Question

A 35-year-old man presents after several episodes of vomiting in the last 24 hours; there is loose stool and strong pain that is localized in the upper-middle region of the abdomen. Physical examination indicates a temperature of 101°F and a tender epigastrium. Lab tests reveal an initial WBC count of 18x109/L. C-reactive protein level is 325 mg/L, and amylase is 130 U/L. There is a lactate dehydrogenase level of 816 U/L. The patient has no history of pancreatic disease, and declares himself a non-drinker. He is overweight. He has a history of diabetes type-2 and hypertension. He takes medicine to control his high blood pressure and obesity.

What is the most appropriate next step in establishing diagnosis for this patient?

1. Abdominal radiography
2. Abdominal ultrasonography
3. Abdominal computed tomography scanning
4. Endoscopic retrograde cholangiopancreatography
5. Endoscopic ultrasonography

Answer 1

Abdominal ultrasonography is the most appropriate next step for the diagnosis of the patient's symptoms, as it is a non-invasive method to identify potential acute abdominal inflammatory processes such as gallbladder disease and pancreatitis.

Step-by-step explanation:

The most appropriate next step in establishing a diagnosis for this 35-year-old man with vomiting, loose stools, strong pain in the upper-middle region of the abdomen, and elevated inflammatory markers would be abdominal ultrasonography. The patient's symptoms and elevated levels of WBCs, C-reactive protein, and amylase suggest an acute inflammatory process in the abdomen. Abdominal ultrasonography is a non-invasive test that is excellent for imaging intra-abdominal organs and can help identify gallbladder disease and pancreatitis, which are potential diagnoses given the patient's symptoms and lab findings.