Gynaecological causes
- Dysmenorrhoea or endometriosis: prior and/or during menstrual bleed
- Mittelschmerz: mid-cycle colicky pain
- Pelvic inflammatory disease: fever variable
Obstetric causes
- Ectopic pregnancy: sudden onset with shock or peritonism
- Ovarian cyst rupture/torsion
- Miscarriage/abortion/retained foetal products
Drugs/toxins
- Paracetamol overdose
- Iron overdose
- Venoms: spider bite, scorpion sting
- Soap ingestion
- Erythromycin
Referred pain
- Usually musculoskeletal: examine for scoliosis, joint tenderness
Rare causes
- Angioneurotic oedema: episodic, rash or facial/lip swelling – allergy/immunology referral
- Familial Mediterranean fever or systemic lupus erythematosis: episodic fever and raised inflammatory markers with extra-intestinal symptoms – rheumatology referral
- Acute intermittent porphyria: episodic, send urine for porphyrins during an attack
- Peptic ulcer disease – often associated with Helicobacter pylori infection
Information: Rome III criteria for functional bowel diseases
- No evidence of an inflammatory, anatomical, metabolic or neoplastic process
- Symptoms: at least once a week for at least 2 months before diagnosis
Functional dyspepsia
- Persistent or recurrent pain or discomfort above the umbilicus
- Not relieved by defecation or associated with the onset of a change in stool frequency or stool form
Irritable bowel syndrome
Abdominal discomfort or pain associated with two or more of the following at least 25% of the time:
- Improved with defecation
- Onset associated with a change in frequency of stool
- Onset associated with a change in form (appearance) of stool
Functional abdominal pain
- Episodic or continuous abdominal pain
- Insufficient criteria for other functional gastrointestinal disorders
Functional abdominal pain syndrome
- Must include: functional abdominal pain at least 25% of the time and either some loss of daily functioning or additional somatic symptoms such as headache, limb pain or difficulty in sleeping
Information: Abdominal migraine
Criteria:
- Two or more times in the preceding 12 months
- Paroxysmal episodes of intense peri-umbilical pain lasting >1 hour
- Intervening periods of usual health lasting weeks to months
- Pain interferes with normal activities
- Pain is associated with two or more of the following:
- Anorexia
- Nausea
- Vomiting
- Headache
- Photophobia
- Pallor
- Anorexia
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