ABDOMINAL PAIN History Taking

History Taking in ED

1. Introduce. Check patient's identity, ask for comfort and pain relief

2. Ensure the patient is safe. Consider moving to resus or major area of life threatening conditions

3. Presenting complains (ODPARA)

a. Onset

i. Sudden (seconds)

1. Rupture- AA, E. Pregnancy, ulcer perforattion

2. Ischemia- ACS, mesenteric ischemia, ovarian torsion

ii. Rapid (minutes)

1. Obstruction – Gallstones, kidney

2. Pancreatitis

iii. Gradual -Inflammatory: Appendicitis, phyelonephritis

b. Duration

c. Progression

i. Migration

1. Epigastrium to RLQ Appendicitis

2. RLQ to epigastrium Peritonitis

ii. Radiation

1. Shoulder/supraclavicular – Cholecystitis, PE, pneumonia

2. Left scapula – Diaphargmatic irritarion

3. Neck, jaw, arm - ACS

4. Back -AA

5. Lower back – Renal, gynecologic, testicular torsion

iii. Colickly – Affected by persistalsis (renal colic, bowel)

d. Aggravating factors

i. Inspiration

1. Organs adjacent to the diaphragm: Gallblader, pneumonia, Low PE

2. Pancreatitis

3. Irritated peritoneum

ii. Movement

1. Mechanical (muscular)

2. Irritated peritoneum

e. Releasing factors

i. Not moving – Muscular.

f. Associated symptoms

i. Vomiting – Gastroenteritis, surgical disease

ii. Diarrhea – Gastroenteritis

iii. Billiary vomits – Bowel obstruction

iv. Anorexia – Present in appendicitis, not in ovarian torsion.

v. Hematuria Urologic

vi. Polyuria- DKA

vii. Absence of menstruation – ectopic pregnancy

viii. Ongoing menstruation – endometriosis

4. Positive Hx – confirm diagnosis

5. Negative history –rule out certain conditions

6. Risk factors – Hx of illness

a. DM – DKA, ACS

b. Recent surgery – Intraabdominal abscess

c. Gall stone Hx- Cholecystitis, gall blader colic, pancreatitis

d. Previous renal lytiasis – Renal colic, obstructive PN

e. Inflammatory bowel disease

f. Hx of previous ulcer – perforation

g. AF –Rick factor for mesenteric ischemia

h. Colonoscopy, gastroscopy - perforation

7. APMLE History

a. Allergies

b. Social History

i. Travels

ii. Early pregnancy – Ectopic pregnancy

iii. Late pregnancy – Abruptio placentae

c. Medications

i. Corticosteroids, NSAID – Ulcer

ii. Inmunosupressive medication - Infections

d. Etanol - Pancreatitis

e. Smoking - ACS

8. Ask expectations and concerns

9. Explain Mx plan

10. Thank patient

REFERENCES

1. Emergency medicine, problems, pattens and probability Eric Dryver, MD, FRCPC, FEBEM

2. London clinical courses 2020 edition