Chronic abdominal pain in women: Cost-conscious ways to avoid diagnostic errors

A meticulous history taking and physical examination help differentiate between life-threatening and functional sources of chronic abdominal pain in women and thus may eliminate unnecessary and invasive diagnostic procedures. Fever, lower abdominal tenderness, and cervical discharge suggest pelvic inflammatory disease; pain provoked by eating, associated with weight loss, may indicate chronic mesenteric ischemia. Consider the risk factors for ovarian cancer (over age 50, family history of ovarian cancer, and family or personal history of breast cancer) when assessing a woman with dull pelvic pain, pressure in the bladder or pelvis, and abdominal bloating. Eliminate other serious causes of chronic abdominal pain before considering such functional causes as irritable bowel syndrome, gastroesophageal reflux, and nonulcer dyspepsia.