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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Imaging strategies of suspected acute colonic diverticulitis: how does it work?

Clinical scenario

A 66 yo man complains of left lower quadrant (LLQ) pain, anoressia and fever, it is the first time. The pain is acute, there is not vomit, temperature is 38°C. Abdomen is treatable, with severe pain and tenderness localized at LLQ , there is not history of prior abdominal surgery. Probably this patient suffers of an acute colonic diverticulitis (ACD).

Is Computer Thomography (CT) the imaging procedure of choice for this patient? 

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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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