Abdominal Pain History │ Medical English 23

0:00 It's hard to describe. It's not sharp, exactly. It's more of an ache that comes and goes. And sometimes it feels like everything in here is just cramping up.

0:13 That's really helpful. Comes and goes and cramping are exactly the kind of words I need. Let me ask you a few more questions so we can work out what's going on. Hello, med nomads, and welcome back to Medical Voices. I'm Nadia.

0:29 And I'm Tom. Great to have you with us.

0:32 Last week, we sat in on a pain history for a sore knee. This week, we're staying at Elmwood Surgery and taking that same framework somewhere a little trickier. The abdomen. A man in his forties has had several weeks of on and off discomfort low down in his tummy. And the GP needs to turn his everyday words into a clear clinical history.

0:55 And that's really the heart of today's episode. Patients say, my stomach, I feel sick, I've been going more often. Clinicians write abdominal pain, nausea, a change in bowel habit. Moving between those two ways of speaking, out loud and in real time, is a skill you need in every history you take. And it's exactly what an OET speaking roleplay asks you to show.

1:24 I'm playing the GP, Dr. Aisha Khan. And if you watched episode 13, you've already met her. Tom is Mr. Andrew Blake, a new patient.

1:35 10 terms, one consultation, three quiz questions. And as always, we're here for the language, not for medical advice.

1:44 Stay to the very end. The last quiz question is about two words that mean exactly the same thing, and why a good clinician still wouldn't swap them.

1:54 Let's start with the words. For most of today's terms, you'll get two versions, what the patient says and what goes in the notes. Nadia, off you go. Term 1.

2:06 Abdominal pain. Pain anywhere in the abdomen, the area between the lower ribs and the pelvis. Patients usually say stomach ache or tummy pain, but the stomach is only one organ sitting in the upper abdomen, so abdominal pain is the accurate clinical term. Example. How long have you been having this abdominal pain?

2:30 Term 2. Nausea. The feeling that you might vomit whether or not you actually do. A British patient will usually call this feeling sick, so listen carefully because that is not the same as being sick. Example.

2:53 Term 3. Vomiting. Bringing up the contents of the stomach through the mouth. Patients say being sick or throwing up, and in written notes you may also see the word emesis. Example. Any vomiting or just the nausea?

3:12 Term 4. Bowel habit. And a change in bowel habit. Bowel habit is a person's usual pattern of opening their bowels, how often and what the stools are like. A change in bowel habit means that pattern has shifted recently, which is different from bowel function after surgery back in episode 9. Example. Have you noticed any change in your bowel habit recently?

3:44 Term 5.

3:45 Bloating. A feeling of fullness, tightness, or swelling in the abdomen. Strictly speaking, bloating is what the patient feels, while distension is when the abdomen looks visibly bigger, and the two don't always go together. Example. Is the bloating worse towards the end of the day?

4:05 Term 6. Cramping and colicky, pain that tightens and then eases in waves. Cramping is the everyday word you can use with the patient, and colicky is the more formal descriptor for the notes. It comes from the same root as colic, the word you may know from crying babies. Example Lower abdominal pain, colicky in nature.

4:32 Term 7. Guarding. A tensing of the abdominal muscles when a tender area is pressed during an examination. Like tenderness in last week's episode, it's something the clinician finds, not something the patient describes. Example.

5:01 In episode 12, it came up in a mood screening. Today it comes back in a digestive history. Same term, different clinical frame. Example, have you had any appetite loss over the last few weeks?

5:18 Term 9. Passing wind and flatulence. Releasing gas from the bowel. Passing wind is the polite British phrase to use with patients. American patients will usually just say gas, and flatulence is the clinical term for the notes. Example.

5:43 Term 10. Localized and diffuse. Localized pain stays in one specific area. Diffuse pain is spread over a wider area with no single clear spot. Localized came up in last week's knee consultation and diffuse is new. So together they describe how the pain is distributed. Example. Is the pain localized to one spot or more diffuse?

6:16 That's the list. Now let's hear how those words sound in a real consultation. So here we are at Elmwood Surgery. I'm Dr. Kahn, one of the GPs, and Tom is Mr. Blake, a new patient in his mid-40s. Mr. Blake? Hello, come on in and have a seat. I'm Dr. Kahn, one of the GPs here. Before we start, can I just check your date of birth?

6:44 Of course. 14th of March 1981.

6:48 Thank you. So what can I do for you today?

6:51 Well, I've been having this pain in my stomach for a few weeks now. It's not terrible, but it keeps coming back, and my wife finally told me to get it looked at.

