General and Thoracic Surgery Referral Guidelines

Right upper quadrant pain

Initial Work-Up:

• Abdominal ultrasound

Referral When:

• Any right upper quadrant pain with gallstones on ultrasound

Data Needed:

• Clinic notes
• Laboratory evaluation

Right upper quadrant pain

Initial Work-Up:

• Medical and expectant management
• Gastroenterology referral

Referral When:

• Failure of medical management
• Complicated GERD with respiratory symptom or infections
• Growth failure
• Esophagitis/Hiatal Hernia

Data Needed:

• Clinic notes
• Imaging studies
• Endoscopy reports
• pH probe results if available

Crohns Disease, Ulcerative Colitis

Referral When:

• Failure of medical management

Data Needed:

• Clinic notes
• Contrast studies
• Current medication list

Initial Work-Up:

• Physical exam
• May require ER visit if incarceration suspected

Referral When:

• Upon identification

Data Needed:

• Clinic notes

A protrusion of the chest wall. Can be asymptomatic or have symptoms such as chest pain or diminished exercise capacity.

Initial Work-Up:

• Chest x-ray

Referral When:

• Symptoms
• Family education and options

Data Needed:

• Clinic notes
• Imaging studies
• Cardiology and pulmonology notes if available

A protrusion of the chest wall. Can be asymptomatic or have symptoms such as chest pain or diminished exercise capacity.

Initial Work-Up:

• Chest x-ray

Referral When:

• Symptoms
• Family education and options

Data Needed:

• Clinic notes
• Imaging studies
• Cardiology and pulmonology notes if available

Initial Work-Up:

• Physical exam
• Antibiotics
• May need incision and drainage

Referral When:

• Failure to heal
• Recurrence

Data Needed:

• Clinic notes

Initial Work-Up:

• Antibiotics
• Personal hygiene
• Perineal, sacral shaving
• Keep area clean and dry
• May require urgent drainage in emergency department

Referral When:

• Upon identification

Data Needed:

• Clinic notes

Hereditary spherocytosis, Sickle Cell Anemia, Idiopathic Thrombocytopenia, Purpura

Initial Work-Up:

• Hematology consultation
• Abdominal ultrasound

Referral When:

For splenectomy to reduce

• Symptoms
• Transfusions
• Thrombocytopenia

Data Needed:

• Clinic notes
• Ultrasound
• Transfusion records
• Hematologists consult

Initial Work-Up:

• Physical exam
• If incarcerated (rare)
• Send to emergency department

Referral When:

• Persistent hernia in child
• after 4-5 yrs of age
• Large defect

Data Needed:

• Clinic notes

Hemangiomas/Lymphatic or Vascular Anomalies

Initial Work-Up:

• Ultrasound

Referral When:

• For further management and advice, contact Children’s Vascular Anomalies Clinic at 202-476-2151.

Data Needed:

• Clinic notes
• Any imaging studies