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

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