Epigastric Pain

Last updated 30.03.13

 

Index

 

Definition

-  Abdominal pain arising superior to transpyloric plane between costal margins & subcostal plane

 

Causes

-  Peritonitis

-  PUD, GORD

-  Pancreatitis

-  Hernia: epigastric, incisional, hiatus

-  Cholecystitis

-  Gastritis

-  Bowel obstruction, pneumoperitoneum

-  Mallory Weis tear

-  Superior mesenteric artery syndrome

-  AAA

-  AMI

-  Pneumonia

-  Appendicitis

 

Associated S/S

-  Nausea, vomiting, anorexia: GIT related

-  Referred pain (see below) from tissue supplied by celiac trunk = embryonic foregut

-  Coelic trunk = left gastric a., splenic a., common hepatic a.

-  Oesophagus, stomach, liver, spleen, pancreas, duodenum (D1, D2 upto CBD)

-  +/- appendix

-  Abdo Exam

-  Peritonism (rebound, guarding, rigidity)

 

Pain Referral

-  Shoulder

-  Left: spleen, pancreatitis (tail), stomach

-  Right: gall bladder, liver

-  Either/both: pneumoperitoneum, diaphragm

-  Scapular

-  Left: spleen, pancreatitis (tail)

-  Right: gall bladder, biliary tree

-  Back

-  Pancreatitis, PUD +/- perforation, AAA

 

Relevant Local Anatomy

-  Oesophagus

-  Stomach

-  Gall Bladder

-  Pancreas

-  Abdominal Aorta

-  Sternum

 

Ix

-  Bloods

-  FBE

-  U&E

-  LFTs

-  Cholecystitis

-  Hepatitis

-  Lipase: pancreatitis

-  +/- Trop & ECG

-  Imaging

-  +/- AXR

-  +/- Abdo U/S

-  +/- CT – Abdo

-  +/- Gastroscopy

 

Mx

-  Analgesia

-  Pink lady

-  Antiemetics

 

 

 

References