist/oncology team. |
MRI small bowel | Small bowel stenosis | Discuss with supervising clinician and refer as clinically appropriate to a GI surgeon/gastroenterologist/oncology team. |
If all tests are negative, but symptoms persist |
|
EPI, exocrine pancreatic insufficiency; FODMAPs, fermentable oligo-, di- and mono-saccharides and polyols; GI, gastrointestinal; OGD, oesophago-gastroduodenoscopy; SIBO, small intestinal bacterial overgrowth.