Laboratory evaluation

Rectal and pelvic examination

Digital examination of the rectum may detect cancer, fecal impaction, or pelvic appendicitis. Stool should be checked for gross or occult blood.

Pelvic examination. Vaginal discharge should be noted and cultured. Masses and tenderness should be sought bimanually. Adnexal or cervical motion tenderness indicate pelvic inflammatory disease.

Laboratory evaluation

Leukocytosis or a left shift on differential cell count are non-specific findings for infection. Leukopenia may be present in sepsis. The hematocrit can detect anemia due to occult blood loss from cancer. The hematocrit may be elevated with plasma volume deficits.

Electrolytes. Hypochloremic metabolic acidosis occurs with severe hypovolemia or sepsis.

Urinalysis. Bacteriuria, pyuria, or positive leukocyte esterase suggest urinary tract infection. Hematuria suggests urolithiasis.

Liver function tests. High transaminases with mild to moderate elevations of alkaline phosphatase and bilirubin suggests acute hepatitis. High alkaline phosphatase and bilirubin and mild elevations of transaminases suggests biliary obstruction.

Pancreatic enzymes. Elevated amylase and lipase indicates acute pancreatitis. Hyperamylasemia also may occur in bowel infarction and perforated ulcer.

Serum beta-human chorionic gonadotropin is required in women of childbearing age with abdominal pain to exclude ectopic gestation.

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