 Welcome to your approach to abdominal pain part 3. In this section, we will discuss using lab values and imaging to hone in on our diagnosis. Let's first start with lab tests. We will start with the CBC, electrolytes, creatinine, and then more specific tests based on the presentation of the patient. In the CBC, if there is an infection or an inflammation, the weight-blessed account might be increased. If the patient is bleeding, their hemoglobin might be low. In terms of their electrolytes and creatinine, the patient's potassium might be low because of repeated diarrhea. In the patient who have lost volume, the creatinine might also be increased. And now, let's move on to specific tests. We'll go back to the classification we discussed before. Remember how we divide up the abdomen into nine different areas with the embolicis in the middle? Let's focus on what our clinical suspicion is, but we'll then order these specific tests. First, let's start off in the right of a quadrant. In the patient we're worried about hepatitis, we may wish to draw inflammatory markers such as ALT and AST. In patients with colostitis or colidohalophiasis, we may wish to add an obstructive enzyme such as bilirubin and alkofos. What about the epigastric area? We may wish to order an ECG and cardiac markers if the patient's history sounds cardiac. For the left upper quadrant, there are no specific tests for the spleen. In the patients with flank pain, if we're worried about pylonephritis or renal colic, we should do a urine dip. We'll be looking for the presence of red blood cell, white blood cell and bacteria in the urine. In the umbilical area, if we're worried about pancreatitis, we can order lipaseoemylase. If we're worried about ischemic gut that give patient generalized pain, we should order a lactate. In the lower abdomen, in patients with right lower quadrant pain and left lower quadrant pain, in female patients, we need to ensure that they are not pregnant. For patients with PID or tubular ovarian abscess type symptoms, swabs needs to be done during the pelvic exam. In those with suprapubic pain, a urine dip is often needed to roll out an infection. These are the most commonly seen lab tests we'll order in patients. Next, we'll move on to imaging. We'll divide this up into x-ray, ultrasound and CT. We'll talk about what conditions will be shown by these imaging. X-ray for the abdominal pain patient can show a few things. That includes an ammonia in the lower lobes, bar obstructions, perforation and foreign body. Let's look at a few examples. This is an x-ray of a patient with crampy colic abdominal pain. Do you see the problem here? He had dilated small bowels and multiple air fluid levels, suggestive of a small bar obstruction. This is the same patient with the same bar obstruction now lying on their side. You can see the air fluid level as indicated. What about this x-ray? There are multiple foreign bodies that are very well seen by the x-ray. What about this patient who's lying on their side? We can see that there is black air that is seen between the liver edge and the chest wall, indicating that there was a viscous perforation. We'll explore that a bit more in the viscous perforation videos. In terms of ultrasound, there is bedside ultrasound which can tell us very specific information about the patient right by the bedside. They include whether there is any free fluid in the abdomen, whether there is a AAA, and whether there is an intrauterine pregnancy. We'll take a look at what these look like. This is a still of a bedside ultrasound. The liver is here, and the kidney is here. This is the free fluid. Based on the clinical context, it could be blood or other kind of free fluid such as societies. In this still of a bedside ultrasound, you can see this which happens to be an enlarged abdominal aorta. In this still, you can see that there is a pregnancy in the uterus. Bedside ultrasound can give us some information very quickly. When the patient goes for a formal ultrasound, there is more information that can be gained. Formal ultrasound can diagnose gallstones and CBD stones, colostitis, and colongitis. In the left upper quadrant, it can tell whether there is a splenic laceration, infarct, or thrombosis of the splenic vein. For the patient with flank pain, ultrasound can diagnose hydronephrosis, kidney stones. Ultrasound can also tell you how big the abdominal aorta is. We use ultrasound to diagnose appendicitis. In some patients, diverticulatus can be picked up in patients with left lower quadrant pain. For the non-GI cause of low abdominal pain, ultrasound can be used in females to rule out ectopic pregnancy, ovarian torsion, and tubo ovarian abscess. In males, it's helpful to rule out testicular torsion and epididymitis. In general, CT is better than ultrasound in delineating the pathology for the patients. It has highest sensitivity and highest specificity. However, it has radiation, and the patient has to be stable enough to leave the emergency department. In the specific videos about each abdominal condition, we will discuss this further. In summary, we discussed the labs and imaging for patients with abdominal pain. We'll order CBC lysine creatinine, and then specific tests based on where the patient's pain is. Remember that urine is important to rule out pregnancy and to diagnose conditions such as renal colic and UTI. In terms of imaging, X-ray is good in conditions such as obstruction, perforation, and foreign body. Where a bedside ultrasound can quickly tell us some information about the patient. And lastly, we can either use a formal ultrasound or CT for a specific diagnosis. In the next video, we'll discuss how to put this all together. Thank you for watching.