Common abdominal histories
Abdominal pain
Exploring symptom
- Pain
- Site
- Onset
- Character
- Radiation
- Associated symptoms
- Timing
- Exacerbating/relieving factors
- Severity
Relevant system reviews
- General
- Gastrointestinal
- Weight: loss, appetite change
- Work down body: dysphagia, nausea/vomiting, indigestion/heartburn, bowel habit change, tenesmus, blood/mucus in stool
- Urological
- Storage: frequency, volume, urgency, nocturia, incontinence
- Infection: dysuria, haematuria, odour
- Gynaecological
- PV bleeding: menorrhagia, intermenstrual, post-coital, post-menopausal
- PV discharge
- Pain: pelvic, dysmenorrhoea, dyspareunia
- Pregnancy risk
Differential diagnoses and clues
Gastrointestinal
Appendicitis
-
- Periumbilical pain moving to RIF
Gallstones
- Biliary colic
- Intermittent severe RUQ / epigastric pain
- Exacerbated by fatty food (after 30-60 minutes)
- Cholecystitis
- Continuous RUQ / epigastric pain
- Cholangitis
- Charcotβs triad = Jaundice, Fever/rigors, RUQ pain
Acute pancreatitis
-
- Severe constant epigastric pain
Gastritis/peptic ulcer
- Epigastric pain related to meals
- Risk factors, e.g. NSAIDs, alcohol, spicy food
Diverticulitis
Bowel obstruction
- Vomiting + abdominal distension + no bowel motions
- Colicky pain
Urological
Renal colic
-
- Spasms of severe loin to groin pain
- Dysuria/haematuria
Pyelonephritis
Gynaecological
Ectopic pregnancy
- Increasing iliac fossa / pelvic pain
- 4-12Β weeks gestation / not using contraception / recent period of amenorrhoea
- May have spotting
Pelvic inflammatory disease
- PV discharge
- Lower abdominal pain
- Dyspareunia
- Risk factors (e.g. new or multiple sexual partners)
Endometriosis
- Lower abdominal pain, worst during menstruation
- Dyspareunia
Others
Others
- Ruptured AAA
- Gastroenteritis
- Volvulus
- Pyelonephritis
- IBD
- Mesenteric ischaemia/ischaemic colitis
- Pelvic inflammatory disease
- Endometriosis
- Constipation
- Non-abdominal (e.g. DKA)
Change in bowel habit
Exploring symptom
- Timeframe
- Stool
- How much, how often
- Consistency, colour and contents (mucus, blood)
Relevant system reviews
- Gastrointestinal
- Weight: loss, appetite change
- Work down body: dysphagia, nausea/vomiting, indigestion/heartburn, abdominal pain, tenesmus, blood/mucus in stool, flatus
Differential diagnoses and clues
Gastrointestinal
Colon cancer
- Elderly
- Blood in stool / melaena
- Weight loss + anaemia Sx (SOB, tiredness)
Gastroenteritis
- Acute diarrhoea
- Nausea and vomiting
Inflammatory bowel disease
- Blood/mucus in stool
- Abdominal pain
- Weight loss
Irritable bowel syndrome
- Fluctuate between diarrhoea/constipation
- Anxious personality/associated with stress
- Crampy abdominal pain and bloating
Coeliac disease
- Diarrhoea, steatorrhoea
- Anaemia symptoms
- Abdominal discomfort
Endocrinological
Thyrotoxicosis
- Diarrhoea
- Heat intolerance
- Irritability/restlessness
- Tremor
- Oligomenorrhoea/amenorrhoea
Hypothyroidism
- Constipation
- Cold intolerance
- Lethargy/tiredness
- Menorrhagia
Others
Others
- Small bowel obstruction (not passing flatus)
- Changes in oral intake (food/fluid)
- Medication side effects
- Overflow diarrhoea due to constipation
- Dietary intolerances (e.g. lactulose)
- Malabsorption (e.g. pancreatic insufficiency, bile acid malabsorption)
Rectal bleeding
Exploring symptom
- Timeframe
- Duration
- Onset (sudden or gradual)
- Progression β how often?
- Timing (intermittent or continuous)
- Rectal bleeding
- Blood: fresh/altered/ melaena
- On tissue or mixed in stool
- When does it occur
- Stool
- Any mucus
- How much, how often, consistency
Relevant system reviews
- Gastrointestinal
- Weight: loss, appetite change
- Work down body: dysphagia, nausea/vomiting, indigestion/heartburn, abdominal pain, bowel habit change, mucus in stool
Differential diagnoses and clues
Upper GI (melaena)
Oesophageal varices
- History of liver disease/alcoholism
- May have encephalopathy or alcohol withdrawal
- Haematemesis
Haemorrhagic peptic ulcer/ gastritis
- Gastritis symptoms
- Haematemesis
- Risk factors, e.g. NSAIDs, alcohol, spicy food
Lower GI (fresh red PR bleeding)
Proximal polyp/malignancy
- Weight loss
- Anaemia symptoms
Proximal polyp/malignancy
- Weight loss
- Anaemia symptoms
Angiodysplasia
- Elderly
- Painless
- May be subtle
Haemorrhagic infective gastroenteritis
- Acute diarrhoea and vomiting
- History of high risk food intake
Inflammatory bowel disease
- Blood mixed with stool
- Mucus
- Diarrhoea
- Abdominal pain
- Weight loss
Distal polyp/malignancy
- Alternating bowel habit
- Weight loss
- Urgency/tenesmus
- Anal discomfort/pruritus
Diverticular haemorrhage
- Sudden painless rectal bleeding
- Elderly
HaemorrhoidsΒ
- Bleeding on defecation
- Bright red on tissue paper
- Constipation history
- Anal pruritus
Anal fissure
- Bleeding on defecation
- Bright red on tissue paper
- Intense anal pain
- Constipation history
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Haematemesis
Exploring symptom
- Timeframe
- Duration
- Progression
- Timing (intermittent or continuous)
- Vomit
- How much, how often,
- Consistency, colour and contents (blood)
Relevant system reviews
- Gastrointestinal
- Weight: loss, appetite change
- Work down body: dysphagia, indigestion/heartburn, abdominal pain, bowel habit change, blood in stool/melaena
Differential diagnoses and clues
Gatrointestinal
Oesophageal varices
-
- History of liver disease/alcoholism
-
- May have encephalopathy or alcohol withdrawal
Mallory-Weiss tear
-
- Multiple vomits before haematemesis
-
- Commonly after binge drinking
Peptic ulcer haemorrhage / haemorrhagic gastritis / oesophagitis
-
- Previous gastritis symptoms
-
- Risk factors, e.g. NSAIDs, alcohol, spicy food
Try some questions
A patient presents to the emergency department after vomiting blood. What would you want to know about their past medical/drug/social history?
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A 19 year old female presents with a constant central abdominal pain for 12 hours, which his now moved to the right iliac fossa. Which systems review questions would you ask? Which conditions would you think about for each symptom group?
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Want to test yourself?
- Change in bowel habit
- Diarrhoea
- Abdominal pain
- Diverticulitis
- And there’s so much more!