Key Questions
It is vital to take an accurate pain history as this can provide important information.
There are four key questions to ask about abdominal pain:
Onset – sudden or gradual?
Sudden onset abdominal pain is suggestive of the following:
- Perforation of a viscus (image, right, an abdominal x-ray showing free gas (arrowed) secondary to perforation)
- Peptic ulcer
- Ectopic pregnancy
- Rupture of an aneurysm
- Impaction of a stone as in renal colic
Duration or recurrence of the pain
Recurrent symptoms may indicate following:
- Peptic ulcer disease
- Renal colic
- Gallstone colic and diverticulitis
In females, the following may be related to the menstrual cycle:
- Mittleschmertz
- Endometriosis
Character or nature of the pain
- Sharp, constant pain worsened by movement may represent peritonitis
- Pain more marked than physical findings suggests ischaemic bowel or pancreatitis
Pain due to inflammation of an organ tends to come on gradually and results in guarding on examination.
Pain due to obstruction tends to be intermittent and come in waves (image, right, an abdominal x-ray showing small bowel obstruction (arrowed)).
Location of the pain
Pain radiating to the back may represent aortic aneurysm rupture, peptic ulcer disease or pancreatic pathology (image, below a CT showing aortic aneurysm (arrowed)).
Furthermore, associated symptoms will provide further information on the patient’s condition (Table 1, below)
| Nausea/vomiting |
Altered bowel habit |
Urinary symptoms | Gynaecological history | Genito-urinary medicine (GUM) |
| Vomiting is non-specific and presents with many causes of abdominal pain | Diarrhoea | Dysuria | Last menstrual period | Sexual history may be important and should be asked about if appropriate |
| Pain followed by vomiting suggests a surgical cause | Constipation | Frequency | Vaginal bleeding | |
| Rectal bleeding | Haematuria | Vaginal discharge | ||
| Melaena | Dyspareunia |