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A 44 year old lady has been having epigastric pains for the past 4 weeks.
A 44 year old lady has been having epigastric pains for the past 4 weeks.
Gastrointestinal Cause
Gallstone (Typically these types of conditions cause pain on your lower right side, but that pain can spread up to your upper abdomen.)
Biliary colic
Cholecystitis
Choledocholithiasis
Cholangitis
Stomach
Peptic ulcers*
Pain 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; epigastric tenderness, pallor, Haemoccult-positive stool or black tarry stool
Gastritis* (e.g. due to alcoholic inflammation)
Gastric cancer*?
Pancreas
Pancreatitis (acute/chronic)*
chronic postprandial pain; hx of recurrent acute pancreatitis or alcohol abuse; brittle diabetes; greasy, foul-smelling stools and weight loss suggest exocrine insufficiency
Pancreatic cancer*
Weight loss, depression, jaundice, hx of chronic pancreatitis, palpable abdominal mass
Liver (right hypochondriac pain)
Spleen (left hypochondriac pain)
Esophagus
Gastro-esophageal reflux disease*
burning chest pain, worse with some foods and recumbency; improved by antacids; enamel erosion
Boerhaave's syndrome
Intestinal (lower/generalised abdominal pain)
Intestinal obstruction
Ischemic
Inflammatory
Appendicitis (peri-umbilical/right iliac)
Merkel's diverticulum (peri-umbilical/right iliac)
Diverticulitis (iliac fossa pain)
Inflammatory bowel disease
Infective
Gastroenteritis
Infective colitis
Intra-abdominal abscess
Other causes
Tenesmus (urgent, painful but unproductive desire to pass stool)
*Functional causes (e.g. IBS -> common cause of chronic pelvic pain)
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
Constipation colic (diagnosis of exclusion)
Lactose Intolerance*
abdominal pain, bloating, gas, and/or loose stool after ingestion of dairy products (or any product that contains the sugar lactose)
Renal/Urological Cause (flank/lower abdominal pain)
Urolithiasis
Urinary tract infection
Acute urinary retention (supra-pubic pain)
Spontaneous bacterial peritonitis (in patients with ascites)
Reproductive System Cause (lower abdominal/pelvic)
Males
Hernia
Testicular torsion
Epididymo-orchitis
Female
Pregnancy*
Hormone fluctuations can lead to issues with digestion that cause acid reflux and other conditions associated with epigastric pain.
Non-pregnant
Acute pain
Ovarian torsion
Ovarian cyst
Pelvic inflammatory disease
Recurrent dysmenorrhoea
Endometriosis & adenomyosis
Leiomyoma
Primary dysmenorrhoea
Chronic pelvic pain
Endometriosis & adenomyosis
Pelvic inflammatory disease
Ovarian cancer
Other Causes
Metabolic and toxic causes
Acute renal crisis
Hypercalcemia
Metabolic ketoacidosis
Poison
Other causes
Abdominal aortic aneurysm (pain located in the abdomen, back or groin)
Neurological causes: e.g. herpes zoster
Dengue virus (acute abdominal pain: sign of hemorrhagic fever)
Vasculitis (e.g. SLE)
Traumatic abdomen
Referred pain (upper abdomen)
Cardiovascular
Respiratory