General and Thoracic Surgery Referral Guidelines

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

Initial Work-Up:

• Nutrition/Gastroenterology referral (all patients must see nutrition prior to surgery for G-tube)
• Upper GI (not required)

Referral When:

• Failure of medical management 

Data Needed:

• Clinic notes
• Radiology reports, if applicable

Initial Work-Up:

• Physical exam
• Referral to Gastroenterology

Referral When:

• Failure of medical management with GI

Data Needed:

• Clinic notes

Referral When:

• Diagnosis confirmed on imaging 
  

Data Needed:

• Clinic notes
• Radiology reports and images
• Referral to our Thoracic and Foregut Program

Referral to Colleen Helen Cotton, MD, in Dermatology. General Surgery does NOT see for Hidradenitis unless referred by Dermatology.

Initial Work-Up:

• Physical exam/symptoms

Referral When:

• Upon identification
• Failure of medical management

Data Needed:

• Clinic notes
• Referral to our Thoracic and Foregut Program

Initial Work-Up:

• If do not meet obesity severity criteria, or who are <13yo → refer to IDEAL clinic for initial management

Referral When:

Patients 13yo and older with severe obesity who meet the following criteria:

• Class 2 Obesity: BMI 35-39 (or weight >120% of the 95th percentile for age/sex) with weight related medical comorbidities (OSA, diabetes, HTN, idiopathic intracranial HTN, severe joint or mobility issues, liver disease/dysfunction, PCOS)

OR

• Class 3 Obesity: BMI ≥ 40 (or weight >140% of the 95th percentile for age/sex) with or without comorbidities

Data Needed:

• Clinic notes
• Laboratory results
• Referral to Bariatric Surgery Program

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 (not required)

Referral When:

• Symptoms
• Family education and options

Data Needed:

• Clinic notes
• Imaging studies
• CT chest without contrast (not required, we will obtain after initial visit)
• 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

Initial Work-Up:

• Referral to Gastroenterology

Referral When:

• Failure of medical management

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

Referral When:

• Upon identification

Data Needed:

• Clinic notes