Showing 1-20 of 101 for: Essential Evidence Topics > Gastrointestinal 
- Abdominal mass
Essential Evidence Topics, 30-Jul-2021
Overall Bottom Line: Perform a thorough history and physical examination to determine the location, physical findings and symptoms associated with the mass. For some masses (e.g., umbilical hernia and bladder distension), examination findings may be defin
- Abdominal pain (adult)
Essential Evidence Topics, 22-Nov-2020
Overall Bottom Line: Use clues from the history and physical examination to establish a presumptive diagnosis on which to base diagnostic testing. History and physical examination alone are often adequate to begin initial treatment for gastroesophageal
- Abdominal pain (pediatric)
Essential Evidence Topics, 13-Oct-2022
Overall Bottom Line: Differentiate abdominal from extra-abdominal etiology ( and ). When there is uncertainty regarding the pain's origin, ultrasound is the first step in evaluation. Early administration of pain medications provides relief to the pati
- Abnormal liver function test evaluation
Essential Evidence Topics, 4-Oct-2021
Overall Bottom Line: Do not order serum liver chemistries to screen asymptomatic patients. Based on the American College of Gastroenterology guideline (2017), one should repeat the lab panel and/or perform a clarifying test (e.g., gamma-glutamyl transpe
- Acute gastroenteritis and dehydration (child)
Essential Evidence Topics, 29-Jul-2022
Overall Bottom Line: Clinical history and physical examination should be the basis for diagnosing acute gastroenteritis and the degree of dehydration. Laboratory tests are not recommended for routine cases. Combinations of findings are most effective in
- Alpha-1 antitrypsin deficiency
Essential Evidence Topics, 26-Dec-2022
Overall Bottom Line: Population screening for alpha-1 antitrypsin (AAT) deficiency is not generally recommended. AAT levels should be checked in patients when there is a high degree of suspicion (); if abnormal, confirm by genetic testing. Consider AA
- Anorectal fissure
Essential Evidence Topics, 16-Sep-2021
Overall Bottom Line: The diagnosis of anal fissure is made clinically; no diagnostic tests are necessary. An initial trial of conservative therapy is warranted (topical nitrate, calcium channel blocker or botox). If surgery is needed for recurrence or
- Anorectal fistula
Essential Evidence Topics, 24-Oct-2019
Overall Bottom Line: The diagnosis of anal fistula depends primarily on the history and physical examination (including examination under anesthesia if needed). Additional tests are only required for suspected complex fistulae and can include fistulograph
- Aphthous stomatitis and ulcers
Essential Evidence Topics, 6-Feb-2022
Overall Bottom Line: Most patients with mild aphthae require no treatment or only periodic topical therapy (amlexanox, steroids, and tetracycline). There is no proven preventive therapy, although amlexanox may be beneficial if taken in the prodromal pha
- Appendicitis
Essential Evidence Topics, 10-Feb-2023
Overall Bottom Line: Diagnosis in both adults and children is typically clinical, with a classic presentation of right lower quadrant abdominal pain followed by nausea and vomiting, low-grade fever, positive psoas sign, tachycardia, and guarding. Use of a
- Ascariasis
Essential Evidence Topics, 26-Mar-2019
Overall Bottom Line: Mild infection may result in only nausea, mild abdominal discomfort, mild anorexia, and/or dyspepsia, whereas more severe infection may lead to mechanical obstruction, perforation, biliary and pancreatic duct obstruction, and/or appen
- Ascites
Essential Evidence Topics, 27-Feb-2022
Overall Bottom Line: For patients with new-onset ascites, the initial test is a paracentesis with serum-ascitic albumin gradient (SAAG), cell count and total protein. If infection is suspected and/or paracentesis produces purulent ascitic fluid , cultur
- Blunt abdominal trauma
Essential Evidence Topics, 30-Jan-2022
Overall Bottom Line: In all patients with a suspected abdominal injury, conduct a primary and secondary survey and a focused assessment for the sonographic examination of trauma (FAST) examination. Physical examination is not reliable in patients who ar
- Bowel obstruction
Essential Evidence Topics, 20-Sep-2019
Overall Bottom Line: The history and serial physical examinations are the basis of diagnosis in bowel obstruction. Plain films are appropriate, but CT scan with IV contrast is more sensitive and specific. Early surgical consultation is recommended.
- Bruxism (tooth grinding)
Essential Evidence Topics, 10-Nov-2021
Overall Bottom Line: Abnormal tooth wear, orofacial pain, temporomandibular joint (TMJ) sounds, and difficulty closing the mouth support the diagnosis. Occlusal mouth splints are the mainstay of treatment for sleep bruxism to protect teeth from damage,
- Candidiasis (oral and esophageal)
Essential Evidence Topics, 29-Nov-2021
Overall Bottom Line: Suspect oropharyngeal or esophageal candidiasis in at-risk patients with pain or discomfort in the mouth, angles of the lips, or beneath an oral prosthesis; dysphagia or chest pain when swallowing. Visually examine the oropharynx; s
- Celiac disease
Essential Evidence Topics, 9-Dec-2022
Overall Bottom Line: Celiac disease typically presents with bloating, flatulence/gas, chronic unexplained diarrhea, irritable bowel syndrome, constipation, abdominal pain, nausea, loss of appetite, and symptoms since childhood. IgA antiendomysial and IgA
- Cholangitis
Essential Evidence Topics, 25-Mar-2021
Overall Bottom Line: Suspect acute cholangitis in at-risk patients (ie, cholecystitis, recent instrumentation) presenting with fever, pain, and/or jaundice. Order CBC with platelets, CRP, hepatic transaminases, metabolic profile, and INR to confirm diag
- Cholecystitis
Essential Evidence Topics, 1-Nov-2022
Overall Bottom Line: Ultrasound is the best initial diagnostic test for cholecystitis; scintigraphy with hepatobiliary iminodiacetic acid (HIDA) can be obtained if ultrasound results are negative or equivocal. Early laparoscopic cholecystectomy (within
- Cholelithiasis
Essential Evidence Topics, 27-Mar-2023
Overall Bottom Line: Suspect symptomatic gallstones in patients with episodic right upper quadrant or epigastric pain (biliary colic) that radiates to the right shoulder, flank, or back; especially if occurring at night or following a fatty meal. Ultras