7:02 I'm glad you came in. So you've been having some abdominal pain for a few weeks. When you say stomach, can you show me where you feel it?

7:11 Down here mostly, below my belly button.

7:15 That's helpful because people often say stomach for the whole tummy area. So we're talking about the lower abdomen. Is it always in the same spot or does it move around?

7:25 Usually it's just here, in one spot, but on a bad day it's more spread out, like my whole lower belly aches.

7:35 So most of the time it's localized in one area, but sometimes it becomes more diffuse, spread across the lower abdomen. And how did it start? Did it come on suddenly or build up gradually?

7:49 Gradually, I think. I first noticed it maybe five or six weeks ago, just now and then, and it's been happening more often since. Can you describe what the pain actually feels like? It's hard to describe. It's not sharp, exactly. It's more of an ache that comes and goes, and sometimes it feels like everything in here is just cramping up.

8:15 That's really helpful. Comes and goes and cramping are exactly the kind of words I need. Let me ask you a few more questions so we can work out what's going on. Sure, fire away. A pain that tightens and then eases like that in waves is what we sometimes call colicky. Does it build up and then settle, or is it there all the time in the background?

8:38 It builds up, lasts maybe 10 or 20 minutes, then eases off. In between, there's sometimes a dull ache, but nothing much.

8:50 So a cramping colicky pain that comes in waves with a mild ache in between. Is there anything that makes it worse or anything that helps?

8:59 It's usually worse after a big meal, and lying down with a hot water bottle helps a bit.

9:06 Thank you. Now, have you been feeling sick at all or actually being sick?

9:12 Feeling sick? Yes, sometimes, mostly when the cramps come on. But I haven't actually been sick, no.

9:20 So some nausea but no vomiting. That's an important difference, thank you. Med nomads, a quick one for you. If you've ever taken an abdominal history in English, which question was the hardest to ask clearly? Tell us in the comments. Have you noticed any changes in your bowel habit recently? Sorry, my bowel habit?

9:43 Sorry, I mean going to the toilet. How often you open your bowels, and whether that's changed at all.

9:49 Oh, right. Yes, actually. I've been going more often than usual, three or four times a day some days, and it's looser than normal.

9:59 So more frequent and looser than usual. That's exactly what we mean by a change in bowel habit. And what's normal for you usually?

10:08 Once a day. Pretty regular. Always has been.

10:12 And any bloating, a feeling of fullness or swelling?

10:15 Yes, quite a lot. By the evening, my trousers feel tight, and I feel full even when I've hardly eaten anything. And how about your appetite? Has that changed? I'm eating less, to be honest. I just don't fancy much at the moment.

10:34 So some appetite loss as well. I know this can feel like an awkward question, but have you noticed any change in passing wind?

10:43 Haha, yes, more than usual, I'd say. It's a bit embarrassing, actually.

10:48 Not at all. It's a completely normal thing to ask about, and it's useful. In my notes, I'll write that down as flatulence, but passing wind is perfectly fine between us.

11:00 Flatulence. That sounds much more respectable.

11:04 Thank you, Mr. Blake. Now I'd like to examine your abdomen if that's alright. Could you pop up on the couch and lie flat for me? Sure. I'm going to press gently in a few different areas. Let me know if anything's sore. If your muscles tense up when I press somewhere, we call that guarding, and it helps me understand where the tenderness is.

11:27 That's a bit sore, just there, low down.

11:31 Okay, a little tenderness there. Your tummy is nice and soft though, and there's no guarding. You can sit up now.

11:38 Mednomads, if you're preparing for an OET roleplay or an OSCI station on abdominal pain, which question do you always forget to ask? Let us know below.

11:50 So, Mr. Blake, let me check I've got everything right. For about five or six weeks, you've had pain in your lower abdomen. Most of the time it's in one spot, but on bad days it spreads out. It's a cramping pain that comes in waves, worse after big meals. You've had some nausea, but no vomiting. You're going to the toilet more often, and it's looser than usual.

12:13 You've also had bloating, you've been eating less, and you're passing more wind than usual. Is that right? Yes, that's it. That's all of it. Thank you. That's a really clear picture. I'm not going to guess at the cause today. What I'd like to do is arrange some blood tests to find out what's going on, and depending on the results, I may refer you on for further tests.

12:36 Does that sound okay?

12:37 Yes, that's fine. Is it anything to worry about?

12:42 It's too early to say, and that's exactly why we're doing the tests. In the meantime, if the pain gets much worse, or you notice anything new that worries you, please don't wait for the results. Contact us or get seen sooner.

12:56 Thanks, Doctor. I'd been putting this off for a while, to be honest.

