Abdominal Pain – Investigation

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Laboratory Investigation

INVESTIGATION INDICATION
HB If bleeding suspected
WCC If infection suspected
EUC if GI loss is prominent (e.g. vomiting and diarrhoea) or third spacing (e.g. bowel obstruction)
If renal pathology suspected
LFT If hepato-biliary disease is suspected
Amylase / Lipase Biliary colic
Pancreatitis
CK/Phosphate/Lactate If an ischaemic process is suspected e.g. mesenteric ischaemia, closed loop obstruction
Calcium/Urate Renal colic
Pancreatitis (Ca++ for Ranson’s prognostic criteria)
ABG If the patient is systemically unwell or an ischaemic process is considered

IMAGING

An unwell patient may be too unstable for formal imaging.  Early involvement of a surgeon (for immediate laparotomy) or ICU (for stabilisation) may be a better option.

IMAGING MODALITY

INDICATION

CXR Perforated viscus
Pancreatitis (Ranson’s criteria)
AXR Bowel obstruction (70% sensitivity)
Renal calculi (90% sensitivity)
Upper abdominal Ultrasound Biliary Colic
Cholecystitis
Obstructive Jaundice
Pelvic Ultrasound Ectopic pregnancy
Ovarian torsion
Ovarian cyst rupture
CT abdomen AAA (if stable)
Renal calculi
Intrabdominal collection/abscess

 

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