History

Presenting complaint

“Well, I went to my GP because I’ve noticed that over the last week or two that my skin is getting
more and more yellow. I didn’t think it was too bad, but my husband said that I was very yellow
especially the whites of my eyes. I’m also getting a lot of abdominal pain, which has been getting
much worse!”

When did you or your husband first notice you were yellow?

“My husband said he first noticed something was wrong about 12 days ago”

Have you been unwell recently?

“No I’ve been pretty well for a while now.”

Have you noticed any other associated symptoms?

“Well I’ve had some on and off pain in my abdomen and my bowels have been a bit off, but other
than that I’ve been ok, no fevers or anything like that.”

What’s changed with your bowels?

“Well they just seem a weird colour, pale I’d say, weird right?”

Have you had any urinary symptoms?

“My urine is definitely a lot darker, but other than that, no other changes”

Abdominal pain questions

Site – Where is this pain specifically?

“Here, on my side” (*she indicates her right hypochondrium*)

Onset – When did you first start experiencing the abdominal pain?

“It’s been on and off for a few months”

Character – What kind of pain is it? Is it sharp or a dull ache?

“It can be quite sharp actually, when it’s bad it can just completely stop me in my tracks.”

Radiation – Does it move anywhere else?

“It used to give me some back pain behind my right shoulder, but, now it’s only sore in the same
place on my side.”

Associated symptoms – Do you experience any other symptoms when you have the
abdominal pain?

“I often feel a bit nauseated when it’s happening, but that’s about it.”

Timing – How frequently are you experiencing the abdominal pain?

“Well when it started a few months ago, I’d get the pain every week or so, but now I’m getting at
least one or two bouts of pain a day.”

Exacerbating / Relieving factors – Does anything seem to trigger the pain or make it
better?

“I know that if I eat a big dinner it will get more painful. I don’t eat much at all now because it
makes me sore and a bit nauseous.”

Severity – If you were to rate the pain out of 10, how bad would you say it is?

“Right now? I’d say 7 out of 10.”

Past medical / surgical history:

 Any medical conditions?

 Have you ever had any previous hospital admissions?
 Have you ever had surgery?
 Have you ever had a blood transfusion?
“The only times I was ever in hospital were for the birth of my two children and for appendix
surgery when I was a teenager. I never had a blood transfusion to my knowledge.”

Drug history:

 Do you take any regular medication?

 Have you started any new medication recently?
 Do you take any over the counter medication?
 Do you have any allergies?

“I just take a blood pressure tablet, can’t remember the name, but I’ve taken it for years. Other
than that I don’t take anything. I don’t have any allergies.”

Social history:

 How much alcohol would you drink in an average week?

 Do you smoke? How much?
 Have you ever taken recreational drugs? For example, drugs administered using needles?
 Have you done any recent foreign travel?

“I would usually have a glass of wine each day with dinner. I’ve never smoked nor did
recreational drugs. I was on holiday last summer but it wasn’t abroad.”

Family history:

 Any illnesses in the family?

“Nothing really.”

Flucloxacillin and co-amoxiclav are the most common causes of drug-induced jaundice.

Others include paracetamol (in overdose), nitrofurantoin, steroids, oral contraceptive pill,
tuberculosis drugs and malaria drugs

Diagnosis

Acute Cholecystitis