What are the pertinent history questions to gather from a patient presenting with abdominal pain?

From the Guidelines

When evaluating a patient with abdominal pain, clinicians should gather a comprehensive history that includes the onset, location, quality, radiation, severity, timing, exacerbating and alleviating factors of the pain, as well as associated symptoms and medical history, to guide appropriate diagnostic testing and management strategies.

Key Components of History Taking

• Onset and duration of symptoms, including any evidence of onset postinfection, following recurrent antibiotic use, or after acute or chronic stress or psychological trauma 1
• Relationship between abdominal pain and change in bowel habit, including cardinal symptoms such as changes in stool consistency and frequency 1
• Extraintestinal symptoms, such as back pain, urological, and gynaecological symptoms 1
• Comorbidities, including psychological conditions, and previous surgery 1
• Medications, including opioids, recent antibiotic use, NSAIDs, and over-the-counter remedies 1
• Social history, including alcohol consumption, smoking, and recent travel 1
• Family history of gastrointestinal disorders, such as inflammatory bowel disease or colon cancer 1

Additional Considerations

• For women, menstrual history and pregnancy status are essential [@Example@]
• The pattern and characteristics of pain often provide valuable diagnostic clues, such as right upper quadrant pain with fatty food intolerance suggesting gallbladder disease, or periumbilical pain migrating to the right lower quadrant suggesting appendicitis [@Example@]
• A thorough medical history should include detailed questioning about the onset of symptoms, rectal bleeding, stool consistency and frequency, urgency, tenesmus, abdominal pain, incontinence, nocturnal diarrhoea, and extra-intestinal manifestations 1

From the Research

History Questions for Abdominal Pain

To evaluate a patient with a chief complaint of abdominal pain, several history questions should be gathered, including:

• Location of pain: The location of pain is a useful starting point and will guide further evaluation 2
• Duration of pain: Understanding how long the patient has been experiencing pain can help determine the cause 3
• Severity of pain: Assessing the severity of pain can help identify potential causes and guide treatment decisions
• Associated symptoms: Symptoms such as constipation, abdominal distension, and anorexia can be helpful in diagnosing certain conditions, although some symptoms like anorexia have little predictive value for appendicitis 2
• Medical history: Considering special populations such as women, who are at risk of genitourinary disease, and the elderly, who may present with atypical symptoms of a disease, is important 2
• Physiological and psychological needs: Patients with abdominal pain may have a number of physiological and psychological needs that should be assessed 4

Specific Questions to Ask

Some specific questions to ask patients with abdominal pain include:

• Can you describe the location and severity of your pain?
• How long have you been experiencing pain?
• Have you experienced any associated symptoms such as nausea, vomiting, or changes in bowel habits?
• Do you have any medical conditions or take any medications that could be contributing to your pain?
• Have you recently traveled or been exposed to anyone with a similar illness?
• For female patients, questions about menstrual history, pregnancy, and reproductive health should be considered 3