Common Abdominal Histories Flashcards
Examples of different presenting complaints a patient may have?
- abdominal pain
- change in bowel habit
- rectal bleeding
- haematemesis
A patient presents with abdominal pain, what other areas would you want to explore?
- general
- GI
- urological
- gynaecological if relevant
GI system review will involve checking for:
- weight loss
- appetite change
- dysphagia
- nausea
- heart burn
- indigestion
- bowel habit change
- blood / mucus in stool
general systems review would include querying about:
- fevers
- sweats
urological systems review will mean asking about:
- storage
- frequency
- volume
- urgency
- nocturia - infection
- dysuria
- haematuria
gynae systems review involves asking about:
- PV bleeding
- menorrhagia
- intermenstrual bleeding
- post coital
- post menopausal bleeding - PV discharge
- Pain: pelvic / dysmenorrhoea / dyspareunia
- pregnant?
Abdominal pain
the following points to which differential:
- younger patient
- periumbilical pain
- moves to RIF
- anorexia
appendicitis
Abdominal pain
the following points to which differential:
- intermittent RUQ
- exacerbated by fatty food
gallstones
- biliary colic
Abdominal pain
the following points to which differential:
- continuous RUQ pain
cholecystitis
Abdominal pain
the following points to which differential:
- jaundice
- RUQ pain
common bile duct stones
Abdominal pain
the following points to which differential:
- jaundice
- fevers / rigors
- RUQ pain
cholangitis
Abdominal pain
the following points to which differential:
- severe epigastric/ central pain
- radiating to back
- relieved by sitting forwards
- vomiting
pancreatitis
Abdominal pain
the following points to which differential:
- epigastric pain
- related to meals
- risk factors: e.g. NSAIDs, alcohol, spicy food
gastritis / peptic ulcer
Abdominal pain
the following points to which differential:
- elderly
- LIF pain
- pyrexia
diverticulitis
Abdominal pain
the following points to which differential:
- vomiting
- abdo pain
- no bowel motions
bowel obstruction
Abdominal pain
the following points to which differential:
- spasms of loin to groin pain (excruciating)
- nausea and vomiting
- cannot lie still
renal colic
Abdominal pain
the following points to which differential:
- increasing iliac fossa/ pelvic pain
- 6 weeks pregnancy / not using contraception
- may have spotting
ectopic pregnancy
other differentials of abdominal pain to be aware of
- ruptured AAA
- gastroenteritis
- volvulus
- pyelonephritis
- IBD
- mesenteric ischaemia
- pelvic inflammatory disease
- endometriosis
- MI, pneumonia, DKA
what should you ask in a patient with a change in bowel habit:
Timing
- when it started
- onset
- duration
- progression
- intermittent or continuous
Stool
- how much, how often, consistency
- colour and contents (mucus, blood, bile if vomiting)
Change in bowel habit:
the following points to which differential:
- elderly
- blood in stool , melaena
- weight loss
colon cancer
Change in bowel habit:
the following points to which differential:
- acute diarrhoea
- nausea and vomiting
gastroenteritis
Change in bowel habit:
the following points to which differential:
- blood / mucus in stool
- abdominal pain
inflammatory bowel disease
Change in bowel habit:
the following points to which differential:
- fluctuate between diarrhoea and constipation
- associated with stress
- anxious personality
irritable bowel syndrome
Change in bowel habit:
the following points to which differential:
- diarrhoea, steatorrhoea
- anaemia symptoms
- abdominal discomfort
coeliac disease
Change in bowel habit:
the following points to which differential:
- diarrhoea
- heat intolerance
- irritability / restlessness
- tremor
- oligomenorrhoea / amenorrhoea
thyrotoxicosis
Change in bowel habit:
the following points to which differential:
- constipation
- cold intolerance
- lethargy
- menorrhagia
hypothyroidism
other differentials for change in bowel habit?
- bowel obstruction
- diet, lifestyle changes
- haemorrhoids, fissure
- drugs (opiates, iron, antacid, abx)
- diverticulitis
- overflow constipation
- lactose intoleranc e
- chronic infection
What else would you ask a patient presenting with rectal bleeding?
- timing
- blood: altered, fresh, melaena
- when does it occur
- stool: mucus, consistency, how much, how often
Rectal Bleeding
the following points to which differential:
- bleeding on defecation
- bright red on tissue paper
- intense anal pain
- constipation history
anal fissure
Rectal bleeding
the following points to which differential:
- bleeding on defecation
- bright red on tissue paper
- constipation history
haemorrhoids
Rectal bleeding
the following points to which differential:
- sudden painless rectal bleeding
- elderly
diverticular haemorrhage
Rectal bleeding
the following points to which differential:
- alternating bowel habit
- weight loss
- urgency
- tenesmus
distal polyp / cancer
Rectal bleeding
the following points to which differential:
- blood mixed with stool
- mucus
- diarrhoea
- abdominal pain
inflammatory bowel disease
Rectal bleeding
the following points to which differential:
- acute diarrhoea and vomiting
- history of suspicious food intake
haemorrhagic infective gastroenteritis
Rectal bleeding
the following points to which differential:
- weight loss
- anaemia symptoms
proximal polyp, cancer
Rectal bleeding
the following points to which differential:
- gastritis symptoms
- risk factors e.g. NSAIDs, alcohol, spicy food
haemorrhagic peptic ulcer / gastritis
Rectal bleeding
the following points to which differential:
- hx liver disease
- hx alcoholism
- may be encephalopathy or alcohol withdrawal
- haematemesis
oesophageal varices
Haematemesis
the following points to which differential:
- previous gastritis symptoms
peptic ulcer haemorrhage
Haematemesis
the following points to which differential:
- hx liver disease, alcoholism
- may be encephalopathy or alcohol withdrawal
oesophageal varices
Haematemesis
the following points to which differential:
- multiple vomits before haematemesis onset
- commonly after binge drinking
mallory-weiss tear
Haematemesis
the following points to which differential:
- previous gastritis symptoms
- risk factors e.g. NSAIDs, alcohol, spicy food
haemorrhagic gastrits
oesophagitis
