Key Practice Recommendations

These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patientoriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

1. When evaluating possible acute appendicitis, ultrasonography and clinical prediction tools such as the Appendicitis Inflammatory Response (AIR) score should be used to improve diagnostic sensitivity and specificity and decrease the need for computed tomography.
Evidence rating: SORT C
Source: Section One, references 14, 15, and 23

2. Ultrasonography is used as the first-line imaging modality for evaluation of right upper quadrant pain.
Evidence rating: SORT C
Source: Section Two, reference 19

3. Patients at intermediate risk for choledocholithiasis should undergo further evaluation with endoscopic ultrasonography or magnetic resonance cholangiopancreatography.
Evidence rating: SORT C
Source: Section Two, reference 25

4. Antibiotics may not be required for outpatient management of acute uncomplicated diverticulitis in appropriately selected immunocompetent patients.
Evidence rating: SORT C
Source: Section Three, reference 29

5. Elective resection of the sigmoid colon may be recommended for those with complicated diverticulitis after acute treatment is completed.
Evidence rating: SORT C
Source: Section Three, reference 34

6. In patients with small bowel obstruction managed nonoperatively who are at low risk of aspiration and have undergone decompression, stabilization, and evaluation by general surgery, water-soluble oral contrast medium and serial abdominal radiography should be used to accelerate and demonstrate resolution.
Evidence rating: SORT C
Source: Section Four, references 4, 11, 12, and 21

7. Enhanced recovery after surgery protocols, multimodal approaches to surgical care designed to help limit the effects of recent surgery on the patient, should be used to help decrease the incidence of postoperative ileus.
Evidence rating: SORT C
Source: Section Four, reference 25

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