University Medical Center at Brackenridge. Gastroenterology Clinic Worksheet

Similar documents
Pediatric Gastroenterology Referral Guidelines

Western Health Specialist Clinics Access & Referral Guidelines

GASTROENTEROLOGY ESSENTIALS

June By: Reza Gholami

A Trip Through the GI Tract: Common GI Diseases and Complaints. Jennifer Curtis, MD

CHRONIC DIARRHEA DR. PHILIP K. BLUSTEIN M.D. F.R.C.P.(C) DEFINITION: *LOOSE, WATERY STOOLS *MORE THAN 3 TIMES A DAY *FOR MORE THAN 4 WEEKS

Corporate Medical Policy

REFERRAL GUIDELINES GASTROENTEROLOGY

May 2015 CLINICAL REFERENCE. gastroenterology

The most current assessment of this problem can be found in the Apex note dated

GUIDANCE ON THE INDICATIONS FOR DIAGNOSTIC UPPER GI ENDOSCOPY, FLEXIBLE SIGMOIDOSCOPY AND COLONOSCOPY

Treatment of Helicobacter pylori Infection

The 2012 SAGE Wait Time Program: Survey of Access to GastroEnterology in Canada Can J Gastroenterol 2013;27:83-9.

Medical Necessity Guidelines: Upper GI Endoscopy: Certain Elective Procedures

Management of dyspepsia and of Helicobacter pylori infection

Gastroenterology and Feeding Issues in Fanconi Anemia

Objectives. Identify age-related changes in the gastrointestinal tract

Gastrointestinal, Hepatic, and Nutritional Challenges in FA

Patient Interview Form

Gastroenterology. Certification Examination Blueprint. Purpose of the exam

Fecal incontinence causes 196 epidemiology 8 treatment 196

Lahey Clinic Internal Medicine Residency Program: Curriculum for Gastroenterology

Patient Interview Form

Patient Interview Form

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT OF DYSPEPSIA

GI update. Common conditions and concerns my patients frequently asked about

Treatment of Inflammatory Bowel Disease. Michael Weiss MD, FACG

Helicobacter Pylori Testing HELICOBACTER PYLORI TESTING HS-131. Policy Number: HS-131. Original Effective Date: 9/17/2009

Peptic ulcer disease Disorders of the esophagus

Patient Interview Form

Managing Upper GI Tract Disease. Michael Herzlinger, MD Pediatric Gastroenterology 7/2018

Gastroenterology Fellowship Program

Patient Interview Form

GASTROINTESTINAL AND ANTIEMETIC DRUGS. Submitted by: Shaema M. Ali

Viral hepatitis. Supervised by: Dr.Gaith. presented by: Shaima a & Anas & Ala a

IBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition

JOHN MICHAEL ROACH, MD

MANAGEMENT OF DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)

Monash Health Referral Guidelines

Chronic diarrhea. Dr.Nasser E.Daryani Professor of Tehran Medical University

Endoscopy When to use it and How to get the most out of it. Dr Deepak Suri Consultant Gastroenterologist/Hepatologist. Highgate Private Hospital

Gastroenterology. 3. Which of the following clotting factors is dependent on Vitamin K? a) II b) VII c) IX d) X e) All of the above

IBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition

GASTROENTEROLOGY Maintenance of Certification (MOC) Examination Blueprint

PATIENT INFORMATION (Please print all information) Date:

Chapter 14: Training in Radiology. DDSEP Chapter 1: Question 12

Setting The setting was secondary care. The economic study was carried out in Hong Kong, China.

6/25/ % 20% 50% 19% Functional Dyspepsia Peptic Ulcer GERD Cancer Other

Guidelines for the Management of Dyspepsia and GORD. Gastroenterology/ Acute Adult Governance. Drugs and Therapeutics Committee

Clinical Policy Title: Noninvasive testing for H. pylori

Clinical Policy Title: Noninvasive testing for H. pylori

Proton Pump Inhibitors Drug Class Prior Authorization Protocol

Bloating, Flatulence, and

Division of GIM Lecture Series Case Presentation David A. Erickson, M.D October 9th, 2013

Last Revised: September 15 Last Reviewed: September EOSINOPHILIC ESOPHAGITIS (EOE)/PPI-RESPONSIVE ESOPHAGEAL EOSINOPHILIA (PPI-REE)

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Reflux of gastric contents, particularly acid, into the esophagus

CHAPTER 11 Functional Gastrointestinal Disorders (FGID) Mr. Ashok Kumar Dept of Pharmacy Practice SRM College of Pharmacy SRM University

58 year old male complaining of 3-week history of increasing epigastric pain

Urea Breath Test for Diagnosis of Helicobactor pylori. Original Policy Date 12:2013

