Assessment for Malnutrition
• History and physical examination • Laboratory studies: ▶ Complete blood count (to evaluate for infection or cancer) ▶ Thyroid-stimulating hormone test (to evaluate for hypothyroidism)
▶ Metabolic panel (to evaluate for diabetes and electrolyte imbalance)
Figure 1. Evaluation of Suspected Gastroparesis Initial Evaluation
▶ Amylase test (if the patient has abdominal pain—to rule out pancreatitis) ▶ Pregnancy test (if appropriate)
YES
Initial evaluation suggestive of underlying cause?
Treat underlying cause and consider further work-up if incomplete response
NO
ultrasonography (if patient has biliary tract symptoms or significant abdominal pain)
series with small bowel follow-through (to rule out mechanical obstruction or other gastrointestinal conditions) and
Further testing with upper endoscopy or an optional upper gastrointestinal
Evaluation suggestive of underlying cause?
YES
Treat underlying cause
manometry to assess for intestinal pseudoobstruction, differentiate neuropathy from myopathy, and identify mechanical obstruction as appropriate.
Consider gastroduodenal Gastroparesis functional dyspepsia)
Consider alternative diagnosis (eg,
No gastroparesis NO
Gastric emptying scintigraphy, or wireless motility capsule
Delayed Normal
