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1. Pain is a distressing feeling often
caused by intense or damaging
stimuli.
The International Association for
the Study of Pain defines pain as
"an unpleasant sensory and
emotional experience associated
with, or resembling that
associated with, actual or
potential tissue damage

4. •If the patient complains pain, ask (formula-
SOCRATES):
•Site: Where is your pain?
•Onset: Was it gradual or sudden?
•Character: What is the nature of the pain? (dull
ache, colicky, stabbing, compressive, crushing,
agonizing, etc).
•Radiation: Does it radiate to anywhere?

5. Site: Where is your
pain?

12. •Association: Is it associated with diarrhea,
vomiting, dyspepsia, altered bowel habit,
urinary complaints, gynecological complaints,
abdominal distension, etc.?
•Timing and duration – How long have you
been suffering from this pain? When does it
start?
When does it go? Has it changed since it has
begun?

13. •Exacerbating and relieving factors –
What brings it on? What makes it
worse? Is it related to meal? What
makes it better?
•Severity—How severe is it?

15. Causes of abdominal pain
in different diseases
according to site of pain:
• Epigastric pain: Peptic ulcer, acute
pancreatitis, GERD, cholecystitis.
(sometimes, there may be referred
• pain of acute myocardial infarction and
basal pneumonia).
• Right iliac fossa pain: acute
appendicitis, Crohn’s disease,
salpingitis.
• Pain starts at mid abdomen and then
shifts to right iliac fossa—acute

16. • Left iliac fossa pain: diverticulitis,
volvulus, salpingitis, IBS.
• Right hypochondriac pain: acute
cholecystitis, liver abscess, acute viral
hepatitis, enlarged tender
• liver in CCF, subphrenic abscess,
perihepatitis (Fitz Hugh Curtis
syndrome).
• Right hypochondriac colicky pain with
jaundice: gallstone in common bile
duct.

17. Abdominal pain in
different diseases
according to onset:
• Acute pain: acute cholecystitis, acute
appendicitis, acute pancreatitis, intestinal
obstruction, perforation of gas containing hollow
viscus.
• Chronic pain: peptic ulcer disease, irritable bowel
syndrome.

18. • Abdominal pain in different diseases according to
severity and nature:
• Severe pain: ureteric colic, acute pancreatitis, acute
cholecystitis, burst appendicitis, perforation.
• Burning pain: peptic ulcer disease.
• Colicky pain: intestinal obstruction, ureteric stone, stone in
common bile duct, ascariasis in common bile duct.

19. Abdominal pain in different diseases
according to aggravating and relieving
factors:
• Pain aggravated by smoking, alcohol, NSAIDs or steroid and
relieved by antacids: peptic ulcer disease.
• Duodenal ulcer is worse in empty stomach and relieved by
taking food and gastric ulcer pain is worse
• after taking food.
• Pain aggravated by heavy meal and alcohol, but partially
improved by bending forward: acute pancreatitis.
• Pain aggravated by fatty food: cholelithiasis.
• Pain aggravated by eating: ischemic pain of gut.

20. Abdominal pain in different diseases
according to aggravating and relieving
factors:
• Pain aggravated by movement: peritonitis.
• Pain relieved by vomiting: gastric outlet
obstruction.
• Pain relieved by spasmolytics or defecation:
intestinal obstruction.

21. Abdominal pain in different diseases
according to radiation:
• Pain radiating to back: acute pancreatitis, penetrating peptic
ulcer.
• Pain radiating from loin to groin: renal colic.
• Pain referred to right shoulder: acute cholecystitis (because of
diaphragmatic irritation), also diaphragmatic pleurisy.

22. Abdominal pain in different diseases
according to radiation:
•Pain referred to left shoulder: splenic
infarction, perisplenitis.
•Pain radiating to neck: esophageal reflux.