First, some philosophical points.

In medicine, things are not always what they to appear to be. This phenomenon has been born out a plethora of times dating all the way back to Dr. Osler himself.

Further, in medicine, there are two competing approaches to diagnosis. The first is Occam’s Razor: all things being equal, the simplest explanation is likely to be the correct one. That is to say, a single unifying diagnosis is the most plausible and likely the correct and only one. The second approach is entrenched in what is called Saint’s Triad: more than one disease process may be responsible for the presenting illness.

So, which philosophy do internists, pediatricians, etc., take in the process of differential diagnosis? Well, that is highly dependent on the intelligence, experience, and acumen of the individual clinician.

Without knowing all the facts, I suspect that your wife’s abdominal pain is the NOTmain problem. Her pain may simply be a manifestsation of the problem (Occam’s Razor) or problems (Saint’s Triad). Often, clincians are fooled by the fallacy that a symptom or sign MUST be originating from the geographical organ system. Not true . . . ohhhh, so not true . . .

Based on the information that you’ve provided (thank you), I suspect that the abdominal pain is not visceral per se, but is being caused by either a systemic inflammatory process, (i.e., autoimmune disease, paraneoplastic syndrome) or a metabolic syndrome (i.e., acute intermittent porphyria) or an infectious process.

There are several salient features in your wife’s case, but the one that intrigues (and worries) me the most is PHOTOSENSITIVITY, which has a limited differential diagnosis. But what immediately comes to mind is systemic lupus erythematosis and acute intermittent porphyria.

If I may ask for additional details,

1. How old is your wife?
2. Does she have any oral or canker sores?
3. Does her urine change color when the abdominal pain strikes?
4. Is her serum calcium normal?
5. Has she been evaluated for primary hyperparathyroidism?

Your gall bladder evacuates at a normal rate, but there may be disease there anyway.

If I were a doctor, and I have no medical training, I would also see an endocrinologist.

The liver, pancreas, and gall bladder all hang out there, and it is possible there is infection.

Inflammation also may indicate auto-immune possibilities. Some of the symptoms are lupus-like, and it wouldn’t hurt to get checked out. Joint pain and sun-sensitive rashes raise my suspicions. There’s a blood test (ANA) that can rule it out.

The endocrinologist can help with the hormone changes and may be able to narrow down what’s wrong.