The following investigations may be selected:

• haemoglobin—anaemia with chronic blood loss, e.g. peptic ulcer, carcinoma, oesophagitis

• blood film—abnormal red cells with sickle cell disease

• white cell count—leucocytosis with appendicitis (75%), 2 acute pancreatitis, mesenteric adenitis (first day only), cholecystitis (especially with empyema), pyelonephritis

• ESR—raised with carcinoma, Crohn's disease, abscess, but non-specific

• C reactive protein (CRP)—use in diagnosing infection, inflammation, e.g. pancreatic

• liver function tests—hepatobiliary disease

• serum amylase—if raised to greater than 5 times normal upper level acute pancreatitis is most likely; also raised partially with most intraabdominal disasters, e.g. ruptured ectopic, perforated peptic ulcers, ruptured empyema of gall bladder, ruptured aortic aneurysm

• pregnancy tests—urine and serum b HCG: for suspected ectopic

o blood: ureteric colic (stone or blood clot), urinary infection o white cells: urinary infection, appendicitis (bladder irritation) o bile pigments: gall bladder disease o porphobilinogen: porphyria (add Ehrlich's aldehyde reagent) o ketones: diabetic ketoacidosis o air (pneumaturia): fistula, e.g. diverticulitis, other pelvic abscess, pelvic carcinoma

• faecal blood—mesenteric artery occlusion, intussusception ('redcurrant jelly'), carcinoma colon, diverticulitis, Crohn's disease and ulcerative colitis

Dealing With Back Pain

Dealing With Back Pain

Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.

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