- Site: where is the pain?
- Patients point with- finger vs hand
- Locations (Great degree of overlap)
- Right hypochondrium.- Hepatobiliary, gallbladder
- Left hypochondrium.- Spleen
- Epigastrium.- Stomach and duodenum
- Lumber- kidney
- Umbilical- small bowel, caecum, retroperitoneal
- Right iliac fossa- Appendix, caecum
- Left iliac fossa- Sigmoid colon
- Hypogastrium- Colon, urinary bladder, adenexae
- Onset :
- Slow: inflammation
- Sudden: perforation, ischemia
-
Duration: acute or chronic
-
Severity: Numeric Pain Rating Scale (1-10)
- 4-6 – moderate pain
- Mild beginning- inflammation
- Severe- perforation, ischemia
- Nature:
- Dull (inflammation),
- Sharp (rupture viscus),
- Colic (intermittent)
- Throbbing (abscess)
- Progression:
- Steady increase (inflammation),
- Fluctuating (colic)
- Aggravating factors:
- Fatty foods increases pain in gallstone disease
- Eating
- Fasting
- Relieving factors:
- Sitting & leaning forward eases pain- acute pancreatitis.
- Eating relieves pain- duodenal ulce
- Radiation or referred pain:
- Shoulder- cholecystitis,
- Groin- ureteric colic
- Shifting or migration:
- periumbilical to RIF in acute appendicitis
- Cause:
- Trauma,
- Food from outside- gastroenteritis
- Medication (NSAID)- perforation, bleeding