Investigations

Question 1

Bloods FBC?

Answer 1

for signs of infection, inflammation or blood loss.

Question 2

Bloods CRP?

Answer 2

infection or inflammation.

Question 3

Bloods Pancreatic amylase or lipase?

Answer 3

increase in pancreatitis, amylase rises within hrs of onset and returns to normal 3-5 days later.

Question 4

Bloods liver enzymes?

Answer 4

AST and ALT suggest pathology within liver.

Raised ALP, bilirubin, GGT suggest biliary tree pathology or extrinsic compression of biliary tree.

Rise in ALP without GGT suggests source other than liver,

isolated GGT rise suggests alcohol excess.

Question 5

Bloods albumin?

Answer 5

useful prognostic factor for pancreatitis.

Question 6

Bloods U&Es and creatinine

Answer 6

deranged in dehydrated, renal hypoperfusion if shock, or if patient has been vomiting.

Question 7

Bloods calcium?

Answer 7

hypercalcaemia can cause pancreatitis and an establish pancreatitis can cause hypocalcaemia.

Question 8

Bloods glucose?

Answer 8

hyperglycaemia is a marker of severity of pancreatitis reflecting lack of insulin production

Question 9

Bloods ABG?

Answer 9

as resp distress syndrome is a complication of acute pancreatitis, lactate and pH will also be elevated in inflammatory processes.

Question 10

Bloods troponin?

Answer 10

check for MI.

Question 11

Investigations ECG?

Answer 11

straight away if any risk of MI.

Question 12

Investigations erect CXR?

Answer 12

air under diaphragm suggests perforated peptic ulcer, lower lobe consolidation suggests basal pneumonia. Pleural effusion is not uncommon in pancreatitis or with boerhaaves perforation.

Question 13

CXR perforated peptic ulcer?

Answer 13

Question 14

CXR basal pneumonia?

Answer 14

Question 15

CXR pleural effusion?

Answer 15

Question 16

Investigations abdominal radiograph?

Answer 16

look for bowel dilation, foreign bodies, calcification at the head of the pancreas, pneumoperitoneum or small segments of dilated loops (sentinel loops). Ultrasound – to look for AAA (>3cm) or look for gallstones.

Question 17

Investigations CT?

Answer 17

only useful if other findings are inconclusive or if mesenteric infarction or AAA is suspected.

Question 18

investigations ultrasound?

Answer 18

look for AAA (>3cm) or look for gallstones.