How to interview a patient with abdominal pain

The place, the type and the spread of abdominal pain narrow the causes quickly. Always ask about pregnancy in anyone who could be pregnant: it changes the diagnosis and the tests.

Step by step

1. Introduce yourself and check stability

   Say your name and role, get consent and look for pallor, sweating or a rigid belly. Low blood pressure or vomiting blood means call for help first. [1]

2. Where is the pain?

   Ask the patient to point with one finger. Note the quadrant and if the pain moved (for example from the navel to the lower right). [2]

3. Type and timing

   Sudden or gradual, constant or coming in waves (colicky), how long it has lasted and severity 0 to 10. [2]

4. Radiation

   To the back (pancreas, aorta), the right shoulder (gallbladder) or the groin (kidney stone). [2]

5. Bowel and stomach

   Nausea, vomiting (blood or coffee grounds), appetite, last bowel movement, diarrhea or constipation, blood or black stool, weight loss. [1]

6. Urine and gynecologic questions

   Burning, frequency or blood in urine. Date of the last period, chance of pregnancy, vaginal bleeding or discharge. [1]

7. History, medications, habits

   Past surgeries, gallstones, ulcers, alcohol, anti-inflammatory drugs (NSAIDs), steroids and blood thinners. [1]

8. Summarize and plan

   Repeat the story, name the likely cause and the dangerous ones to rule out, and explain the next steps. [3]

Common errors

• Not asking about pregnancy.
• Missing pain in the back or flank in older adults (aortic aneurysm).
• Not asking about alcohol and anti-inflammatory drugs.

Sources

1. NCCPA PANCE Content Blueprint
2. NBOME COMLEX-USA clinical presentations
3. AAMC Core Entrustable Professional Activities (Core EPAs)

Facts and steps follow NBOME COMLEX-USA clinical presentations; NCCPA PANCE Content Blueprint. Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.