Gastrointestinal  Consult

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Gastrointestinal  Consult by Mind Map: Gastrointestinal  Consult

1. Abdominal Pain

1.1. Localized

1.1.1. RUQ

1.1.1.1. Duration

1.1.1.1.1. Short (30 min-1 hr), Continuous

1.1.1.1.2. Persistent (4-6hr)

1.1.1.1.3. With Systemic Symptoms

1.1.2. RLQ

1.1.2.1. Progression

1.1.2.1.1. Periumbilical w/ subsequent migration to RLQ

1.1.2.1.2. Fatigue, prolonged diarrhea, weight loss, and fever

1.1.2.1.3. Pain worsens during coitus/shortly after menses for females

1.1.2.1.4. Midcycle pain, mild, unilateral, lasting for a few hours to days

1.1.3. LUQ

1.1.3.1. History of Trauma, worse with inspiration

1.1.3.1.1. Splenic Rupture

1.1.3.2. Associated left shoulder pain, early satiety

1.1.3.2.1. PE: enlarged spleen on abdominal palpation and Traube's space, or on UTZ

1.1.4. LLQ

1.1.4.1. Constant pain several days before

1.1.4.1.1. Localized peritoneal signs, DRE: mass/tenderness to palpation,

1.1.5. Epigastric

1.1.5.1. Associated Symptoms

1.1.5.1.1. Radiation of Pain

1.1.5.1.2. Relation to Food Intake

1.1.6. Flank

1.1.6.1. Dysuria, frequency, urgency, hematuria,

1.1.6.1.1. PE: Costovertebral tenderness, Urinalysis: pyuria

1.1.6.2. Renal colic, hematuria, NO fever

1.1.6.2.1. CT/UTZ: stones

1.2. Generalized

1.2.1. (-) Abdominal Distention, non-bilious vomiting, not constipated

1.2.1.1. Proximal/Small Bowels Obstruction

1.2.2. (+) Abdominal Distention, bilious vomiting, constipation

1.2.2.1. Distal/Small Bowel Obstruction

1.2.3. Fever, ascites, peritoneal irritation

1.2.3.1. PE: Hypotension, tenderness, guarding

1.2.3.1.1. Peritonitis

1.2.4. Growth retardation and malnutrition, with or without obstruction

1.2.4.1. Microscopy: eggs visualized, CBC: Eosinophilia, large collections visualized on plain film

1.2.4.1.1. Parasitic Infection

2. Vomiting

2.1. Type of Vormitus

2.1.1. Undigested food

2.1.1.1. Achalasia

2.1.2. Bile

2.1.3. Feculent/Odorous

2.2. Associated Symptoms

2.2.1. Abdominal Pain

2.2.1.1. Organic Etiology

2.2.2. Diarrhea

2.2.2.1. Acute Gastroenteritis

2.2.3. Abdominal distention and tenderness

2.2.3.1. Bowel Obstruction

2.2.4. Relation to food intake

2.2.4.1. Before Breakfast

2.2.4.1.1. Inc. ICP

2.2.4.1.2. Pregnancy

2.2.4.2. During/Directly after meals

2.2.4.3. 1-4 hours after a meal

2.2.4.3.1. Gastric Outlet Obstruction

2.2.4.3.2. Gastric Paresis

2.2.5. Heartburn and nausea

3. Diarrhea

3.1. Timing

3.1.1. </= 14 Days

3.1.1.1. Acute

3.1.1.1.1. Appearance of Stool

3.1.1.1.2. Timing

3.1.1.1.3. Exposure

3.1.2. 14-30 Days

3.1.2.1. Persistent

3.1.3. >30 Days

3.1.3.1. Chronic

3.1.3.1.1. Parasitic

3.1.3.1.2. Associated Symptoms

4. Jaundice

4.1. Hyperbilirubinemia

4.1.1. Mainly Unconjugated

4.1.1.1. CBC, Retic count, Peripheral blood smear

4.1.1.1.1. (+)Hemolysis

4.1.1.1.2. (-)Hemolysis

4.1.2. Mainly Conjugated

4.1.2.1. Liver Function Tests

4.1.2.1.1. Normal AST, ALT, ALP

4.1.2.1.2. AST/ALT > ALP (Hepatocellular)

4.1.2.1.3. ALP > AST/ALT (Cholestatic)

5. GI Bleeding

5.1. Character of Bleed

5.1.1. Hematemesis/Melena

5.1.1.1. UPPER BLEED - Proximal to the Ligament of Treitz

5.1.1.1.1. Associated Symptoms

5.1.1.1.2. Endoscopic Findings

5.1.2. Hematochezia

5.1.2.1. LOWER BLEED - Distal to the Ligament of Treitz

5.1.2.1.1. Signs of hypovolemia

5.1.2.1.2. CBC: Hb at baseline (acute)

5.1.2.1.3. Associated symptoms

5.1.2.1.4. Colonoscopy

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