Epigastric abdominal pain

Background

• This page outlines the general approach to adult epigastric pain

Classification by Abdominal pain location

Side-by-side comparison of quadrants and regions.

Chart of commonly reported referred pain sites.

RUQ pain	Epigastric pain	LUQ pain
Flank pain	Diffuse abdominal pain	Flank pain
RLQ pain	Pelvic pain	LLQ pain

Clinical Features

• Pain in the epigastrum

Differential Diagnosis

Epigastric Pain

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer disease with or without perforation
  • Zollinger-Ellison syndrome
• Gastritis
• Pancreatitis
• Gallbladder disease
  • Acute cholecystitis
  • Cholangitis
  • Symptomatic cholelithiasis
  • Acalculous cholecystitis
• Myocardial Ischemia
• Splenic Infarctionenlargement/rupture/aneurysm
• Pericarditis/Myocarditis
• Aortic dissection
• Hepatitis
• Pyelonephritis
• Pneumonia
• Pyogenic liver abscess
• Fitz-Hugh-Curtis Syndrome
• Hepatomegaly due to CHF
• Bowel obstruction
• SMA syndrome
• Pulmonary embolism
• Bezoar
• Ingested foreign body

Evaluation

Workup

• CBC
• Chem
• LFTs
• Lipase
• Coags
• Urinalysis
• Urine pregnancy (females)
• ?ECG (if >50 or at risk for cardiac disease)
• ?RUQ US
• ?CXR
  • Consider if at risk for perforated ulcer

Management

• Treat underlying disease process
• Consider PO antacid (e.g. Maalox Plus)
  • The addition of viscous lidocaine 2% and/or Donnatol (i.e. "GI Cocktail") is no more effective than plain liquid antacid

Disposition

• Disposition per underlying disease process

See Also

• Abdominal Pain
• Abdominal Pain (Peds)