Table 12 -- Examples of Symptoms and Diagnoses that Prompt Referral to a Gastroenterologist
Symptom/Diagnosis Features Timing of Referral
GI bleeding
Orthostatic hypotension,
tachycardia. Signs suggesting ongoing bleeding (melena, bright red blood in vomitus)

Urgent
Alkaline caustic ingestion

Dysphagia, odynophagia stridor, chest pain, abd pain
Urgent
Acetaminophen overdose

Rising prothrombin time, mental status changes Urgent; evaluation
for orthotopic liver
transplantation
Suspected gastric outlet obstruction Vomiting old food, large volume of vomitus, succusion splash Urgent or elective
Immunocompromised pt Dysphagia, odynophagia, chest/abd pain Urgent or elective
Inflammatory bowel disease Bloody diarrhea, fever, abdominal pain, abdominal distention Urgent or elective
Cholangitis Fever, leukocytosis, jaundice,
elevated transminases, bilirubin, alkaline phosphatase
Urgent
GE reflux disease Refractory to symptomatic treatment Elective
Chronic intractable
nausea/vomiting with
unrevealing workup
  Elective