Age of the patient:
- Infant: cannot complaint of pain, but would present with episodes of crying.
- 3 month colic: crying every evening for 2 to 3 hours since the age of 2 to 3 weeks
- Functional pain – in school going children
- Girls- suffer from severe abdominal pain with each menstrual period especially around menarche.
Onset of Pain and Progression
- Sudden onset of within minutes and hours suggest colic. It is short lasting, self limiting and often recurrent.
- If pain is recurrent: - check following
- Duration of pain free intervals
- Recurrence occurs in worm infestation, urinary infection, urinary tract infections, ulcers, renal calculi, sickle cell disease, abdominal epilepsy and psychogenic causes.
- Pain lasting longer than 3 hours–due to an organic cause like appendicitis
Location of pain and radiation
- Site of pain: localised to a quadrant or all over abdomen
- Generalised pain is more common and is due to intestinal or peritoneal pathology.
- Functional abdominal pain – is peri umbilical. (Closer the pain occurs to the Umbilicus less is the chance of organic disease.)
- Acute appendicitis and lymphadenitis –pain in right iliac fossa
- Acute Hepatitis, liver abscess, congestive cardiac failure- pain in right hypochondrium
- Abdominal pain in kidney disease: over back, flanks and lower abdomen
- Ureteric colic: pain radiates from loin to groin
- Pain radiating to right shoulder: acute cholecystitis
- Radiation to left shoulder: splenic rupture
- Pain radiating to back: acute pancreatitis
Nature of pain
- Dull aching pain- chronic pathology
- Pain in peri umbilical region in an adolescent- functional pain
- Obstructive lesions of gut- severe colicky pain in abdomen
- Stabbing pain- peritonitis
- In some cases of peritonitis- patient lies still in bed and does not move
- In renal colic- child is restless, rolls and doubles up
Exacerbating and Relieving Factors
- Acute gastritis- consumption of food may aggravate the pain
- Duodenal ulcer- ingestion of food relieves pain
- Cough can exaggerate pain- basal pneumonia and pleurisy
- Peritonitis- movement aggravates pain
- Passage of flatus relieves pain from intestinal cause
- Vomiting: commonly associated with gastroenteritis.
- Vomiting and pain in the right iliac fossa- feature of appendicitis
- Allergy to milk proteins: colicky abdominal pain, vomiting and diarrhoea
- Red current jelly stool- intussusception
- Constipation: common cause of dull ache in abdomen
- Fever: viral hepatitis, acute gastroenteritis, acute pancreatitis,
- Dysuria and increased frequency of micturition- urinary tract infection
- Commonest cause of chronic abdominal pain in older children is functional
- Enquire about parent- child relationship, school environment and whether child is reluctant to go to school
- Menstrual history
- In adolescent girls enquire about dysmenorrhea