Pain in the upper abdomen (epigastrium) develops with many diseases of the gastrointestinal tract: intestinal infections, gastritis, and peptic ulcer, pathologies of the organs of the pancreatobiliary zone. Some extra-abdominal causes include lower lobe pneumonia, intercostal neuralgia, and lesions of the abdominal aorta and its branches. For diagnostic purposes, a complex of instrumental studies (ultrasound, radiography and CT, endoscopy) is carried out in combination with analyzes and functional methods. To stop the pain, analgesics, antispasmodics and antisecretory drugs are used. A different treatment regimen is selected taking into account the underlying pathology.
Pain in the epigastrium is provoked by errors in the diet, the abuse of fast food, and dry food. Unpleasant symptoms are usually disturbed by stress, during travel, and jet lag. The pains are aching or pulling, and have a moderate intensity. Less commonly, patients report sharp stabbing sensations in the upper abdomen. Similar manifestations are observed periodically under the influence of predisposing factors.
Simultaneously with the pain syndrome, a feeling of heaviness and overflow in the epigastrium, nausea, and heartburn increase. Belching with air is a characteristic, which develops as a result of aerophagia. With functional disorders of the stomach, symptoms from the gastrointestinal tract are accompanied by disorders of the autonomic nervous system. Characterized by pallor and cold extremities, increased sweating, and increased heart rate.
For gastritis with high acidity, sharp pains in the upper abdomen are characteristic, which intensify 20-30 minutes after eating, lasting several hours. With gastritis with low acidity, there is a constant dull or aching pain that is not associated with eating. At the end of the meal, patients complain of heaviness in the epigastrium, nausea, and belching.
With an acute form of gastritis or an exacerbation of a chronic process, pain appears sharply against the background of errors in the diet, and alcohol intake. The pain syndrome is very strong, resembling an "acute abdomen". Chronic gastritis is characterized by periodic moderate pain, accompanied by changes in the stool, belching, and heartburn. Due to impaired absorption of iron, pallor of the skin, weakness, and dizziness occurs.
A stomach ulcer is manifested by severe pain in the epigastric part, which appears immediately after eating, accompanied by nausea, and heartburn. Patients induce vomiting to alleviate discomfort. With a complication of peptic ulcer - perforation of the ulcer - a "dagger pain" is suddenly felt in the upper abdomen. The person lies motionless, pulling his legs up to his stomach since the pain syndrome increases with movements.
Pain in the upper abdomen
In the compensated stage, there are dull and aching pains in the epigastrium after a heavy meal, combined with a feeling of heaviness in the stomach, and belching. With decompensation of pyloric stenosis, there are constant severe pains in the upper abdomen, aggravated by the end of the meal. Vomiting of foods eaten the day before opens, after which the state of health improves for a short time.
In the acute course of pancreatitis, the pain is localized in the epigastric part and the left hypochondrium which has a shrouding character. Unpleasant sensations are aggravated by lying on the back. The appearance of a painful attack is typical of abundant feasts with alcohol. The pain is combined with repeated vomiting, which does not bring relief to the patient. Perhaps an increase in body temperature, and slight yellowness of the sclera.
Chronic pancreatitis is characterized by discomfort in the upper abdomen, occasionally radiating pain to the heart area. When following a diet, pain rarely bothers, it is moderately pronounced and short-lived. Pancreatitis occurs with exocrine pancreatic insufficiency, so the pain syndrome is accompanied by steatorrhea, Renteria, and flatulence.
With inflammation of the gallbladder, pain is localized in the upper abdomen and right hypochondrium. The association of symptoms with the use of fatty foods is characteristic. In chronic cholecystitis, epigastric pains are aching in nature, they are accompanied by heaviness in the abdomen and stool changes. Acute cholecystitis is characterized by a sharp paroxysmal pain in the upper part of the abdominal cavity. The clinical picture is complemented by vomiting with bile, yellowness of the skin, and mucous membranes.
Diaphragmatic hernia is manifested by severe pain in the retrosternal region and epigastrium, caused by compression of the stomach in the hernial sac. The symptom is provoked by physical activity, prolonged coughing, and vomiting. Increased pain occurs when the torso is tilted forward, straining. In addition to the pain syndrome, constant heartburn worries, are aggravated after eating and in the supine position. With large diaphragmatic hernias, shortness of breath is observed.
