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44 y/o lady has been having epigastric pains for the past 4 weeks…

- - - - Peptic ulcer disease: may be worsened or relieved by food; pain often worse at night; bloody or coffee-ground emesis or dark black tarry stool indicative of active bleeding and requiring urgent endoscopic evaluation; NSAID and alcohol use predispose to ulcer disease; Helicobacter pylori more common in certain ethnicities, especially South and Central Americans and Asians; Exam: epigastric tenderness, pallor, Haemoccult-positive stool or black tarry stool. GERD: burning epigastric/chest pain, worse with some foods and recumbency; improved by antacids; Exam: enamel erosion. Gastritis/gastropathy: Abdominal discomfort/pain, heartburn, nausea, vomiting, and hematemesis.; Exam: Variety of etiologies including alcohol and nonsteroid anti-inflammatory drugs (NSAIDs). Functional dyspepsia: bothersome postprandial fullness, early satiation; epigastric pain and burning that are unexplained after a routine clinical assessment; may be associated with nausea and vomiting, and exacerbated by psychosocial stressors. Gastroparesis: early satiety, fullness, nausea, vomiting; all symptoms are worse after ingestion of meals; hx of diabetes mellitus or Parkinson's disease; previous abdominal surgery that may result in vagal nerve injury; Exam: succussion splash rarely detected; weight loss; no other specific physical findings.
    - - Chronic pancreatitis: chronic postprandial pain; hx of recurrent acute pancreatitis or alcohol abuse; brittle diabetes; greasy, foul-smelling stools and weight loss suggest exocrine insufficiency; Exam: weight loss, epigastric tenderness consistent with the diagnosis but not diagnostic, and palmar erythema suggest alcohol abuse.
  - - - Hepatitis/perihepatitis. Liver abscess. Budd-Chiari syndrome. Portal vein thrombosis.
    - - Gallstones. Acute cholecystitis /cholangitis. Sphincter of Oddi dysfunction.