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Common Abdominal Histories

Presenting Exploding symptom Relevant system reviews Differential diagnoses Clues to differential
complaint Grouping Differentials
Abdominal Site General Gastrointestinal Appendicitis Young patient
pain Onset Fever, sweats Periumbilical pain
Character Moves to RIF
Radiation Gastrointestinal Anorexia
Associated symptoms Weight: loss, appetite change Gallstones Biliary colic
Timing Work down body: dysphagia, Intermittent RUQ pain
Exacerbating/relieving factors nausea/ vomiting, indigestion/ Exacerbated by fatty food
Severity heartburn, bowel habit change,
blood/ mucus in stool Cholecystitis
Continuous RUQ pain
Urological
Storage: frequency, volume, CBD stones
urgency/ nocturia Jaundice
Infection: dysuria, haematuria RUQ pain

Gynaecological (if female) Cholangitis


PV Bleeding: menorrhagia, Jaundice
inter-menstrual bleeding, post- Fever/rigors
coital, post-menopausal bleeding RUQ pain
PV Discharge Pancreatitis Acute pancreatitis
Pain: pelvic/dysmenorrhoea/ Severe epigastric/central pain
dyspareunia Radiating to back
Chance could be pregnant Relieved by sitting forwards
Vomiting
Gastritis/peptic Epigastric pain
ulcer Related to meals
Risk factors e.g. NSAIDs, alcohol, spicy food
Diverticulitis Elderly
LIF pain
Pyrexia
Bowel obstruction Vomiting + abdo pain + no bowel motions
Urological Renal colic Spasms of loin to groin pain (excruciating)
Nausea and vomiting
Cannot lie still
Gynaecological Ectopic pregnancy Increasing iliac fossa/pelvic pain
6 weeks pregnant/not using contraception
May have spotting
Other Ruptured AAA
differentials Gastroenteritis
Volvulus
Pyelonephritis
IBD
Mesenteric ischaemia
Pelvic inflammatory disease
Endometriosis
Non-abdominal (MI, pneumonia, DKA)

Change in Timing Gastrointestinal Gastrointestinal Colon cancer Elderly


bowel habit When started Weight: loss, appetite change Blood in stool/melaena
Acute/ gradual onset Work down body: dysphagia, Weight loss
Duration nausea/ vomiting, indigestion/ Gastroenteritis Acute diarrhoea
Progression heartburn, abdominal pain, Nausea & vomiting
Intermittent or continuous blood/ mucus in stool Inflammatory Blood/ mucus in stool
bowel disease Abdominal pain
Stool Irritable bowel Fluctuate between diarrhoea and
How much, how often, syndrome constipation
consistency Associated with stress
Colour & contents (mucus, Anxious personality
blood, bile if vomiting) Coeliac disease Diarrhoea, steatorrhoea
Anaemia symptoms
Abdominal discomfort
Endocrinological Thyrotoxicosis Diarrhoea
Heat intolerance
Irritability/ restlessness
Tremor
Oligomenorrhoea/amenorrhoea
Hypothyroidism Constipation
Cold intolerance
Lethargy/ tiredness
Menorrhagia
Other Bowel obstruction
differentials 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 Timing Gastrointestinal Anal fissure Bleeding on defecation
bleeding When started Weight: loss, appetite change Fresh blood Bright red on tissue paper
Acute/ gradual onset Work down body: dysphagia, (distal) Intense anal pain
Duration nausea/ vomiting, indigestion/ Constipation history
Progression heartburn, abdominal pain, Haemorrhoids Bleeding on defecation
Intermittent or continuous bowel habit change, mucus in Bright red on tissue paper
stool Constipation history
Rectal bleeding Diverticular Sudden painless rectal bleeding
Blood: fresh/altered/melaena haemorrhage Elderly
When does it occur Distil polyp/cancer Alternating bowel habit
Weight loss
Stool Urgency/ tenesmus
Any mucus Inflammatory Blood mixed with stool
How much, how often, bowel disease Mucus
consistency Diarrhoea
Abdominal pain
Haemorrhagic Acute diarrhoea and vomiting
infective History of suspicious food intake
gastroenteritis
Angiodysplasia Elderly
Proximal polyp/ Weight loss
cancer Anaemia symptoms
Haemorrhagic Gastritis symptoms
peptic ulcer/ Risk factors e.g. NSAIDs, alcohol, spicy food
gastritis
Melaena Oesophageal History of liver disease/ alcoholism
(proximal) varicies May be encephalopathy or alcohol
withdrawal
Haematemesis

Haematemesis Timing Gastrointestinal Gastrointestinal Peptic ulcer Previous gastritis symptoms


When started Weight: loss, appetite change haemorrhage
Acute/ gradual onset Work down body: dysphagia,
Oesophageal History of liver disease/ alcoholism
Duration indigestion/ heartburn,
varicies May be encephalopathy or alcohol
Progression abdominal pain, bowel habit
withdrawal
Intermittent or continuous change, blood/ mucus in stool
Mallory-Weiss tear Multiple vomits before haematemesis
onset
Vomit
Commonly after binge drinking
How much, how often,
consistency Haemorrhagic Previous gastritis symptoms
Colour & contents (mucus, gastritis/ Risk factors e.g. NSAIDs, alcohol, spicy food
blood, bile if vomiting) oesophagitis

2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students finals OSCE revision