Analysis of Abdominal Pain
1. Site: Where is the Pain?
- Finger pointing vs hand pointing by patients can indicate different pain characteristics
2. Locations (Great Degree of Overlap)
- Right hypochondrium - Hepatobiliary, gallbladder
- Left hypochondrium - Spleen
- Epigastrium - Stomach and duodenum
- Lumbar - Kidney
- Umbilical - Small bowel, caecum, retroperitoneal
- Right iliac fossa - Appendix, caecum
- Left iliac fossa - Sigmoid colon
- Hypogastrium - Colon, urinary bladder, adnexae
3. Onset
- Slow onset - Typically indicates inflammation
- Sudden onset - Suggests perforation, ischemia
4. Duration
- Acute - Recent onset
- Chronic - Long-standing condition
5. Severity: Numeric Pain Rating Scale (1-10)
- Mild (1-3) - Usually inflammatory
- Moderate (4-6) - Significant discomfort
- Severe (7-10) - Suggests perforation, ischemia
6. Nature of Pain
- Dull - Inflammation
- Sharp - Rupture viscus
- Colic - Intermittent, cramping
- Throbbing - Abscess
7. Progression
- Steady increase - Inflammation
- Fluctuating - Colic
8. Aggravating Factors
- Fatty foods - Increases pain in gallstone disease
- Eating - Various conditions
- Fasting - Certain ulcer conditions
9. Relieving Factors
- Sitting & leaning forward - Eases pain in acute pancreatitis
- Eating - Relieves pain in duodenal ulcer
10. Radiation or Referred Pain
- Shoulder - Cholecystitis
- Groin - Ureteric colic
- Shifting or migration:
- Periumbilical to RIF in acute appendicitis
11. Cause
- Trauma
- Food from outside - Gastroenteritis
- Medication (NSAID) - Can cause perforation, bleeding