Chronic or recurrent abdominal pain

Advances in technology have increased the opportunities for diagnosing chronic or recurrent abdominal pain 12 in adults:

• Ultrasound. This is the single most useful screening test. It can detect gallstones, pelvic pathology such as carcinoma of the ovary and retroperitoneal problems such as abdominal aneurysm and carcinoma of the pancreas.

• Endoscopy. This is the next most useful investigation. The history dictates whether it is gastroscopy or colonoscopy.

If the patient has 'red flag' symptoms (Table 30.7) and the above investigations are absent, consider the possibility of conditions such as carcinoma of the pancreas, carcinoma of the ovary, small bowel tumours, mesenteric ischaemia, Crohn's disease, metabolic disorders such as lactase deficiency, and rarer conditions as outlined in Table 30.3 . Other investigations that may help:

• Laparoscopy: This may allow the identification of chronic adhesive obstruction, small bowel tumours or inflammation, or intra-abdominal malignancy.

Table 30.7 Red flags for organic disease 12

Older patient

Nocturnal pain or diarrhoea

Progressive symptoms

Rectal bleeding

Fever

Anaemia

Weight loss

Abdominal mass

Faecal incontinence or urgency (recent onset)

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