What questions to ask a 60-year-old female presenting with lower abdominal pain radiating to the back?

Key Questions for a 60-Year-Old Female with Lower Abdominal Pain Radiating to the Back

The most important questions to ask a 60-year-old female presenting with lower abdominal pain radiating to the back should focus on identifying potentially life-threatening conditions such as diverticulitis, bowel obstruction, or vascular emergencies.

Pain Characteristics

• Ask about the onset of pain (sudden vs. gradual) - sudden onset may suggest vascular emergencies like aortic dissection 1
• Determine pain intensity and quality (sharp, tearing, stabbing vs. dull, cramping) - severe, ripping or tearing pain may indicate aortic pathology 1
• Inquire about radiation patterns - pain radiating to the back is concerning for retroperitoneal processes or vascular issues 1
• Establish the duration of symptoms and any changes in character over time 1
• Ask if there are any aggravating or alleviating factors - pain relieved by sitting may suggest spinal stenosis 1

Associated Symptoms

• Inquire about gastrointestinal symptoms:

  • Changes in bowel habits (constipation, diarrhea) 1
  • Last bowel movement and whether it contained blood 1
  • Nausea or vomiting - may suggest bowel obstruction 1
  • Abdominal distention 1

• Ask about urinary symptoms:

  • Dysuria, frequency, or hematuria - may suggest urinary tract infection or kidney stones 2, 3
  • Changes in urinary pattern 2

• Inquire about systemic symptoms:

  • Fever - may indicate infection such as diverticulitis 1
  • Unintentional weight loss - concerning for malignancy 1
  • Night sweats 1

Medical History

• Ask about previous abdominal surgeries - history of abdominal surgery has 85% sensitivity and 78% specificity for predicting adhesive small bowel obstruction 1
• Inquire about history of diverticulosis, diverticulitis, or inflammatory bowel disease 1
• Ask about history of vascular conditions or connective tissue disorders 1
• Determine if there is a history of kidney stones or urinary tract infections 3
• Inquire about any history of gynecological conditions (even post-menopausal) 4, 5
• Ask about history of cancer 1

Family History

• Inquire about family history of aortic dissection or aneurysm 1
• Ask about family history of colorectal cancer 1
• Determine if there is a family history of inflammatory bowel disease 1

Medication History

• Ask about current medications, particularly those that might affect presentation:
  • Anticoagulants or antiplatelets - may increase risk of bleeding 1
  • Pain medications - may mask symptoms 4
  • Steroids - may suppress inflammatory response 1

Risk Assessment

• Inquire about cardiovascular risk factors (hypertension, smoking, hyperlipidemia) - relevant for vascular causes 1
• Ask about recent trauma or heavy lifting 1
• Determine if there have been recent invasive procedures 1

Physical Examination Focus Points

• Vital signs, particularly looking for tachycardia, hypotension, or fever 1
• Abdominal examination focusing on:
  • Location of tenderness (localized vs. diffuse) 1
  • Presence of peritoneal signs (rebound tenderness, guarding) 1
  • Presence of masses 4
  • Bowel sounds (hyperactive, hypoactive, absent) 1
• Vascular examination:
  • Pulse deficits or asymmetry 1
  • Systolic blood pressure differences between limbs greater than 20 mmHg 1
• Neurological examination:
  • Focal deficits that might suggest neurological involvement 1
  • Sensory or motor deficits in lower extremities 1

Laboratory and Imaging Considerations

• Complete blood count to assess for leukocytosis 2, 3
• Comprehensive metabolic panel including liver and renal function tests 2, 3
• Urinalysis to evaluate for urinary tract infection or nephrolithiasis 2, 3
• Serum lipase to rule out pancreatitis 2, 3
• Consider CT abdomen and pelvis with IV contrast as the most appropriate initial imaging study for left lower quadrant pain 1

Common Pitfalls to Avoid

• Failing to consider vascular emergencies like aortic dissection in patients with sudden-onset severe pain radiating to the back 1
• Missing gynecological causes even in post-menopausal women 4, 5
• Overlooking bowel obstruction, which accounts for approximately 15% of hospital admissions for acute abdominal pain 1
• Relying solely on laboratory tests without appropriate imaging when indicated 3, 6
• Underestimating diverticulitis in elderly patients who may present with more nuanced symptoms 1