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Dr. Jones is examining Alex. He has a bad stomachache.

Dr. Jones: Good morning. What's the problem?
Alex: I have a terrible stomachache, doctor.
Dr. Jones: I see. When did it start?
Alex: It all started last night.

What part of speech is all: a pronoun, an adverb, or a determiner? And what does it mean in this context?

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    I would say it's an adjective, modifying "it" to let us know that "[Everything] started last night." Jan 25 '17 at 8:07
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    I take "it all" to be a compound pronoun: the two parts are inseparable, and function as subject of the sentence. The meaning can be glossed as "the problem in its entirety started last night".
    – BillJ
    Jan 25 '17 at 9:14
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It all started last night.

In here all is a Quantificational Adjunct. Reason?

  • If we insert an auxiliary verb, like an adjunct it preferably follows the auxiliary verb.

It had all started last night.

  • we can replace it with any other Noun Phrase (NP).

The pain all started last night.

N.B- This construction to be distinguished from the they all, we both etc. In OP's sentence it all is not a compound pronoun.

For more information please refer to The Cambridge Grammar of The English Language by Rodney Huddleston and Geoffrey K. Pullum: page no. 427-428

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