Abdominal History

Abdominal History

·        Abdominal Pain:

o   Frequency and duration

o   Site and radiation: pancreas or peptic ulcer may radiate to the back, diaphragm to shoulder and oesophagus to the neck

o   Pattern: colicky pain is due to peristaltic movements against obstruction in bowel or ureters. Biliary pain usually lasts for hours (ie is not colicky)

o   Aggravating or relieving factors, including food, vomiting, defaecation, flatus, lying still in peritonitis

·        Appetite and weight change: 

o   Anorexia and weight loss Þ ?malignancy

o   ­Appetite and weight loss Þ ?malabsorption

·        Nausea and vomiting, ask about vomit (blood, bile, old food Þ outlet obstruction, etc)

·        Heartburn and acid regurgitation

·        Dysphagia: differentiate painful swallowing from actual difficulty

·        Diarrhoea: check frequency and consistency.  Can be:

o   Secretory diarrhoea: large volume

o   Osmotic diarrhoea: disappears with fasting

o   Abnormal intestinal motility

o   Exudative diarrhoea: with blood or mucus

o   Malabsorption: steatorrhoea 

·        Constipation: Check what they mean. Check drugs, hypothyroidism, diabetes, etc. Is it recent (cancer can cause obstruction)?

·        Mucus: ?IBS or rectal ulcer, fistula or villous adenoma

·        Bleeding:

o   Haematemesis (vomiting blood)

o   Melaena (jet black stools)

o   Haematochezia (bright red rectal bleeding) 

·        Jaundice: also ask about dark urine and pale stools (® obstructive jaundice)

·        Pruritis: itching skin.  Can be caused by cholestatic liver disease

·        Abdominal swelling.  Also check ankles

·        Lethargy: common in liver disease

·        Drugs: especially NSAIDS

·        Social history: alcohol, occupational exposure to hepatitis, travel, sexual and recreational drug history