Investigations | Potential results | Clinical management plan |
---|---|---|
Actions from history, medication and dietary assessment | ||
History findings | No other GI symptoms present |
|
Dietary findings | Inadequate dietary intake/malabsorption | Refer for dietetic advice. |
First line | ||
Routine and additional blood tests | Abnormal results | Follow treatment for abnormal blood results (p. 2). |
Stool for faecal elastase | Pancreatic insufficiency | Management of EPI (p. 26). |
US/CT/MRI/PET | 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. | |
Second line | ||
OGD with SI biopsies | Upper GI tract inflammation (p.25) |
|
Malignancy/tumour recurrence | Refer to the appropriate MDT requesting an appointment within 2 weeks. | |
Third line | ||
PET scan | PET scan positive | Discuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks. |
PET scan negative |
| |
Fourth line | ||
If normal investigations/no response to intervention | Consider colonoscopy. Refer to gastroenterology. |
CT, computerised tomography; EPI, exocrine pancreatic insufficiency; GI, gastrointestinal; H2, histamine receptor 2; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PET, positron emission tomography; SI, small intestine; US, ultrasound.