The physician must rule out all of the following and can do so easily by asking the right medical history questions. Things to be kept in mind by the physician examining a hepatic porphyria patient are the cardiac risk factors especially if the patient complains of nausea and vomiting along with the abdominal pain. It is not the usual scenario for cardiac problems and more often is gastroenteritis. But abdominal pain can be life threatening and especially when it involves cardiac problems. In examining a patient with unexplained abdominal pain, it is foremost to consider the worst possibilities first as those require immediate intervention.
Acute appendicitis is always one of the first things to be considered on a check list.
With a majority of porphyria patients, their appendix was removed unnnecessarily because it was thought to be the cause of thje abdominal pain at some earlier time. Intestinal blockage has also often been an incorrect diagnosis for porphyic abdominal pain. However, it is most important to begin hydration of a patient who is suspect for porphyria. Long hours of waiting in an examination room only adds to the problem of the acute attack. Early administration of glucose infusion will in fact reduce the pain index within a few hours as it is the action of the carbohydrate infusion that corrects the over production of porphyrins in the liver.