Coeliac disease

Q. Which of the following medical conditions is not a cause of abdominal pain?

• 1. Diabetic ketoacidosis

  2. Porphyria

  3. Angina

  4. Pneumonia

  5. Coeliac disease

  6. Herpes zoster

An insulin-dependent diabetic should always raise the suspicion of ketosis causing abdominal pain. An urgent blood sugar and urine examination should give the diagnosis. Violent intestinal colic may occur in porphyria, a congenital abnormality of haemoglobin metabolism. Patients may present with anaemia, photosensitivity, hypersplenism and constipation. Epigastric pain can mimic angina. A careful history followed by an ECG should give the diagnosis. Pain in the upper quadrant may be the presentation of lower-lobe pneumonia. Pyrexia with signs in the chest are the diagnostic pointers.Coeliac disease causes malnutrition and abdominal pain is not a feature. Herpes causes pain across the abdomen without guarding or rebound tenderness along a dermatome; pain precedes vesicular skin eruption.