Common Abdominal Histories

Question 1

Examples of different presenting complaints a patient may have?

Answer 1

1. abdominal pain
2. change in bowel habit
3. rectal bleeding
4. haematemesis

Question 2

A patient presents with abdominal pain, what other areas would you want to explore?

Answer 2

1. general
2. GI
3. urological
4. gynaecological if relevant

Question 3

GI system review will involve checking for:

Answer 3

• weight loss
• appetite change
• dysphagia
• nausea
• heart burn
• indigestion
• bowel habit change
• blood / mucus in stool

Question 4

general systems review would include querying about:

Answer 4

• fevers

- sweats

Question 5

urological systems review will mean asking about:

Answer 5

1. storage
   - frequency
   - volume
   - urgency
   - nocturia
2. infection
   - dysuria
   - haematuria

Question 6

gynae systems review involves asking about:

Answer 6

1. PV bleeding
   - menorrhagia
   - intermenstrual bleeding
   - post coital
   - post menopausal bleeding
2. PV discharge
3. Pain: pelvic / dysmenorrhoea / dyspareunia
4. pregnant?

Question 7

Abdominal pain

the following points to which differential:

• younger patient
• periumbilical pain
• moves to RIF
• anorexia

Answer 7

appendicitis

Question 8

Abdominal pain

the following points to which differential:

• intermittent RUQ
• exacerbated by fatty food

Answer 8

gallstones

- biliary colic

Question 9

Abdominal pain

the following points to which differential:

• continuous RUQ pain

Answer 9

cholecystitis

Question 10

Abdominal pain

the following points to which differential:

• jaundice
• RUQ pain

Answer 10

common bile duct stones

Question 11

Abdominal pain

the following points to which differential:

• jaundice
• fevers / rigors
• RUQ pain

Answer 11

cholangitis

Question 12

Abdominal pain

the following points to which differential:

• severe epigastric/ central pain
• radiating to back
• relieved by sitting forwards
• vomiting

Answer 12

pancreatitis

Question 13

Abdominal pain

the following points to which differential:

• epigastric pain
• related to meals
• risk factors: e.g. NSAIDs, alcohol, spicy food

Answer 13

gastritis / peptic ulcer

Question 14

Abdominal pain

the following points to which differential:

• elderly
• LIF pain
• pyrexia

Answer 14

diverticulitis

Question 15

Abdominal pain

the following points to which differential:

• vomiting
• abdo pain
• no bowel motions

Answer 15

bowel obstruction

Question 16

Abdominal pain

the following points to which differential:

• spasms of loin to groin pain (excruciating)
• nausea and vomiting
• cannot lie still

Answer 16

renal colic

Question 17

Abdominal pain

the following points to which differential:

• increasing iliac fossa/ pelvic pain
• 6 weeks pregnancy / not using contraception
• may have spotting

Answer 17

ectopic pregnancy

Question 18

other differentials of abdominal pain to be aware of

Answer 18

• ruptured AAA
• gastroenteritis
• volvulus
• pyelonephritis
• IBD
• mesenteric ischaemia
• pelvic inflammatory disease
• endometriosis
• MI, pneumonia, DKA

Question 19

what should you ask in a patient with a change in bowel habit:

Answer 19

Timing

• when it started
• onset
• duration
• progression
• intermittent or continuous

Stool

• how much, how often, consistency
• colour and contents (mucus, blood, bile if vomiting)

Question 20

Change in bowel habit:

the following points to which differential:

• elderly
• blood in stool , melaena
• weight loss

Answer 20

colon cancer

Question 21

Change in bowel habit:

the following points to which differential:

• acute diarrhoea
• nausea and vomiting

Answer 21

gastroenteritis

Question 22

Change in bowel habit:

the following points to which differential:

• blood / mucus in stool
• abdominal pain

Answer 22

inflammatory bowel disease

Question 23

Change in bowel habit:

the following points to which differential:

• fluctuate between diarrhoea and constipation
• associated with stress
• anxious personality

Answer 23

irritable bowel syndrome

Question 24

Change in bowel habit:

the following points to which differential:

• diarrhoea, steatorrhoea
• anaemia symptoms
• abdominal discomfort

Answer 24

coeliac disease

Question 25

Change in bowel habit: the following points to which differential: - diarrhoea - heat intolerance - irritability / restlessness - tremor - oligomenorrhoea / amenorrhoea

Answer 25

thyrotoxicosis

Question 26

Change in bowel habit: the following points to which differential: - constipation - cold intolerance - lethargy - menorrhagia

Answer 26

hypothyroidism

Question 27

other differentials for change in bowel habit?

Answer 27

- bowel obstruction - diet, lifestyle changes - haemorrhoids, fissure - drugs (opiates, iron, antacid, abx) - diverticulitis - overflow constipation - lactose intoleranc e - chronic infection

Question 28

What else would you ask a patient presenting with rectal bleeding?

Answer 28

1. timing 2. blood: altered, fresh, melaena 3. when does it occur 4. stool: mucus, consistency, how much, how often

Question 29

Rectal Bleeding the following points to which differential: - bleeding on defecation - bright red on tissue paper - intense anal pain - constipation history

Answer 29

anal fissure

Question 30

Rectal bleeding the following points to which differential: - bleeding on defecation - bright red on tissue paper - constipation history

Answer 30

haemorrhoids

Question 31

Rectal bleeding the following points to which differential: - sudden painless rectal bleeding - elderly

Answer 31

diverticular haemorrhage

Question 32

Rectal bleeding the following points to which differential: - alternating bowel habit - weight loss - urgency - tenesmus

Answer 32

distal polyp / cancer

Question 33

Rectal bleeding the following points to which differential: - blood mixed with stool - mucus - diarrhoea - abdominal pain

Answer 33

inflammatory bowel disease

Question 34

Rectal bleeding the following points to which differential: - acute diarrhoea and vomiting - history of suspicious food intake

Answer 34

haemorrhagic infective gastroenteritis

Question 35

Rectal bleeding the following points to which differential: - weight loss - anaemia symptoms

Answer 35

proximal polyp, cancer

Question 36

Rectal bleeding the following points to which differential: - gastritis symptoms - risk factors e.g. NSAIDs, alcohol, spicy food

Answer 36

haemorrhagic peptic ulcer / gastritis

Question 37

Rectal bleeding the following points to which differential: - hx liver disease - hx alcoholism - may be encephalopathy or alcohol withdrawal - haematemesis

Answer 37

oesophageal varices

Question 38

Haematemesis the following points to which differential: - previous gastritis symptoms

Answer 38

peptic ulcer haemorrhage

Question 39

Haematemesis the following points to which differential: - hx liver disease, alcoholism - may be encephalopathy or alcohol withdrawal

Answer 39

oesophageal varices

Question 40

Haematemesis the following points to which differential: - multiple vomits before haematemesis onset - commonly after binge drinking

Answer 40

mallory-weiss tear

Question 41

Haematemesis the following points to which differential: - previous gastritis symptoms - risk factors e.g. NSAIDs, alcohol, spicy food

Answer 41

haemorrhagic gastrits oesophagitis