A rarer cause of epigastric pain is a hernia of the upper part of the white line of the abdomen. Characterized by constant aching sensations at the top of the abdominal cavity, which does not have a clear localization. Symptoms are aggravated by physical exertion and strainstrainpical symptom of this pathology is the appearance of sharp pains when you try to raise your legs while lying on your back. Occasionally, a protrusion of a soft elastic consistency can be felt in the middle of the epigastric region.
Pain in the epigastrium is characteristic of food poisoning that occurs with gastritis or gastroenteritis syndrome. Often they are caused by rotaviruses, enteroviruses, and staphylococci. Symptoms appear in the interval from several hours to 1-2 days after eating food of dubious quality. There is sudden severe pain in the abdominal cavity with nausea and repeated vomiting. Then comes watery diarrhea.
With benign formations (polyps), periodic dull pains develop in the upper abdomen, not associated with food or the action of other external factors. Gastric cancer is characterized by constant increasing pain in the epigastrium, which is not relieved by conventional analgesics and antispasmodics. In addition to the pain syndrome, there is a deterioration in appetite and a change in taste preferences, as a result, patients are rapidly losing weight.
Soreness in the upper abdomen occurs with lower lobar pneumonia and dry and exudative pleurisy. The irradiation of pain sensations is determined by the proximity of the location of the organs of the chest and abdominal cavity, and their common innervation. The pain is dull or aching in nature, aggravated by deep breaths, coughing, and turning the torso. The symptom is combined with high fever, shortness of breath, and lagging behind half of the chest during breathing.
Severe epigastric pain occurs in the abdominal form of myocardial infarction. The pain syndrome develops suddenly, often preceded by an emotional shock. Pain is accompanied by severe weakness. The skin becomes pale and covered with cold sweat. Pain is so strong that the patient is pre-fainting.
With a lesion at the level of the lower ribs, irradiation of pain in the epigastric zone is possible. Sensations are sharp and shooting, localized on one side. They occur when the body is in an uncomfortable position, after tilting or turning the body, with a long stay in one position. The pain is aggravated by palpation of the intercostal spaces, and an attempt to lean in the opposite direction.
A typical iatrogenic cause of upper abdominal pain is NSAID gastropathy. The disease is characterized by periodic discomfort in the epigastrium, which intensifies at night and on an empty stomach. There is a decrease in appetite, nausea, and flatulence. About 40-50% of gastropathy is asymptomatic and manifests as a sharp pain in the projection of the stomach with the development of complications - perforated ulcers, and gastrointestinal bleeding.
During a physical examination, the doctor determines the zones of hyperesthesia and conducts superficial and deep palpation of the epigastric zone. The variety of causes of pain in the upper abdomen requires the gastroenterologist to use a whole range of laboratory and instrumental methods. The most informative for diagnosis are the following studies:
With sharp pains resembling the symptoms of an "acute abdomen", the patient must be examined by a surgeon. If extra-abdominal processes are suspected, consultations with specialized specialists are appointed: a cardiologist, a pulmonologist, and a neurologist. Patients with suspected psychogenic causes of epigastric pain should be evaluated by a psychiatrist.
Gastroscopy
With a sudden onset of pain in the epigastrium, painkillers should not be taken before a visit to the doctor, so as not to blur the clinical picture. If a chronic gastrointestinal disease is diagnosed, to reduce pain, it is necessary to follow dietary recommendations and avoid provoking factors. In case of food poisoning, you need to rinse the stomach, and use sorbents.
Treatment begins with non-drug measures: diet therapy, normalization of the daily regimen and the rejection of bad habits, and elimination of risk factors for the underlying disease. Medicines are selected only after a full diagnosis and identification of the root cause of the pain syndrome. The main groups of medicines that are prescribed for pain in the upper abdomen:
Complicated forms of peptic ulcer and volumetric neoplasms require surgical treatment - resection of the stomach with the imposition of anastomosis, and gastrectomy. With a peptic ulcer, the removal of a part of the organ is combined with selective proximal vagotomy, which dramatically reduces the frequency of relapses. In acute calculous cholecystitis, cholecystectomy is prescribed. For hernias, hernioplasty is performed with own tissues or with an allograft.