I. Definitions. V. Evaluation A. History B. Physical Exam C. Laboratory evaluation D. Bone marrow examination E. Specialty referrals

Patient Interview Form

Clinical problems related to GI involvement in SSc

PEPTIC ULCER DISEASE JOHN R SALTZMAN, MD. Director of Endoscopy Brigham and Women s Hospital Professor of Medicine Harvard Medical School

Irritable Bowel Syndrome vs Inflammatory Bowel Disease

End Stage Liver Disease & Disease Specific Indications for Liver Transplant. Susan Kang, RN, MSN, ANP-BC

End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC

Patient History Form

Patient Interview Form

Gastroenterology New Patient Form. 1) Patient's name: Age:. Date of Birth: Labs X-rays CT scan Barium Ultrasound Endoscopy Colonoscopy Dates:

Clinical Policy Title: Noninvasive testing for H. pylori

Patient Interview Form

Bowel cancer risk in the under 50s. Greg Rubin Professor of General Practice and Primary Care

ABDOMINAL PAIN AND DIARRHEA - IT S NOT (ALWAYS) WHAT YOU THINK. Yakov Wainer, MD Gastroenterology and Hepatology Meir Medical Center

Bleeding in the Digestive Tract

QUICK QUERIES. Topical Questions, Sound Answers

Esophageal Disorders. Gastrointestinal Diseases. Peptic Ulcer Disease. Wireless capsule endoscopy. Diseases of the Small Intestine 7/24/2010

MEDICAL DIAGNOSES IN CHILDREN WITH DEVELOPMENTAL DELAY MEDICAL DIAGNOSES IN CHILDREN WITH DEVELOPMENTAL DELAY AGE (YRS)

Management of Dyspepsia

Diet and Gastrointestinal Problems

Diarrhea may be: Acute (short-term, usually lasting several days), which is usually related to bacterial or viral infections.

NEW CONCEPTS IN CROHN S DISEASE GLENDON BURRESS, MD PEDIATRIC GASTROENTEROLOGY ROCKFORD, IL

Bend Surgical Associates. Michael J. Mastrangelo, MD, FACS. Medication Name Dosage Frequency Medication Name Dosage Frequency

GASTROENTEROLOGY PATIENT QUESTIONNAIRE - PLEASE PRINT

Patient Interview Form

GI CANCER SCREENING- Is It Worth It? Sylvia M. Oats, MSN, APRN, ANP-BC Susan H. Miedecke, MSN, APRN, FNP-BC Gastroenterology Clinic of Acadiana

Chapter 34. Nursing Care of Patients with Lower Gastrointestinal Disorders

The Usefulness of Capsule Endoscopy

Health History Questionaire

HEPATITIS B NON-IMMEDIATE NOTIFICATION EPIDEMIOLOGY PROGRAM

CAPSULE ENDOSCOPY REFERRAL PROCESS & GUIDELINE

CHAPTER 18. PEPTIC ULCER DISEASE, SELF-ASSESSMENT QUESTIONS. 1. Which of the following is not a common cause of peptic ulcer disease (PUD)?

GASTROINTESTINAL SYSTEM MANAGEMENT OF DYSPEPSIA

Saliva & Feces analysis

When to Refer for OGD and the Work Up of Upper GI Malignancies

Clinical Policy: Helicobacter Pylori Serology Testing Reference Number: CP.MP.153

Clinical Policy Title: Breath Testing for H. Pylori

MEDICAL POLICY EFFECTIVE DATE: 05/19/11 REVISED DATE: 05/24/12, 05/23/13 ARCHIVED DATE: 05/22/14 EDITED DATE: 05/28/15, 05/25/16, 05/18/17, 05/17/18

2. Have your symptoms affected your ability to carry out your daily activities? YES NO

Malabsorption: etiology, pathogenesis and evaluation

Transcription:

Gastroenterology Clinic Worksheet 1. GI Bleeding (occult or symptomatic) a. CBC b. Iron, Ferritin b. Medication history 2. Iron Deficiency Anemia and no evident source (if no iron deficiency consider hematological evaluation prior to GI referral) a. CBC b. Iron, TIBC or Ferritin c. Stool hemoccult. 3. Abnormal Liver Tests [LFTs First assess alcohol use and review medication causes a. Abnormal LFTs on 2 sets of results at least 6 weeks apart b. Abdominal liver ultrasound c. Ferritin, Iron, TIBC d. Acute Viral hepatitis panel 4. Cirrhosis a. CBC, PT/INR, CMP b. Acute Viral Hepatitis Panel, hepatitis A antibody total, Hepatitis B surface antibody total, and Hepatitis B core antibody total. c. Abdominal/liver ultrasound d. Documentation of ETOH history e. Document Hepatitis A and B vaccination according to serologies. (Do not exclude patient if this is not included but other materials are present.) f. Recommend Flu/Pneumovax. Pg.25

