Abdomen histories PDF

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Summary

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Common Abdominal Histories Presenting complaint Abdominal pain

Exploding symptom

Relevant system reviews

Differential diagnoses Grouping

Site Onset Character Radiation Associated symptoms Timing Exacerbating/relieving factors Severity

General Fever, sweats

Gastrointestinal

Gastrointestinal Weight: loss, appetite change Work down body: dysphagia, nausea/ vomiting, indigestion/ heartburn, bowel habit change, blood/ mucus in stool

Appendicitis

Gallstones

CBD stones Jaundice RUQ pain

Gynaecological (if female) PV Bleeding: menorrhagia, inter-menstrual bleeding, postcoital, post-menopausal bleeding PV Discharge Pain: pelvic/dysmenorrhoea/ dyspareunia Chance could be pregnant

Pancreatitis

Gastritis/peptic ulcer Diverticulitis

Timing When started Acute/ gradual onset Duration Progression Intermittent or continuous

Gastrointestinal Weight: loss, appetite change Work down body: dysphagia, nausea/ vomiting, indigestion/ heartburn, abdominal pain, blood/ mucus in stool

Young patient Periumbilical pain Moves to RIF Anorexia Biliary colic Intermittent RUQ pain Exacerbated by fatty food Cholecystitis Continuous RUQ pain

Urological Storage: frequency, volume, urgency/ nocturia Infection: dysuria, haematuria

Change in bowel habit

Clues to differential

Differentials

Cholangitis Jaundice Fever/rigors RUQ pain Acute pancreatitis Seee eigaiccentral pain Radiaig  back Relieed b iig fad Vmiig Epigastric pain Related to meals Risk factors e.g. NSAIDs, alcohol, spicy food Elderly LIF pain Pyrexia Vomiting + abdo pain + no bowel motions Spasms of loin to groin pain (excruciating) Nausea and vomiting Cannot lie still Increasing iliac fossa/pelvic pain   6 weeks pregnant/not using contraception May have spotting

Urological

Bowel obstruction Renal colic

Gynaecological

Ectopic pregnancy

Other differentials

Ruptured AAA Gastroenteritis Volvulus Pyelonephritis IBD Mesenteric ischaemia Pelvic inflammatory disease Endometriosis Non-abdominal (MI, pneumonia, DKA)

Gastrointestinal

Colon cancer

Gastroenteritis Inflammatory bowel disease Irritable bowel syndrome

Stool How much, how often, consistency Colour & contents (mucus, blood, bile if vomiting)

Coeliac disease

Endocrinological

Thyrotoxicosis

Hypothyroidism

Other differentials

Eldel Blood in stool/melaena Weight loss Acute diarrhoea Nausea & vomiting Blood/ mucus in stool Abdominal pain Fluctuate between diarrhoea and constipation Associated with stress Anxious personality Diarrhoea, steatorrhoea Anaemia symptoms Abdominal discomfort Diarrhoea Heat intolerance Irritability/ restlessness Tremor Oligomenorrhoea/amenorrhoea Constipation Cold intolerance Lethargy/ tiredness Menorrhagia

Bowel obstruction 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 de finals OSCE revision

Rectal bleeding

Timing When started Acute/ gradual onset Duration Progression Intermittent or continuous

Gastrointestinal Weight: loss, appetite change Work down body: dysphagia, nausea/ vomiting, indigestion/ heartburn, abdominal pain, bowel habit change, mucus in stool

Anal fissure Fresh blood (distal) Haemorrhoids

Rectal bleeding Blood: fresh/altered/melaena When does it occur

Diverticular haemorrhage Distil polyp/cancer

Stool Any mucus How much, how often, consistency

Inflammatory bowel disease

Melaena (proximal)

Haematemesis

Timing When started Acute/ gradual onset Duration Progression Intermittent or continuous Vomit How much, how often, consistency Colour & contents (mucus, blood, bile if vomiting)

Gastrointestinal Weight: loss, appetite change Work down body: dysphagia, indigestion/ heartburn, abdominal pain, bowel habit change, blood/ mucus in stool

Gastrointestinal

Haemorrhagic infective gastroenteritis Angiodysplasia Proximal polyp/ cancer Haemorrhagic peptic ulcer/ gastritis Oesophageal varicies

Bleeding on defecation Bright red on tissue paper Intense anal pain Constipation history Bleeding on defecation Bright red on tissue paper Constipation history Sudden painless rectal bleeding Elderly Alternating bowel habit Weight loss Urgency/ tenesmus Blood mixed with stool Mucus Diarrhoea Abdominal pain Acute diarrhoea and vomiting History of suspicious food intake Elderly Weight loss Anaemia symptoms Gastritis symptoms Risk factors e.g. NSAIDs, alcohol, spicy food History of liver disease/ alcoholism May be encephalopathy or alcohol withdrawal Haematemesis

Peptic ulcer haemorrhage

Previous gastritis symptoms

Oesophageal varicies

History of liver disease/ alcoholism May be encephalopathy or alcohol withdrawal Multiple vomits before haematemesis onset Commonly after binge drinking Previous gastritis symptoms Risk factors e.g. NSAIDs, alcohol, spicy food

Mallory-Weiss tear

Haemorrhagic gastritis/ oesophagitis

© 2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical de finals OSCE revision...