Abdominal History Checklist

Introduction
 Greets patient and checks identity. Introduces self and role.
 Obtains consent

History of Presenting Complaint

 Ask an appropriate open question to identify the nature of presenting problem

 Analysis of symptoms, for each symptom:

1) Timeline
2) Severity
3) Location (as appropriate)
4) Quality (as appropriate)
5) Aggravating / Alleviating Factors (as appropriate)
6) Any associated features

Patient Perspective
 Patient's concerns (i.e. worries) regarding each problem
 Patient's ideas (i.e. beliefs re cause) [if appropriate]
 Effects: how each problem affects the patient's life [if appropriate]
GI&GU System Questions [as appropriate]
 Dysphagia. Odynophagia
 Nausea. Vomiting. Haematemesis.
 Reflux
 Abdominal Pain. Flank Pain. Back Pain.
 Abdominal distention
 Bowel Habit / Characteristics. Malaena ; Frank Blood.
 Jaundice

 Urine Habit / Characteristics. Haematuria. Dysuria.

 Urethral Discharge (male). Vaginal discharge (female).
 Testicular pain (male). Menstrual History ; Pregnancy History (female)
 Sexual History
 Obstructive urinary symptoms

 Urinary incontinence
 Faecal Incontinence

General Questions
 Weight change. Appetite.
 Fever. Night sweats
 Sleep. Mood [as appropriate]
 Fatigue

Review of Systems [as appropriate]

Background Information
 Allergies
 Regular Medications
 Past Medical History
 Social History
 Family History [as appropriate]
 Alcohol. Smoking. Recreational Drugs
 Diet and Exercise [as appropriate]