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How does the character of the abdominal pain help in the evaluation?
- Most pain tends to be midline because of bilateral innervations, with the exception of pain from the kidneys, ureters, abdominal wall, gallbladder, and the ascending or descending colon, which tend to lateralize
Classification of Pain by the Rate of Development
| Explosive and excruciating (instantaneous) | Myocardial infarction Perforated ulcer Ruptured aneurysm Biliary or renal colic (passage of a stone) |
| Rapid, severe, and constant (over minutes) | Acute pancreatitis Complete bowel obstruction Mesenteric thrombus |
| Gradual and steady pain (over hours) | Acute cholecystitis Diverticulitis Acute appendicitis |
| Intermittent and colicky pain (over hours) | Early subacute pancreatitis Mechanical small bowel obstruction |
What are the important historical questions to ask?
- What is the location of the pain and does it radiate?
- What are the exacerbating factors? What are the effects of eating or drinking, activity, position, passage of gas or stool from the rectum, or urination?What associated symptoms are there? Assess for nausea, vomiting, no passage of gas or stool, diarrhea, constipation, bloody stools or emesis, dysuria, dysmenorrhea, dyspareunia, fever, or chills.
- Especially important past medical history questions are conditions that might mute the early symptoms of an acute abdominal process such as immunosuppression, diabetes, chronic renal failure, or steroid use.
- Obtain a family history of medical conditions.
- Obtain a social history of drug use, alcohol abuse, smoking, and sexual behavior.
- Obtain a history of medication use, including prescribed, over the counter, and birth control pills.
- Obtain a menstrual history.
