Investigations

Question 1

RUQ pain investigations FBC?

Answer 1

may show anaemia or high WWC showing inflammation

Question 2

RUQ pain investigations serum amylase levels?

Answer 2

increased in pancreatitis but can also be bowel obstruction, mesenteric ischaemia.

Question 3

RUQ pain investigations liver enzymes?

Answer 3

elevated AST + ALT suggests damage to the hepatocytes (any hepatitis, CBD obstruction by gallstone, duct ingection, duct tumour, inflammation of pancreas). Raised ALP + GGT suggests obstruction of the CBD (cholestatic)

Question 4

RUQ pain investigations bilirubin?

Answer 4

elevated unconjugated suggest increased haemolysis or herediatary deficiency of conjugating enzyme (Gilberts syndrome). Elevated conjugated suggest obstruction to bile flow.

Question 5

RUQ pain investigations erect CXR?

Answer 5

air under diaphragm suggests perforated gastric or duodenal ulcer. A wide mediastinum can suggest aortic dissection.

Question 6

RUQ pain investigations USS?

Answer 6

paying attention to thickness of gallbladder wall (cholecystitis) or gallstones.

Question 7

RUQ pain investigations abdominal radiograph?

Answer 7

only if suspicion of bowel obstruction or perforation.