Gastrointestinal  Consult

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Gastrointestinal  Consult by Mind Map: Gastrointestinal  Consult

1. Abdominal Pain

1.1. Localized

1.1.1. RUQ Duration Short (30 min-1 hr), Continuous Persistent (4-6hr) With Systemic Symptoms

1.1.2. RLQ Progression Periumbilical w/ subsequent migration to RLQ Fatigue, prolonged diarrhea, weight loss, and fever Pain worsens during coitus/shortly after menses for females Midcycle pain, mild, unilateral, lasting for a few hours to days

1.1.3. LUQ History of Trauma, worse with inspiration Splenic Rupture Associated left shoulder pain, early satiety PE: enlarged spleen on abdominal palpation and Traube's space, or on UTZ

1.1.4. LLQ Constant pain several days before Localized peritoneal signs, DRE: mass/tenderness to palpation,

1.1.5. Epigastric Associated Symptoms Radiation of Pain Relation to Food Intake

1.1.6. Flank Dysuria, frequency, urgency, hematuria, PE: Costovertebral tenderness, Urinalysis: pyuria Renal colic, hematuria, NO fever CT/UTZ: stones

1.2. Generalized

1.2.1. (-) Abdominal Distention, non-bilious vomiting, not constipated Proximal/Small Bowels Obstruction

1.2.2. (+) Abdominal Distention, bilious vomiting, constipation Distal/Small Bowel Obstruction

1.2.3. Fever, ascites, peritoneal irritation PE: Hypotension, tenderness, guarding Peritonitis

1.2.4. Growth retardation and malnutrition, with or without obstruction Microscopy: eggs visualized, CBC: Eosinophilia, large collections visualized on plain film Parasitic Infection

2. Vomiting

2.1. Type of Vormitus

2.1.1. Undigested food Achalasia

2.1.2. Bile

2.1.3. Feculent/Odorous

2.2. Associated Symptoms

2.2.1. Abdominal Pain Organic Etiology

2.2.2. Diarrhea Acute Gastroenteritis

2.2.3. Abdominal distention and tenderness Bowel Obstruction

2.2.4. Relation to food intake Before Breakfast Inc. ICP Pregnancy During/Directly after meals 1-4 hours after a meal Gastric Outlet Obstruction Gastric Paresis

2.2.5. Heartburn and nausea

3. Diarrhea

3.1. Timing

3.1.1. </= 14 Days Acute Appearance of Stool Timing Exposure

3.1.2. 14-30 Days Persistent

3.1.3. >30 Days Chronic Parasitic Associated Symptoms

4. Jaundice

4.1. Hyperbilirubinemia

4.1.1. Mainly Unconjugated CBC, Retic count, Peripheral blood smear (+)Hemolysis (-)Hemolysis

4.1.2. Mainly Conjugated Liver Function Tests Normal AST, ALT, ALP AST/ALT > ALP (Hepatocellular) ALP > AST/ALT (Cholestatic)

5. GI Bleeding

5.1. Character of Bleed

5.1.1. Hematemesis/Melena UPPER BLEED - Proximal to the Ligament of Treitz Associated Symptoms Endoscopic Findings

5.1.2. Hematochezia LOWER BLEED - Distal to the Ligament of Treitz Signs of hypovolemia CBC: Hb at baseline (acute) Associated symptoms Colonoscopy

6. LEGEND: Green Border: History Red  Border: Physical Exam Blue Border: Diagnostics Arrows: for interconnected presentations