From the Research
For a patient with left upper quadrant abdominal pain, I recommend ordering a complete blood count (CBC), comprehensive metabolic panel (CMP), lipase, amylase, urinalysis, and erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). These tests provide essential information about potential causes of left upper quadrant pain, which commonly involves the spleen, stomach, pancreas, or left kidney. The CBC can detect infections, anemia, or blood disorders that might affect the spleen. The CMP evaluates kidney and liver function, electrolyte balance, and glucose levels. Lipase and amylase are crucial for assessing pancreatic inflammation, as pancreatitis can present with left upper quadrant pain 1, 2, 3. Urinalysis helps identify kidney stones or infections. ESR or CRP measures inflammation, which is useful for conditions like splenic infarction or inflammatory bowel disease.
Key Considerations
- Lipase and amylase are important for diagnosing acute pancreatitis, with lipase being more sensitive and specific, especially when elevated more than three times the upper limit of normal 3.
- The diagnostic value of simultaneous measurement of amylase and lipase is marginally improved, but mainly increases specificity 4.
- Abdominal imaging, such as ultrasound or CT scan, may be necessary to visualize the affected organs directly, especially in cases where painless lipase elevation is present, as it can increase the diagnosis of acute pancreatitis 5.
Additional Tests
Depending on the clinical presentation, additional tests might include lactate dehydrogenase (LDH) for splenic infarction, a chest X-ray to rule out lower lobe pneumonia, or specific markers for other conditions suggested by the patient's history and physical examination. The choice of tests should be guided by the need to minimize morbidity, mortality, and improve quality of life, prioritizing the most likely causes of left upper quadrant abdominal pain based on the patient's presentation and the results of initial tests.