Common Abdominal Histories
Presenting
complaint
Abdominal
pain
Exploding symptom
Relevant system reviews
Differential diagnoses
Grouping
Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbating/relieving factors
Severity
General
•Fever, sweats
Gastrointestinal
Gastrointestinal
•Weight: loss, appetite change
•Work down body: dysphagia,
nausea/ vomiting, indigestion/
heartburn, bowel habit change,
blood/ mucus in stool
Appendicitis
Gallstones
CBD stones
•Jaundice
•RUQ pain
Gynaecological (if female)
•PV Bleeding: menorrhagia,
inter-menstrual bleeding, postcoital, post-menopausal bleeding
•PV Discharge
•Pain: pelvic/dysmenorrhoea/
dyspareunia
•Chance could be pregnant
Pancreatitis
Gastritis/peptic
ulcer
Diverticulitis
Timing
•When started
•Acute/ gradual onset
•Duration
•Progression
•Intermittent or continuous
Gastrointestinal
•Weight: loss, appetite change
•Work down body: dysphagia,
nausea/ vomiting, indigestion/
heartburn, abdominal pain,
blood/ mucus in stool
•Young patient
•Periumbilical pain
•Moves to RIF
•Anorexia
Biliary colic
•Intermittent RUQ pain
•Exacerbated by fatty food
Cholecystitis
•Continuous RUQ pain
Urological
•Storage: frequency, volume,
urgency/ nocturia
•Infection: dysuria, haematuria
Change in
bowel habit
Clues to differential
Differentials
Cholangitis
•Jaundice
•Fever/rigors
•RUQ pain
Acute pancreatitis
•Severe epigastric/central pain
•Radiating to back
•Relieved by sitting forwards
•Vomiting
•Epigastric pain
•Related to meals
•Risk factors e.g. NSAIDs, alcohol, spicy food
•Elderly
•LIF pain
•Pyrexia
Vomiting + abdo pain + no bowel motions
•Spasms of loin to groin pain (excruciating)
•Nausea and vomiting
•Cannot lie still
•Increasing iliac fossa/pelvic pain
• ̴ 6 weeks pregnant/not using contraception
•May have spotting
Urological
Bowel obstruction
Renal colic
Gynaecological
Ectopic pregnancy
Other
differentials
Ruptured AAA
Gastroenteritis
Volvulus
Pyelonephritis
IBD
Mesenteric ischaemia
Pelvic inflammatory disease
Endometriosis
Non-abdominal (MI, pneumonia, DKA)
Gastrointestinal
Colon cancer
Gastroenteritis
Inflammatory
bowel disease
Irritable bowel
syndrome
Stool
•How much, how often,
consistency
•Colour & contents (mucus,
blood, bile if vomiting)
Coeliac disease
Endocrinological
Thyrotoxicosis
Hypothyroidism
Other
differentials
•Elderly
•Blood in stool/melaena
•Weight loss
•Acute diarrhoea
•Nausea & vomiting
•Blood/ mucus in stool
•Abdominal pain
•Fluctuate between diarrhoea and
constipation
•Associated with stress
•Anxious personality
•Diarrhoea, steatorrhoea
•Anaemia symptoms
•Abdominal discomfort
•Diarrhoea
•Heat intolerance
•Irritability/ restlessness
•Tremor
•Oligomenorrhoea/amenorrhoea
•Constipation
•Cold intolerance
•Lethargy/ tiredness
•Menorrhagia
Bowel obstruction
Diet and lifestyle changes
Peri-anal conditions (haemorrhoids, fissure)
Drugs (e.g. opiates, iron, antacids, antibiotics)
Diverticulitis
Overflow constipation
Lactose intolerance
Chronic infection
© 2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision
Rectal
bleeding
Timing
•When started
•Acute/ gradual onset
•Duration
•Progression
•Intermittent or continuous
Gastrointestinal
•Weight: loss, appetite change
•Work down body: dysphagia,
nausea/ vomiting, indigestion/
heartburn, abdominal pain,
bowel habit change, mucus in
stool
Anal fissure
Fresh blood
(distal)
Haemorrhoids
Rectal bleeding
•Blood: fresh/altered/melaena
•When does it occur
Diverticular
haemorrhage
Distil polyp/cancer
Stool
•Any mucus
•How much, how often,
consistency
Inflammatory
bowel disease
Melaena
(proximal)
Haematemesis
Timing
•When started
•Acute/ gradual onset
•Duration
•Progression
•Intermittent or continuous
Vomit
•How much, how often,
consistency
•Colour & contents (mucus,
blood, bile if vomiting)
Gastrointestinal
•Weight: loss, appetite change
•Work down body: dysphagia,
indigestion/ heartburn,
abdominal pain, bowel habit
change, blood/ mucus in stool
Gastrointestinal
Haemorrhagic
infective
gastroenteritis
Angiodysplasia
Proximal polyp/
cancer
Haemorrhagic
peptic ulcer/
gastritis
Oesophageal
varicies
•Bleeding on defecation
•Bright red on tissue paper
•Intense anal pain
•Constipation history
•Bleeding on defecation
•Bright red on tissue paper
•Constipation history
•Sudden painless rectal bleeding
•Elderly
•Alternating bowel habit
•Weight loss
•Urgency/ tenesmus
•Blood mixed with stool
•Mucus
•Diarrhoea
•Abdominal pain
•Acute diarrhoea and vomiting
•History of suspicious food intake
•Elderly
•Weight loss
•Anaemia symptoms
•Gastritis symptoms
•Risk factors e.g. NSAIDs, alcohol, spicy food
•History of liver disease/ alcoholism
•May be encephalopathy or alcohol
withdrawal
•Haematemesis
Peptic ulcer
haemorrhage
•Previous gastritis symptoms
Oesophageal
varicies
•History of liver disease/ alcoholism
•May be encephalopathy or alcohol
withdrawal
•Multiple vomits before haematemesis
onset
•Commonly after binge drinking
•Previous gastritis symptoms
•Risk factors e.g. NSAIDs, alcohol, spicy food
Mallory-Weiss tear
Haemorrhagic
gastritis/
oesophagitis
© 2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision