What questions should you ask a patient about abdominal pain?

Always ask the following questions regarding abdominal pain (Each question will take you further towards your diagnosis, with the answers to each question serving more or less as components of an equation which usually add up very smoothly provided that you take a good and thorough history):

Site – helps you localize or interpret the organ/s involved.

Intensity – helps your differentiate parietal from visceral pain.

Referred Pain & Radiation – referred pain areas of many organs are predictable and mostly specific which is why this symptoms gives additional clues to reach the diagnosis. In addition to referred pain, how the pain spreads (which is a very important clue in the diagnosis of appendicitis) from one place to another and maybe back again to where it started, is the hallmark of some diseases and aids us further.

Character – points at particular diseases, for example colicky pain is seen in cases of obstruction, sharp pain is a characteristic of abdominal aortic aneurysm, burning pain occurs due to gastro-oesophageal reflux disease, etc.

Onset – gradual or sudden (for example, pain of abdominal aortic aneurysm is sudden and that of cholecystitis is gradual).

Duration – this will tell you whether the condition is acute or chronic.

Frequency – this is the number of times pain episodes were experiences by the patient (a very useful clue in the diagnosis of biliary ‘colic’ is that it is always present at a low degree but gets sudden, multiple episodes of severe pain, subsiding back again).

Aggravating and Relieving factors – this include typical postures (the pain of pancreatitis gets better on leaning forward, etc), foods which aggravate or relieve the pain, etc.

Relationship with meals the pain of cholecystitis worsens after meals whereas that of stomach ulcers gets better temporarily after intake of food, etc.

Associated Symptoms – It is never enough to stick to just the symptom the patient has told you. Even if he or she does not mention any other symptom, ask about each and every symptom of the concerned organ system. When you are considering the gastrointestinal system, inquire about diarrhoea, fever, vomiting, flatus and constipation in addition to a detailed systemic inquiry.

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