5. Hepatitis C Antibody Positive [HCV Ab +] Check the following and refer to GI if HCV is present by PCR. a. HCV RNA PCR quantitative & genotype b. CMP, CBC, HIV antibody c. Hepatitis A total antibody d. Hepatitis B surface antigen, surface antibody, core total antibody e. Abdominal/ liver Ultrasound 6. Hepatitis B Surface Antigen Positive [HBSAg +] Check the following and refer if HBV is present by PCR. a. HBV DNA PCR quantitative b. Hepatitis B surface antigen, surface antibody, e antigen and e antibody c. CMP, CBC, HIV antibody d. Hepatitis A total antibody e. Hepatitis C antibody f. Abdominal/liver Ultrasound 7. Inflammatory Bowel Disease a. Previous History b. Most recent endoscopy and colonoscopy reports c. Pathology reports. d. LFTs, CBC, CMP e. Recommend Pneumovax vaccination f. Document Hepatitis A and B vaccination according to serologies. (Do not exclude patient if this is not included but other materials are present.) g. Recommend flu shot (Must check the type of IBD therapy that the patient is getting before flu shot). Pg.26

8. Family History of Colon Polyps or Cancer [any age] Refer to GI Clinic if 1st degree family history- Age and what relative, 10 years of diagnosis of relative 9. Chronic Diarrhea (> 3 weeks duration) (refer to GI Clinic for any 1 or more of the following): I. Diagnostic uncertainty despite history, physical examination, and laboratory testing including: a. CBC, CMP and sedimentation rate b. Stool C&S, O&P X3 c. C. difficile toxin d. Stool WBCs e. HIV f. Thyroid studies g. Fecal occult blood X 3 If appropriate clinical history: Celiac panel, Qualitative Fecal fat. Giardia antigen, cyclospora, microspora, cryptosporidium. II. History or findings suggestive of malabsorption, or colonic or terminal ileal disease III. Previous surgery involving extensive resection of ileum, right colon, bypass procedures, or cholecystectomy 10. Abdominal Pain (refer to GI Clinic for any 1 or more of the following): I. Diagnostic or therapeutic uncertainty after evaluation, including ALL of the following: a. Laboratory testing (CBC, CMP, serum amylase, serum lipase, urinalysis, urine pregnancy test) b. Noninvasive imaging studies (plain x-rays, ultrasonography, and/or computed tomography) Pg.27

II. Abdominal pain in special populations, including 1 or more of the following: a. Patients > 50 years old b. HIV-positive patients c. Immunosuppressed patients 11. Dysphagia Get ESOPHAGRAM on all patients 12. Dyspepsia (refer to GI Clinic for any 1 or more of the following): a. Persistent symptoms despite negative H. pylori stool antigen or Urea Breath test testing and 4 week PPI trial b. Persistent symptoms despite positive Helicobacter pylori stool antigen or Urea Breath test testing and eradication therapy. The Urea Breath test is a good option instead of the stool antigen with the following precautions: Patient must fast at least one hour prior to testing The patient should not take: Antimicrobials within 4 weeks prior to testing. Proton pump inhibitors or bismuth preparations within 2 weeks prior to testing. H2 antaganist within 3 days prior to testing. Phenylketonuria patients should not have Urea breath test. Wait a minimum of 4 weeks following treatment prior to Urea Breath testing-because of false negative results. c. Patients with 1 or more of the following: Involuntary weight loss Gastrointestinal bleeding Dysphagia Odynophagia Pg.28

Unexplained iron-deficiency anemia Persistent vomiting Palpable mass or lymphadenopathy Jaundice Family history of upper gastrointestinal cancer Patients 50 years of age or older 13. Gastroesophageal Reflux Disease (GERD) (refer to GI Clinic for any 1 or more of the following): a. Symptoms of heartburn or regurgitation that have not responded to 8 week PPI trial b. Symptoms of laryngeal origin (eg, dyspnea, cough, hoarseness) that have not responded to 8 week PPI trial c. Suspected complicated GERD, as indicated by 1 or more of the following: Dysphagia Odynophagia Bleeding Weight loss Early satiety Choking Anorexia Frequent vomiting d. Symptoms of GERD that have lasted longer than 5 years 14. Chronic Constipation a. Documentation of fiber, laxatives, stool softeners tried b. Acute bowel habit change c. List of medications d. TSH Pg.29

e. Serum Calcium f. CBC 15. Suspected Gastroparesis FOUR HOUR Gastric Emptying Study Revised May 2015 Pg.30