Investigations

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

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