What questions should I ask in an abdominal pain history?

Ask where the pain is and whether it has moved, how it started, what it feels like, where it spreads, and what makes it better or worse. Then ask about vomiting, bowel habit, blood in the stool, jaundice, urinary symptoms and fever, and in anyone who could be pregnant, the last menstrual period.

What causes right lower quadrant pain?

Appendicitis is the most common surgical cause. In women, ectopic pregnancy, ovarian torsion and a ruptured ovarian cyst must also be considered. Other causes include terminal ileitis in Crohn's disease, renal colic and mesenteric adenitis in children.

Why ask about the last menstrual period in abdominal pain?

Because ectopic pregnancy can present as abdominal pain in anyone who could be pregnant, and a ruptured ectopic is life-threatening. The history guides suspicion, but a pregnancy test is still needed.

What are the red flags in abdominal pain?

Sudden severe pain with collapse or back pain, pain out of proportion to the findings in a patient with atrial fibrillation, vomiting blood or black stool, not passing stool or gas with vomiting, fever with rigors and jaundice, and pain with a possible pregnancy.

Updated November 10, 2026

Abdominal pain history: questions to ask by location

Abdominal pain has a long differential, and the history narrows it more than anything else. Where the pain is, how it started and what comes with it usually point to two or three likely causes. In anyone who could be pregnant, ectopic pregnancy has to be considered from the start.

Characterize the pain

Onset: sudden pain suggests a perforation, a rupture or a vascular event; pain that builds over hours suggests inflammation, such as appendicitis or cholecystitis.
Site and movement: "Where did it start, and has it moved?" Pain that starts around the umbilicus and moves to the right lower quadrant is the classic story of appendicitis.
Character: colicky pain that comes in waves suggests a blocked tube (bowel, ureter, bile duct); constant pain suggests inflammation.
Radiation: to the back in pancreatitis and a leaking aortic aneurysm; to the right shoulder tip in gallbladder disease; from the loin to the groin in renal colic.
Aggravating and relieving factors: eating, movement, coughing, lying still, opening the bowels.

What the location suggests

Right upper quadrant: Biliary colic, cholecystitis, cholangitis, hepatitis; also right lower lobe pneumonia.
Epigastric: Peptic ulcer disease, gastritis, pancreatitis; also an inferior myocardial infarction.
Right lower quadrant: Appendicitis; in women, ectopic pregnancy, ovarian torsion or a ruptured ovarian cyst.
Left lower quadrant: Diverticulitis; in women, the same gynecologic causes as on the right.
Loin to groin: Renal colic or pyelonephritis.
Diffuse: Bowel obstruction, peritonitis, mesenteric ischemia, gastroenteritis, diabetic ketoacidosis.

Associated symptoms

Nausea and vomiting: how often, and what the vomit looks like (food, bile, blood, coffee grounds)
Bowel habit: diarrhea, constipation, when the bowels last opened and whether the patient is passing gas
Blood in the stool or black, tarry stool
Jaundice, pale stool or dark urine
Urinary symptoms: burning, frequency, blood in the urine
Fever, rigors, loss of appetite and weight loss

The gynecologic history

Ask anyone who could be pregnant about the date of their last menstrual period, whether they could be pregnant, contraception, vaginal bleeding or discharge, and pain during intercourse. Explain why you are asking. A ruptured ectopic pregnancy is a surgical emergency, and a pregnancy test should follow whatever the history suggests.

Background

Previous abdominal surgery, which can cause adhesions and obstruction
Known gallstones, ulcers, inflammatory bowel disease or diverticular disease
Alcohol intake, a leading cause of pancreatitis along with gallstones
Medications: NSAIDs and steroids for ulcers, anticoagulants for bleeding
Atrial fibrillation or vascular disease, which raise the risk of mesenteric ischemia
Recent travel and contacts with similar symptoms

Red flags

Sudden, severe pain, especially in an older patient with collapse or back pain (ruptured aortic aneurysm)
Severe pain in a patient with atrial fibrillation, out of proportion to what you find (mesenteric ischemia)
Vomiting blood or passing black stool
Not passing stool or gas, with vomiting and distension (obstruction)
Fever with rigors and jaundice (cholangitis)
Abdominal pain with a missed period or a positive pregnancy test

Frequently asked questions

What questions should I ask in an abdominal pain history?: Ask where the pain is and whether it has moved, how it started, what it feels like, where it spreads, and what makes it better or worse. Then ask about vomiting, bowel habit, blood in the stool, jaundice, urinary symptoms and fever, and in anyone who could be pregnant, the last menstrual period.
What causes right lower quadrant pain?: Appendicitis is the most common surgical cause. In women, ectopic pregnancy, ovarian torsion and a ruptured ovarian cyst must also be considered. Other causes include terminal ileitis in Crohn's disease, renal colic and mesenteric adenitis in children.
Why ask about the last menstrual period in abdominal pain?: Because ectopic pregnancy can present as abdominal pain in anyone who could be pregnant, and a ruptured ectopic is life-threatening. The history guides suspicion, but a pregnancy test is still needed.
What are the red flags in abdominal pain?: Sudden severe pain with collapse or back pain, pain out of proportion to the findings in a patient with atrial fibrillation, vomiting blood or black stool, not passing stool or gas with vomiting, fever with rigors and jaundice, and pain with a possible pregnancy.