Red Flags (need work-up)
- Treat empirically for most likely diagnosis
- Follow weights
- If no response, reassure & adjust therapy
- Order Labs [see below] (work up abnormals)
- Explore Stressors and possible Mood Disorder as indicated
- Refer to GI as last resort
RED FLAGS IDENTIFIED ON H & PLab Tests to Order
- Sed Rate. If elevated, think Inflammatory Bowel Disease (IBD, not IBS) or cancer.
- Chemistry panel, including electrolytes, calcium, total protein, plus renal & liver function.
- Ferriten. If low, suspect blood loss from a lesion or Celiac Disease.
- Tissue-Transglutaminase (TTG), IgA Antibody —- Celiac Disease.
- Lipase, for chronic pancreatitis.
- If constipation is prominent, a TSH for Hypothyroidism.
- Low Ferriten (= iron deficiency)
- History of Melena / Hematochezia (frank blood in stool)
- TTG elevated (= Celiac Disease; Bx is standard recommendation, though TTG more sensitive & very specific).
- Elevated Sed Rate (especially if diarrhea is a symptom) — looking for IBD.
- Weight Loss
- Age >50 (need colon cancer screening anyway)
Who Needs Abdominal CT
- Significantly abnormal WBC count
- Elevated Sed Rate
- Elevated Lipase
- Weight Loss documented (or let GI order it)
See posting Chronic Abdominal Pain.