422) A 54-year-old man with history of Diabetes Mellitus and End-Stage Renal Disease is evaluated in your office during a follow up visit after undergoing hemo-dialysis in the morning. He has been dependent on Hemo-Dialysis for past four years and undergoes dialysis thrice a week. He reports recurrent epigastric abdominal pain that is burning in quality which is relieved by taking over the counter antacids. He denies any pain at this time. He denies any nausea or vomiting. He has no history of alcohol use or smoking. On examination, he is afebrile and vitals are stable. Abdominal examination is benign. Laboratory investigations are as follows:
Serum amylase 200 IU/L ( N = 25 to 160 U/L)
Serum Lipase 150 IU/L (Normal = 25 to 80U/L)
AST 30 IU/L
ALT 40 IU/L
Total bilirubin 0.6gm%
Alkaline Phosphatase 80IU/L .
Which of the following is indicated in this patient at this time?
A) Ultrasound of the Gall Bladder
B) Nothing by mouth and IV hydration
C) No further investigations or treatment
D) Endoscopic Retrograde Cholangio Pancreatography
E) CT scan of the Abdomen