How to approach GIT cases

With Abd XR
Disease Consultation/operation
PUD with perforation Laparotomy/laparoscopy
Acute appendicitis Laparoscopic appendectomy

Acute diverticulitis Ampicillin-sulbactam,

Acute Cholecystitis Start Piperacillin/tazo →
Afebrile →
Surgery consult + cholecystectomy
Acute pancreatitis
Volvulus Gastroenterology consult
Sigmoidoscopy, flexible
Rectal tube placement
Small bowel obstruction
Abd trauma Trauma work up as per Cheat sheet
Intussusception Barium enema

Without Abd XR
Disease Consultation/operation
Ovarian torsion Gynecology consult
Laparoscopy/Laparotomy
Ruptured AAA Vascular surgery consult
Aneurysmectomy
Sequencing
Emergency orders (if abnormal vital signs)
Cardiac monitor/BP monitor/Pulse oximetry

First set of orders

Physical exam (Don’t forget Rectal)

+
D Diagnosis
Labs
Routine: CBC/BMP/LFT/PT/PTT/UA/FOBT F: B HCG
+
ECG/Troponin/Amylase/Lipase
+
Abd XR (1st table) FAST Ultrasound (only in case of trauma)

+
IVA/ NS/NPO/NGT (if decompression needed related to GIT)
Morphine (if pain)
Phenergan (if N/V)
Inflammation itis (Ampicillin/sulbactam + blood culture)

Second set of orders

CT abd with contrast (after Negative B HCG)
Except
Pelvis U/S (Ovarian torsion)
US abd (Acute cholecystitis - Intussusception – Ruptured AAA)
+
A Advise patient, (High fiber Diet, Exercise, relevant bad habits)
Reassure patient or Family (Peds cases)

After confirmation of diagnosis with radiology

C Consult general surgery

If operation will be done

Admit to Ward
+
Admission orders as per Cheat sheet
+
Surgery orders as per Cheat sheet

M Monitoring with interval history and focused exam after operation