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