Abdominal Pain, Chronic Recurrent
ASK THE FOLLOWING QUESTIONS:
1. Is there a family history of migraine or epilepsy? Migraine and epilepsy both present with abdominal pain.
2. Is the pain colicky or persistent? Chronic colicky abdominal pain may be caused by chronic cholecystitis, cholelithiasis, renal calculus, or partial intestinal obstruction.
3. What is the location of the pain? If the pain is located in the upper abdomen, then one should consider peptic ulcer disease, pancreatitis, cholecystitis, and cholelithiasis. If the pain is located in the flanks, one should consider renal calculus and pyelonephritis. If the pain is located in the lower abdomen, one should consider diverticulitis, salpingitis, endometritis, and chronic appendicitis. Regional ileitis also may be located in the lower abdomen, particularly in the right lower quadrant.
4. What is the relationship to meals? Abdominal pain relieved by food may be caused by a peptic ulcer. Abdominal pain brought on by food may be caused by abdominal angina. If the pain comes on 2 to 3 hours after a meal, it may be caused by a peptic ulcer. On the other hand, pain that comes on 1 to 2 hours after meals, especially if it is a fatty meal, may be related to cholecystitis and cholelithiasis.
5. Is there fever associated with the abdominal pain? Fever and abdominal pain may be caused by pyelonephritis, diverticulitis, or appendicitis.