History in Patients with Acute Abdominal Pain

Where is the pain?

See figure Location of Abdominal Pain and Possible Causes.

What is the pain like?

Acute waves of sharp constricting pain that “take the breath away” (renal or biliary colic)

Waves of dull pain with vomiting (intestinal obstruction)

Colicky pain that becomes steady (appendicitis, strangulating intestinal obstruction, mesenteric ischemia)

Sharp, constant pain, worsened by movement (peritonitis)

Tearing pain (dissecting aneurysm)

Dull ache (appendicitis, diverticulitis, pyelonephritis)

Have you had it before?

Yes suggests recurrent problems such as ulcer disease, gallstone colic, diverticulitis, or mittelschmerz

Was the onset sudden?

Sudden: “Like a light switching on” (perforated ulcer, renal stone, ruptured ectopic pregnancy, ovarian torsion, testicular torsion, some ruptured aneurysms)

Less sudden: Most other causes

How severe is the pain?

Severe pain (perforated viscus, kidney stone, peritonitis, pancreatitis)

Pain out of proportion to physical findings (mesenteric ischemia)

Does the pain travel to any other part of the body?

Right scapula (gallbladder pain)

Left shoulder region (ruptured spleen, pancreatitis)

Pubis or vagina (renal pain)

Back (ruptured aortic aneurysm, pancreatitis, sometimes perforated ulcer)

What relieves the pain?

Antacids (peptic ulcer disease)

Lying as quietly as possible (peritonitis)

What other symptoms occur with the pain?

Vomiting precedes pain and is followed by diarrhea (gastroenteritis)

Delayed vomiting, absent bowel movement and flatus (acute intestinal obstruction; the delay increases with a lower site of obstruction)

Severe vomiting precedes intense epigastric, left chest, or shoulder pain (emetic perforation of the intra-abdominal esophagus)