Blood test and urgent abdominal conditions

Clinical Scenario

A 44 YO man presents to the ED complaining of abdominal pain. He was well until 4 hours ago, when he developed diffuse abdominal pain. This is the first time he suffers abdominal pain. He has not history of surgery.

The patient is afebrile, HR is 80, BP is 180/100, ECG is normal. The abdomen is very painful, but soft.

Is it a serious condition? Asks the worried man.

“We’ll see later, after blood test” says the doctor. 

Conclusion 

WBC count and CRP levels alone or together are insufficient markers to be used as a triage instruments to select an urgent from non-urgent abdominal condition. In several circumstances like acute appendicitis or acute diverticulitis o cholecystitis WBC count and CRP levels can be normal.

Blood test alone are of limited use. 

   

Bibliography 

SL Gans

C-Reactive protein and white blood cell count as triage test between urgent and non urgent conditions in 2961 patients with acute abdominal pain. 

Medicine 2015 vol 94 n 9 1-9.

C Paolillo, I.Spallino

Can C-reactive protein and white blood cell count alore rule out an urgent condition in acute abdominal pain?

Intern Emerg Med 2015 oct 27.

Ciro Paolillo

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Diagnosis of diverticulitis with hands and blood tests. Is it a good idea?

Clinical Scenario

A 66 yo man complains of left lower quadrant (LLQ) abdominal pain from 4/5 hours. The pain is described as crampy initially, than continuous, there is not vomit. Temperature is 37.5°C. Abdomen is treatable, with moderate pain and tenderness localized at LLQ , there is not history of prior abdominal surgery. 

ED US excluded the specter of an AAA.

WBC 13.000/μl

CPR: 51 mg/L

Probably this patient suffers of an acute diverticulitis. 

Is it an urgent imaging necessary to confirm the diagnosis? 

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Is CRP useful alone to support the hypotesis of a bacteremia?

Clinical Scenario

It’s a very cold February, but ED is very hot in every sense of the word. 

A 22 y/o student refers stomach pain, chills, fever and diffuse muscolar pain. He has fever (38° C) there is a mild diffuse abdominal pain. 

The CRP value is 30 mg/L. 

Are there flu symptoms, or it is a bacteremia?

Can we use the CRP test for change our clinical suspicion? 

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Is CRP correlated to CT result in the evaluation of abdominal pain?

A 74 yo/man complained of diffuse abdominal pain. The pain was intermittent and accompained by vomiting. He has no history of abdominal pain or abdominal surgery.

On examinations the patient presented non icteric, afebrile, not tachicardic. 

The abdomen was mildly distensed with midline tenderness. 

The US evidenced a normal aorta diameter. 

Abdominal x ray showed non specific bowel gas pattern. 

CRP value was 7 mg/L.

The radiologist says it is a little value to perform an abdominal CT, we see tomorrow…..

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