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epigastric pain for 4 weeks (episodic (Peptic Ulcer (Gastric ulcer:…
epigastric pain for 4 weeks
episodic
Biliary Colic
HX: pain often after fatty meals
peaks over hours and resolves when gallbladder relaxes.
pain is constant without pain free intervals
N/V but no jaundice
Peptic Ulcer
Gastric ulcer: exacerbated by food and relieved by vomiting
Duodenal Ulcer: relieved by food
Hx: Malena, hematemesis. If perforation, causes peritonitis.
Multiple aetiologies: NSAIDs and steroids (drug hx), H.pylori, smoking. Can progress to malignancy
Gastritis
precursor to ulcers but mucosa intact
Hx: Mild dyspepsia. Screen for anaemia, weight loss, recent onset of symptoms, malena or hematemesis, dysphagia
GERD
Hx: acidic taste in mouth, worse by lying flat. May present more as retrosternal pain rather than epigastric pain
Gastroparesis
Stomach cannot empty itself of food in normal fashion
Hx: N/V, early satiety, cyclical or continuous. Bloating. Symptoms of vitamin or mineral deficiency
Aetiologies: idiopathic, diabetic, post-surgical
Constant
Pancreatitis
Typically lasts for days only so less likely
Hx: sudden onset. classically radiating to the back, relieved by bending forward. Frequent vomiting and persistant nausea.
PE: Bruising of flanks (Grey Turner's Sign) and bruising of umbilicus (Cullen's Sign) ==> indicates retroperitoneal haemorrage
May also have steatorrhoea and new/woresning diabetes (Type 3A)
Pancreatic CA
Hx: constant epigastric pain radiating to the back. Likely to have obstructive jaundice if tumour of the head.
Gastric CA
Hx: Epigastric pain in 80%. Indigestion, nausea, vomiting, dysphagia, postprandial fullness, loss of appetitie, Melena, Hematemesis, Weight Loss
PE: physical signs only in late cancer. succusion splash and palpable stomach. hepatomegaly. Sister Mary Joseph nodule (periumbilical metastasis). Signs of paraneoplastic syndromes such as acanthosis nigricans or circinate erythemas
Oesophageal CA
Hx: Weighloss, hematemesis/melena/anaemia; restrosternal or epigastric pain; hoarseness, persistent cough, respi symptoms caused by aspiration
PE: typically normal unless mets to neck nodes (lymphadenopathy)