The epigastrium is the area of central abdomen lying below the sternum and above the umbilicus.
Irritable bowel syndrome - by definition the pain has been present for at least six months and is associated with bloating and alteration in stool frequency or consistency. Examination is usually normal or there may be mild tenderness/distension.
Peptic ulcer - acute or chronic gnawing or burning pain. This may be improved by food if a duodenal ulcer, and worsened if a gastric ulcer. Typically the pain is worse at night.
Pancreatitis - acute pain which radiates to the back. It is usually accompanied by vomiting. The pain may be relieved by sitting forward. Signs vary, but include jaundice, tachycardia, abdominal rigidity, tenderness, and discolouration around the umbilicus or flanks.
Peritonitis - acute pain with signs of shock and tenderness (possibly rebound). This may be exacerbated by coughing. The abdomen may feel 'rigid'.
Pre-eclampsia - epigastric pain is very significant, especially if severe or associated with vomiting.
Gastrointestinal obstruction - acute colicky pain. Vomiting brings relief. Accompanied by distension and 'tinkling bowel sounds'.
Gallbladder disease - acute constant pain with vomiting, fever, local tenderness and rigidity. It may be possible to palpate a gallbladder mass.
Ruptured aortic aneurysm - acute pain which radiates to the back or groin. The patient may be in cardiovascular collapse. A mass is felt swelling and contracting with the pulse.
Gastric carcinoma - be suspicious in male patients who are over 55 years old and who smoke. Advanced cases may also have weight loss, vomiting, palpable mass/nodes, hepatomegaly, vomiting and dysphagia.
Referred pain - this may be from the heart in myocardial infarction; also from pleural disease or spinal nerves.
NB: epigastric pain may also be of psychosomatic origin.
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- Khoury G et al; Emergent Management of Pancreatitis, Medscape, Jun 2011
- Anand BS et al, Peptic Ulcer Disease, Medscape, Jun 2011
- Irritable bowel syndrome, Prodigy (August 2008)
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