13:01 Well, I'm glad you didn't put it off any longer. The receptionist will book your blood test on your way out.

13:07 Thanks, Dr. Khan. Right, let's go back over three key exchanges from that consultation. A touch more slowly this time. Well, I've been having this pain in my stomach for a few weeks now. It's not terrible, but it keeps coming back, and my wife finally told me to get it looked at.

13:30 I'm glad you came in. So you've been having some abdominal pain for a few weeks. When you say stomach, can you show me where you feel it? Thank you. Now, have you been feeling sick at all? Or actually being sick?

13:47 Feeling sick? Yes, sometimes. Mostly when the cramps come on. But I haven't actually been sick, no.

14:47 So some nausea but no vomiting. That's an important difference, thank you.

14:53 Oh, right. Yes, actually. I've been going more often than usual. Three or four times a day some days, and it's looser than normal.

15:04 So more frequent and looser than usual. That's exactly what we mean by a change in bowel habit. And what's normal for you, usually?

15:14 Once a day, pretty regular, always has been.

15:19 Right, let's look at what the GP actually did with her language in that consultation, one move at a time. Point 1. Saying the translation out loud. When the patient said pain in my stomach, the GP didn't correct him, she gave his meaning back in clinical terms, so you've been having some abdominal pain, and then asked him to show her where, because patients use stomach for the whole tummy, while the stomach itself sits in the upper abdomen.

15:47 Doing that translation aloud shows you've understood, gives the patient a chance to correct you, and quietly teaches the words you'll use together. And watch the word sick in British English. I feel sick means nausea. I've been sick means vomiting, but in American English, sick usually just means unwell.

16:10 Point 2. Cramping, colloqui, and constant. These are three ways of describing what pain does over time. Constant pain is there all the time. Cramping pain tightens and eases, and colloqui describes that same wave pattern in formal, written language. Notice the order the GP used. First, she accepted the patient's own word, cramping, then offered colicky as the clinical label, then checked with a question, does it build and settle, or is it always there?

16:44 That check matters because a patient can have both waves of cramping on top of a background ache. In conversation, say cramping. In your notes, write colicky.

16:57 Point 3. Asking about Bowhabit without awkwardness. The GP asked, have you noticed any changes in your Bow Habit recently? The key word is recently. You're not asking about someone's lifelong routine. You want to know what has changed. And when the patient didn't understand Bowel Habit, she didn't repeat it louder.

17:20 She rephrased in plain words, then asked, What's normal for him, so she had a baseline to compare against. One regional note. British notes usually say change in bowel habit in the singular. While in North America, you'll more often hear bowel habits, or simply bowel movements.

17:46 Many learners default to gas, which is understood, but it's the everyday American word and can sound out of place in a British clinic. The GP did two things. First, she named the awkwardness before asking, I know this can feel like an awkward question. That gives the patient permission to answer. Then she used the patient-friendly phrase passing wind and kept flatulence for her notes.

18:16 In OET speaking, assessors listen for exactly this language that suits the person in front of you. Flatulence in the consultation sounds as out of place as passing wind in a referral letter.

18:45 This patient's pain was usually in one spot, but spread across the lower abdomen on bad days. So the GP used both words. Where pain sits and how widely it spreads shapes which questions come next and which tests a clinician may consider. So it's worth describing precisely. And the structure you heard today, sight and onset, then character, then associated symptoms, then what makes it better or worse, is used in primary care across the UK, Australia, and North America.

19:22 Even where the exact wording differs. Question one. The patient says, I feel sick. What is the clinical word the GP would use?

19:44 Nausea. And if he'd said, I've been sick, that would be vomiting.

19:51 Question two. What does a change in bowel habit mean?

20:00 It means a recent change in how often someone opens their bowels or in what their stools are like. It's not their usual lifelong pattern, it's what's different now.

20:13 Question 3. The GP writes flatulence in her notes, but she asked the patient about passing wind. Why use different words?

20:28 Register. Passing wind is right for talking with the patient, and flatulence is right for the clinical record. Same meaning, different audience.

20:41 Every term from today, plus the full consultation, is in the free PDF transcript. The link is in the description.

20:48 That's episode 23. Next week, we're heading into maternity care. Mrs. Harris, who you met at her booking visit back in episode 16, is now 34 weeks pregnant, and she's back with midwife Santos to talk through her birth plan, the language of choices, preferences, and what happens if things don't go to plan.

21:13 Whether you're watching on YouTube or listening on the podcast, thanks for spending this time with us.

21:19 Take care, Med Nomads.

21:22 See you next week.