Definition

Abdominal pain is a highly unpleasant physical sensation felt in the abdomen.

History

Site

Where is the pain?
Does it radiate anywhere else?

Quality

What does the pain feel like?

Severity

How bad is the pain on a scale of 0 to 10?

Time Course

Onset-Offset

Was the onset sudden or gradual?

Duration

How long have you had the pain?

Temporal Profile

Does the pain come and go? Does it go away completely?
How long does the pain last?

Context

Can you think of anything that has caused the pain?
What were you doing when you first noticed the pain?
Has anybody else had the same abdominal pain?

Aggravating Factors

Is there anything that makes it worse?

Relieving Factors

Is there anything that makes it better?

Associated Features

Is there anything else you've noticed?
Have you had any of the following:

Past History

Medications

Have you been taking:

Family History

Has anybody in your family ever had:

Occupational History and Hobbies

Drug and Alcohol History

  • Excessive alcohol consumption (Liver, Pancreatitis)
  • Narcotic withdrawal

Examinations and Investigations

First Line

Imaging

  • Erect Plain Abdominal X-Ray (may visualise obstruction)
  • Chest X-Ray (perforation)
  • Abdominal CT (helpful in many cases but ordered after X-ray)
  • Ultrasound (Right Upper Quadrant pain)
  • Endoscopy (Upper GI bleeding, Bowel Cancer)

Differential Diagnosis

Upper Abdominal Pain

Central Abdominal Pain

Lower Abdominal Pain

Other Causes

Red Flags

Management

  • Analgesia
  • Fluid Resuscitation
  • Nil Orally
  • Surgery

See Also

Oxford Handbook of Clinical Medicine - 9th edition p608-09