Abdominal Symptoms Assessment
Swelling or Mass
When was it noticed?
- Acute onset - Suggests hematoma, abscess
- Chronic - More likely neoplasm, organomegaly
How was it noticed?
- Incidental discovery - May indicate the swelling has been present for longer duration
Painful or Painless?
- Painful - Typically inflammatory conditions, some neoplasms
- Painless - Often suggests chronic conditions or certain neoplasms
Change in Size
- Since first noticed?
- Increasing size - Concerning for neoplasms
- Decreasing/disappearing - May suggest reducible hernias or resolving inflammation
Aggravating/Relieving Factors
- Hernias - Increase in size with activity, coughing, straining
Any Identifiable Cause?
- Trauma - May indicate hematoma
- Coughing/straining - May indicate hernia
Vomiting
Characteristics
- Non-bilious - Early stage obstruction, late pyloric obstruction
- Bilious - Bowel obstruction
- Faeculent - Late stage of bowel obstruction
- Bloody - Duodenal ulcer, esophageal varices, tumor
Relationship to Pain
- Vomiting relieves pain - Suggests gastric ulcer
- Vomiting food taken few days ago - Suggests pyloric stenosis
Bowel Habits
Constipation
- Habitual - Chronic condition
- Recent onset - Concerning for neoplasm
Absolute Constipation (Obstipation)
- Intestinal obstruction - Complete inability to pass stool or gas
Diarrhea
- Duration - Acute vs chronic
- Frequency - Number of stools per day
- Characteristics - Any blood or mucous (suggests IBD)
- Bright red - Anal or rectal bleeding
- Maroon - Colon bleeding
- Black (melena) - Upper gastrointestinal bleeding
History of Discharge
Site
- Anal, perineal, wound locations
Duration
- Acute vs chronic discharge
Nature
- Purulent - Suggests anal fistula
- Bloody - Suggests hemorrhoids
- Fecal from wound - Indicates intestinal fistula
- Mixed with stool - Suggests inflammatory bowel disease
- Independent of stool - Suggests hemorrhoids
Associated Pain
- Painful discharge - Common with hemorrhoids, anal fistula