Case study 12.2

Consider which investigations you would be able to do in this primary care setting for Sue in order to assist in reaching a diagnosis.

Give a rationale for each investigation.

Critically discuss the difficulties that may be faced in referring for or carrying out clinical investigations within the primary care or community setting.

URINALYSIS – Urinary tract infection is a common cause of lower abdominal pain in women. Positive nitrites and leucocytes on urinalysis will assist in confirming the diagnosis.

BHCG (PREGNANCY TEST) – With any female of childbearing age who presents with abdominal pain, you should always consider an ectopic pregnancy. This test will assist in ruling this in or out.

WHITE CELL COUNT AND C-REACTIVE PROTEIN – These inflammatory markers are likely to be raised in an infective diagnosis, UTI is likely in this case.

Blood tests may take days for the results to come back in primary care. It would need to be considered if you can safely treat the patient in the community whilst awaiting any results.

Most radiographic and endoscopic procedures are carried out in acute care hospitals, which may be situated in larger towns and cities. Do all patients in the community have access to travel to these? What might hinder their access, i.e. finances? Public transport? Mobility? Confusion in places not known to them?