Abdominal Pain and the Acute Abdomen

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Chief Compliant: The patient is a 50 year old white male with diabetes who complains of right lower quadrant abdominal pain for 4 hours.

History of the Present Illness: Duration of pain, pattern of progression; exact location at onset and at present; diffuse or localized; location and character at onset and at present (burning, crampy, sharp, dull); constant or intermittent ("colicky"); radiation of pain (to shoulder, back, groin); sudden or gradual onset.

Effect of eating, vomiting, defecation, flatus, urination, inspiration, movement, position on the pain. Timing and characteristics of last bowel movement. Similar episodes in past; relation to last menstrual period.

Associated Symptoms: Fever, chills, nausea, vomiting (bilious, feculent, blood, coffee ground-colored material); vomiting before or after onset of pain; jaundice, constipation, change in bowel habits or stool caliber, obstipation (inability to pass gas); chest pain, diarrhea, hematochezia (rectal bleeding), melena (black, tarry stools); dysuria, hematuria, anorexia, weight loss, dysphagia, odynophagia (painful swallowing); early satiety, trauma.

Aggravating or Relieving Factors: Fatty food intolerance, medications, aspirin, NSAID's, narcotics, anticholinergics, laxatives, antacids.

Past Medical History: History of abdominal surgery (appendectomy, cholecystectomy), hernias, gallstones; coronary disease, kidney stones; alcoholism, cirrhosis, peptic ulcer, dyspepsia. Endoscopies, X-rays, upper GI series.

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Constipation Prescription

Constipation Prescription

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