History-taking
CPSA · Focused history · Gastrointestinal
Abdominal pain
Location + character + associated GI/urinary/gynae symptoms localise the cause. Always consider the surgical abdomen and, in women, an ectopic pregnancy.
Focused questions
Characterise (SOCRATES)
- Site (which quadrant), onset, character (colicky vs constant), radiation (loin-to-groin, to back, to shoulder tip), timing, relation to food/movement, severity
Associated symptoms
- GI: nausea/vomiting, bowel habit change, blood/melaena, appetite/weight
- Urinary: dysuria, frequency, haematuria
- Gynae: LMP, discharge, pregnancy possibility (β-hCG)
- Systemic: fever, jaundice
By location
- RUQ: biliary (Murphy’s), hepatitis
- Epigastric: peptic ulcer, pancreatitis (radiates to back), MI
- RIF: appendicitis, ectopic, ovarian
- Loin-to-groin colic: renal stone
- Central→RIF migrating: appendicitis
Differentials to screen
AppendicitisCentral pain migrating to RIF, anorexia, low-grade fever
Biliary colic / cholecystitisRUQ pain after fatty food, Murphy’s positive if inflamed
PancreatitisSevere epigastric pain radiating to the back, vomiting, alcohol/gallstones
Renal colicLoin-to-groin colicky pain, haematuria, can’t lie still
Ectopic pregnancyFemale, missed period, PV bleeding, positive β-hCG — exclude in every woman
Red flags — exclude these
- Signs of peritonitis (rigid abdomen)
- Haemodynamic instability (bleeding/perforation/AAA)
- Positive pregnancy test with pain/bleeding (ectopic)
- GI bleeding (haematemesis/melaena)
OSCE tips
- Do a pregnancy test in every woman of childbearing age with abdominal pain.
- Migratory central-to-RIF pain with anorexia is classic appendicitis.
- Consider a leaking AAA in any older patient with abdominal/back pain and collapse.