Abdominal Pain History Taking | OSCE Tips

Abdominal Pain history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a abdominal pain history during an OSCE.

Presenting complaint (PC):

What brought you here today?

Can you tell me more about your abdominal pain?

History presenting complaint (HPC):

You can adapt SOCRATES to explore skin problems too: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors and Severity.

Site: where do you feel the pain?

Onset: when did the pain start? suddenly or gradually?

Character: can you describe to me how it feels. Is the pain sharp, burning, dull, cramping or stabbing?

Radiation: does the pain travel to anywhere else in your body? for example your back or chest?

Associate symptoms:

Nausea / vomiting
Change in bowel habit
Diarrhoea / constipation
Bloating
Rectal bleeding
Loss of appetite
Weight loss
Night sweats

Timing: are the symptoms getting worse or better? how long does the pain last for? constant or on/off? is it worse during or after meals?

Exacerbating/Relieving factors: does anything make it better or worse?

Severity: from a scale from 1 to 10. with 10 being the worst, how severe is the pain?

Ideas, Concerns & Expectations (ICE):

Now is a good idea to ask Ideas, Concerns & Expectations (ICE): do you have an idea what might be causing your symptoms? is there anything that particularly concern you? what were expecting to achieve in this consultation?

Medical history (MH):

Do you have a history of high blood pressure, heart conditions or diabetes?

Past medical history (PMH):

Ask about any previous episodes of abdominal pain or treatment or investigations?

Any previous diagnosis of Irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) or diverticulitis

Drug history (DH):

Are you taking any medication (prescribed or over-the-counter (OTC)? If so, any side effects.

Any recent use of medications that might have caused the pain?

Note: the following medications might cause abdominal pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), some antibiotics, opiods (codeine) or antidepressants.

Allergies:

Are you allergic to any medications?

Family history (FMH):

Is there any family members who have similar symptoms?

Social History (SH):

Ask about living condition, occupation and social support.

Do you smoker? alcohol? recreational drug use?

System review:

Review each body system to check for any other symptoms that might be causing the bleeding.

Possible differential diagnosis:

Gastrointestinal disorders: gastroesophageal reflux disease (GERD), IBD, IBS or gastritis.
Cholelithiasis (gallstones) or cholecystitis.
Appendicitis (RLQ pain with nausea, vomiting, fever).
Ectopic pregnancy (LLQ pain).
Ovarian Cyst.
Abdominal Hernia.
Pancreatitis.
Diverticular disease.
Cancer.

Summaries your findings.

Investigation:

Bloods: full blood count (FBC), Urea and electrolytes (U&E), Hba1c, thyroid function test (TFT), liver function test (LFT)+ amylase and lipase (to diagnosis pancreatitis), C-reactive protein (CRP) + Erythrocyte Sedimentation Rate (ESR).
Urinalysis + pregnancy test.
Imaging: abdominal (XR, ultrasound or CT).
Endoscopy/colonoscopy.
Stool test ( Faecal Calprotectin, Faecal Immunochemical Test).

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