Extraabdominal Causes of Abdominal Pain

Diabetes mellitus (DM), chronic renal failure (CRF), amyloidosis, sickle cell anemia (SCA) and acute intermittent porphyria are among diseases that can be associated with abdominal pain (AP) at some point in the course of the pathological process. Diabetic ketoacidosis (DKA) is a severe life-threatening syndrome characterized by fluid loss, electrolyte changes, hyperosmolarity and acidosis. These pathophysiologic factors can explain AP in patients with DKA. Vomiting and AP can also be initial manifestations of DKA even in euglycemic patients. SCA is one of the most common autosomal recessive diseases classified in hemoglobinopathies. The disease is first recognized by history, then by peripheral smear and hemoglobin electrophoresis, and advanced studies. Splenic sequestration crisis is a severe complication of SCA that prompts emergent treatment, Opiate analgesia and hydration is the main treatment. Patients with chronic renal failure (CRF) and end-stage renal disease are also prone to severe AP due to peritonitis which is triggered by continuous ambulatory peritoneal dialysis in vulnerable patients. Amyloidosis is mostly recognized with typical attacks i.e., febrile episodes, exanthema, AP, myalgias and arthralgias. Acute intermittent porphyria is an autosomal dominant disorder characterized by severe neurovisceral attacks of AP, nausea, vomiting, tachycardia, and hypertension in the absence of signs compatible with peritonitis. Management of mild attacks comprises symptomatic treatment, optimized calorie intake, and fluid replacement to beware dehydration.

Keywords: Abdominal pain, Acute intermittent porphyria, Amyloidosis, Chronic renal failure, Diabetes mellitus, Peritonitis, Porphyria, Sickle cell anemia, Splenic sequestration crisis.