Abdominal Pain

Question 1

OSCORATES ,

Answer 1

Open- tell me a bit more about the problem
Site- point to it exactly. Where did it first start
Onset- when did it start and has it gotten worse
Character- what does it feel like eg. Sharp, cramping, dull etc.
Radiation- does the pain move anywhere/ can you show me- back, sides, groin, testicles, shoulder tip
Associated Features- discussed later
Timing- pain all the time or does it come and go/ any particular time when it’s worse (night or menses)/ how long do the outs occur/ have you had thus pain before
Exacerbating or relieving factors- what brings it on/ anything make it worse or better/ anything you’ve taken to relieve the pain/ any positions make a difference
Severity- out of 10/ how have the Sx affected your day to day life

Question 2

Systems review

Answer 2

FWAR- also sweats

GI- dysphagia, n and v, indigestion, bowel habit change, tenesmus, blood or mucus in stool

Urological- frequency, volume, urgency, nocturia, incontinence, dysuria, haematuria, odour

Gynaecological- pregnancy risk, discharge, pain, bleeding, periods (how have they been), bloating (ovarian cancer)

CVS- do you ever get chest pain/ does it come on during exercise (VERY IMPORTANT TO EXCLUDE ACS)

Question 3

Appendicitis

Answer 3

Most common in the young
Periumbilical pain
Moves to RIF
Anorexia

Question 4

Biliary colic

Answer 4

Intermittent severe RUQ/ epigastric pain

Exacerbated by large meals (30-60 mins)

Question 5

Cholecystitis

Answer 5

Continuous RUQ/ epigastric pain, fever

Question 6

CBD Stones

Answer 6

Jaundice

RUQ pain

Question 7

Ascending cholangitis

Answer 7

Charcots triad- fever, jaundice, RUQ pain

Reynolds Pentad- confusion and hypotension

Question 8

Acute Pancreatitis

Answer 8

Severe epigastric or central pain
Radiated to back
Relieved by sitting forwards
Vomiting

Question 9

PUD

Answer 9

Epigastric pain related to food

Risk factors

Question 10

Diverticulitis

Answer 10

Elderly
LIF pain
Pyrexia

Question 11

Bowel obstruction

Answer 11

Vomiting and distension
No bowel movements
Colicky pain

Question 12

Renal colic

Answer 12

Excruciating spasms loin to groin
Nausea and vomiting
Can’t sit still

Question 13

Ectopic pregnancy

Answer 13

Increasing iliac fossa or pelvic pain
4-12 weeks gestation/ not using contraception/ recent period of amenorrhoea
May have spotting

Question 14

Others

Answer 14

Gastroenteritis 
AAA
Pyelonephritis (fever)
IBD 
MI
Ischaemic colitis
PID
Ovarian/testicular torsion

Question 15

Investigations for acute abdominal pain

Answer 15

Urinalysis- where required
Bloods- FBC UE LFT clotting amylase and glucose
Pregnancy test- where required
Imaging- USS/ MRI etc,

Question 16

What not to forget in young females

Answer 16

Could you be pregnant!

Recent unprotected sexual intercourse- PID

Question 17

Commonest causes of abdominal pain

Answer 17

Constipation 
Menstrual pain 
Appendicitis 
UTI
IBS
Non specific pain

Question 18

Investigations for chronic abdominal pain

Answer 18

Bloods and urinalysis 
H pylori stool antigen test (dyspepsia)
Faecal cal protection 
Endoscopy 
USS
CT or MR abdomen

Question 19

Viral hepatitis

Answer 19

Consider asking about sexual history/ IVDU/ travel abroad to rule in/out viral hepatitis

Question 20

PID

Answer 20

PV discharge
Abdominal pain
Recent unprotected sex