General Surgery · Model history
Abdominal pain migrating to the right side: a model surgical history
- Setting
- Emergency department
- Patient
- Mr. Irwin, 26, has pain that began around his navel and has moved to his lower right abdomen over the past 18 hours.
- Listen
- 4 min
After listening
Say the next question
Read the patient’s answer, say your next question aloud, then reveal the model.
“Yes, all of that. Even the bumps in the taxi on the way here made it much worse.”
Ask one question that screens for a gastrointestinal or urinary mimic of appendicitis.
Have you had any diarrhea or constipation, or any burning or urgency when you urinate?
Model interview
Full transcript
- Doctor
Mr. Irwin, I'm Dr. Bennett. I can see you're in a lot of pain. While the nurse gets your vital signs, tell me what's been going on.
- Patient
I've had stomach pain for about eighteen hours. It started as a dull ache around my belly button, but now it's a sharp pain low down on my right side.
- Doctor
When exactly did the pain first start?
- Patient
About eighteen hours ago, sometime yesterday evening. It was mild at first, so I didn't think much of it.
- Doctor
How has the pain changed since then?
- Patient
Over the last six hours it moved from around my navel down to my lower right side, and it's become much sharper and more constant.
- Doctor
Can you point with one finger to exactly where it hurts the most right now?
- Patient
Right here, low on my right side, about halfway between my hip bone and my belly button.
- Doctor
On a scale from zero to ten, how bad is it, and does it come and go or stay constant?
- Patient
It's about an eight out of ten, and it hasn't let up at all. It's constant now.
- Doctor
Have you lost your appetite, felt nauseated, or vomited?
- Patient
I haven't wanted to eat all day, I've felt sick to my stomach, and I threw up once after the pain moved to my right side.
- Doctor
Have you had a fever or felt chilled?
- Patient
I felt hot and a bit shaky earlier. I think I had a low fever, but I didn't check my temperature.
- Doctor
Does moving around, coughing, or pressing on your belly make the pain worse?
- Patient
Yes, all of that. Even the bumps in the taxi on the way here made it much worse.
- Doctor
Have you had any diarrhea or constipation, or any burning or urgency when you urinate?
- Patient
No, my bowel movements have been normal, and I haven't had any problems urinating.
- Doctor
Have you ever had pain like this before, or hurt your abdomen recently?
- Patient
No, I've never had anything like this, and I haven't injured myself.
- Doctor
Have you ever had abdominal surgery, or do you have any other medical conditions?
- Patient
No surgery, and I've always been healthy.
- Doctor
Do you take any regular medicines, and do you have any medicine allergies?
- Patient
No regular medicines, and no allergies that I know of.
- Doctor
What do you think might be causing this, and what's worrying you most?
- Patient
I think it's my appendix, and I'm scared it's about to burst if we don't do something soon.
- Doctor
What were you hoping would happen today?
- Patient
I want something for the pain, antibiotics if I need them, and if it really is my appendix, I want it taken out safely.
- Doctor
Let me make sure I have this right. For eighteen hours you've had pain that began as a dull ache around your navel and moved over the last six hours to a sharp, constant pain in your lower right abdomen. It's worse with movement, coughing, and pressure, and you've had loss of appetite, nausea, one episode of vomiting, and a low fever. You've had no diarrhea, urinary symptoms, prior surgery, or similar pain before. Is that accurate, and is there anything else I should know?
- Patient
That's exactly right. Nothing else.
- Doctor
Thank you. I'll examine your abdomen now, and we'll get blood tests and likely a CT scan moving right away. Until then you'll stay off food or drink, and we'll start IV fluids and pain relief. If this is appendicitis, we'll begin antibiotics and get the surgical team involved promptly so nothing is delayed.
- Patient
Okay, thank you. That makes me feel a little better about what happens next.
Flow at a glance
The route through the history
- Invite the patient's story while assessing
- Establish exact onset and duration
- Track the pain's migration from periumbilical to right lower quadrant
- Characterize severity and associated GI symptoms
- Screen aggravating factors and mimicking symptoms
- Review background, medicines, and allergies
- Explore the patient's own ideas and expectations
- Summarize and move to examination and same-day surgical planning
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Editorial record
Tied to one reviewed case
This model uses a fictional Bedside English case as its source. The page and pre-generated WAV audio are checked against the same transcript and source-case fingerprints.
Editorial update: