What are the 5 commonest causes of abdominal pain?
 
The Riddle of the Sphinx
 
 
“What walks on 4 legs in the morning, two legs in the afternoon, and 3 legs in the evening?” - The Sphinx -
 
What can we learn from the Riddle of the Sphinx?  First, a riddle of our own:
In ancient Thebes, King Laius and Queen Jocasta have a healthy newborn child. To their horror the Oracle informs them that the fate of the child is to kill his father, the King, and marry his mother, the Queen. The King decides the child should be killed and so orders a slave to pierce the child’s ankles, bind them with leather cords, and leave him to die in the hostile mountains. The child is found by a passing shepherd who takes him to the King and Queen of Corinth, who are delighted and adopt the child as they had been unable to have children of their own. They name him Oedipus (swollen-foot) and grow to love him so much that they never tell him he was adopted. When Oedipus grows he hears an oracle again proclaim he is to kill his father and marry his mother and nobly decides he must leave Corinth immediately to spare his ‘parents’, whom he loves dearly, such a fate. He wanders, and on a crossroads encounters a haughty man in a chariot who threatens him off the road with a whip. Our prince, Oedipus, responds with equal arrogance, and when the man strikes the whip Oedipus pulls him from his chariot and kills him. Oedipus eventually comes to the gates of Thebes where he encounters the Sphinx – a terrible beast sent by the Gods, with a body of a lion and head and torso of a woman. She had barricaded and terrorised the city, allowing no one to pass without answering a riddle. Any person getting the riddle wrong (everyone until Oedipus arrived) was killed and eaten. Oedipus approaches and is presented the riddle (above). Oedipus answers correctly, and the frustrated Sphinx throws herself from the city walls and dies on the road. The Thebans are so grateful that they appoint Oedipus their new king, as King Laius had mysteriously disappeared over a year ago on his travels. The widowed queen was made Oedipus’ wife. And so, though he did not know it, Oedipus became guilty of his two terrible prophesised crimes: patricide and incest. Much harm is visited upon Thebes by the Gods, and when Oedipus learns the truth, and finds his wife and mother has hung herself, he takes her brooch and gouges out his own eyes and goes into exile where he atones for his crimes.
If you don’t know the story of Oedipus, here is a very quick précis:
A terrible tale. Amidst the allegory, the lesson for us here is in the Sphinx’s riddle. Do you know the answer? It is mankind: 4 legs in the morning (crawling as a baby), 2 legs in the afternoon (walking as a man) and 3 legs in the evening (walking with a stick). Humans are not just healthy middle class male adults! Diseases and their manifestations are different in children and adults, and differ again in older age. And they may differ between males and females, between ethnicities, or between socioeconomic groups. A thinking clinician keeps this in mind when thinking of presentations. You may even want to make distinctions when you write your cards, for example by using symbols (say little circles with 2-4 legs) to differentiate which age groups suffer from each manifestation. So what is the answer to our riddle about abdominal pain above? It is: Stupid Question!
The common causes of abdominal pain are different in 3-year-old children of the Kalahari when compared to 21-year-old sexually-active females from Canada, or to 80-year-old rest home residents from Armenia.