Upper abdominal pain (epigastrium) develops in many diseases of the gastrointestinal tract: intestinal infections, gastritis and peptic ulcer, pathologies of the pancreatobiliary zone. There are extra-abdominal causes, which include lower lobe pneumonia, intercostal neuralgia, lesions of the abdominal aorta and its branches. For diagnostic purposes, a complex of instrumental studies (ultrasound, radiography and CT, endoscopy) is carried out in combination with analyzes and functional methods. To relieve pain, analgesics, antispasmodics and antisecretory drugs are used. The further treatment regimen is selected taking into account the underlying pathology.
Causes of upper abdominal pain
Functional dyspepsia
Upper abdominal pain is provoked by errors in the diet, abuse of fast food and dry food. Unpleasant symptoms usually bother with stress, during travel and jet lag. The pains are aching or pulling, have a moderate intensity. Less often, patients report acute stabbing sensations in the upper abdomen. Similar manifestations are observed periodically under the influence of predisposing factors.
Simultaneously with the pain syndrome, a feeling of heaviness and overflow in the epigastrium, nausea, heartburn increase. Belching with air is characteristic, which develops as a result of aerophagy. In functional disorders of the stomach, gastrointestinal symptoms are accompanied by disorders of the autonomic nervous system. Characterized by pallor and cold extremities, increased sweating, increased pulse rate.
Gastritis
Gastritis with high acidity is characterized by sharp pains in the upper abdomen, which intensify 20-30 minutes after eating, last for several hours. With gastritis with low acidity, there is a constant dull or aching pain that is not associated with eating. At the end of the meal, patients complain of heaviness in the epigastrium, nausea, belching.
In the acute form of gastritis or exacerbation of the chronic process, pain appears sharply against the background of errors in diet, alcohol intake. The pain syndrome can be very strong, resembling a “sharp stomach”. Chronic gastritis is characterized by periodic moderate pain, accompanied by changes in stool, belching, heartburn. Due to a violation of iron absorption, pallor of the skin, weakness, dizziness occurs.
Peptic ulcer disease
Stomach ulcer is manifested by severe pain in the epigastric part, which appears immediately after eating, accompanied by nausea, heartburn. To treat unpleasant sensations, patients cause vomiting. With a complication of peptic ulcer disease – a perforation of the ulcer – a “dagger pain” is suddenly felt in the upper abdomen. A person lies motionless, pulling his legs up to his stomach, because the pain syndrome increases with movements.
Pylorostenosis
In the compensated stage, there are dull and bursting pains in the epigastrium after a heavy meal, combined with a feeling of heaviness in the stomach, belching. With decompensation of pylorostenosis, there are constant severe pains in the upper abdomen, aggravated by the completion of nutrition. Vomiting opens with foods eaten the day before, after which the state of health improves for a short time.
Pancreatitis
In acute pancreatitis, the pain is localized in the epigastric part and the left hypochondrium, has a shingling character. Unpleasant sensations increase when lying on your back. The appearance of a painful attack is typical for heavy feasts with alcohol. The pain is combined with repeated vomiting, which does not bring relief to the patient. Possible increase in body temperature, slight jaundice of the sclera.
Chronic pancreatitis is characterized by discomfort in the upper abdomen, occasionally irradiation of pain in the heart area. When following a diet, soreness rarely bothers, it is moderately pronounced and short-lived. Pancreatitis occurs with external secretory insufficiency of the pancreas, so the pain syndrome is accompanied by steatorrhea, lienterea, flatulence.
Cholecystitis
With inflammation of the gallbladder, pain is localized in the upper abdomen and right hypochondrium. The connection of symptoms with the use of fatty foods is characteristic. In chronic cholecystitis, upper abdominal pain is aching, accompanied by heaviness in the abdomen and changes in stool. Acute cholecystitis is characterized by a sharp paroxysmal pain in the upper part of the abdominal cavity. The clinical picture is complemented by vomiting with bile, jaundice of the skin and mucous membranes.
Hernias
Diaphragmatic hernia is manifested by severe pain in the chest area and epigastrium caused by compression of the stomach in the hernial sac. The symptom is provoked by physical exertion, prolonged coughing, vomiting. Increased pain occurs when the torso is tilted forward, straining. In addition to the pain syndrome, constant heartburn worries, which worsens after eating and lying down. With large diaphragmatic hernias, shortness of breath is observed.
A more rare cause of upper abdominal pain is a hernia of the upper part of the white line of the abdomen. There are constant aching sensations at the top of the abdominal cavity, which do not have a clear localization. Symptoms are aggravated by physical exertion, straining. A typical symptom of this pathology is the appearance of sharp pains when trying to lift your legs lying on your back. Occasionally, in the middle of the epigastric region, a protrusion of a soft-elastic consistency can be felt.
Intestinal infection
Upper abdominal pain is characteristic of food poisoning that occurs with gastritis or gastroenteritis syndrome. They are often caused by rotaviruses, enteroviruses, staphylococci. Symptoms appear in the interval from several hours to 1-2 days after eating food of questionable quality. Suddenly there are severe pains in the abdominal cavity with nausea and repeated vomiting. Then watery diarrhea joins in.
Neoplasms
With benign formations (polyps), periodic dull pains develop in the upper abdomen that are not associated with food or the action of other external factors. Stomach cancer is characterized by constant increasing pain in the epigastrium, which is not relieved by conventional analgesics and antispasmodics. In addition to the pain syndrome, there is a deterioration in appetite and a change in taste preferences, as a result, patients are rapidly losing weight.
Respiratory damage
Soreness in the upper abdomen occurs with lower lobe croup pneumonia, dry and exudative pleurisy. The irradiation of pain is determined by the proximity of the thoracic and abdominal organs, their general innervation. Pain of a dull or aching nature, increases with deep breaths, coughing, torso turns. The symptom is combined with high fever, shortness of breath, lagging half of the chest when breathing.
Myocardial infarction
Severe upper abdominal occurs in the abdominal form of myocardial infarction. Pain syndrome develops suddenly, often it is preceded by an emotional shock. The pain is accompanied by a sharp weakness. The skin becomes pale and covered with cold sweat. The pain can be so strong that the patient is in a pre-fainting state.
Intercostal neuralgia
With a lesion at the level of the lower ribs, pain may radiate into the epigastric zone. The sensations are sharp and shooting, localized on one side. They occur when the body is in an uncomfortable position, after bending or turning the trunk, with a long stay in one position. The pain increases when feeling the intercostal spaces, trying to bend in the opposite direction.
Complications of pharmacotherapy
A typical iatrogenic cause of pain in the upper abdomen is NSAID-gastropathy. The disease is characterized by periodic discomfort in the epigastrium, which increases at night and on an empty stomach. There is a decrease in appetite, nausea, flatulence. About 40-50% of gastropathies are asymptomatic and manifest sharp pain in the projection of the stomach with the development of complications – a perforated ulcer, gastrointestinal bleeding.
Rare reasons
- Spleen lesion: splenomegaly, abscess or cyst of the spleen, perisplenitis.
- Rare gastric diseases: acute expansion of the stomach, inversion of the stomach.
- Kidney diseases: pyelonephritis, renal colic.
- Vascular pathologies: portal vein thrombosis, abdominal aortic aneurysm, ischemic abdominal syndrome.
- Intoxication: nicotine, morphine, heavy metals (lead, mercury).
- Psychogenic states: hysteria, masked depression, somatoform disorder.
Diagnostics
During physical examination, the doctor determines the zones of hyperesthesia, conducts superficial and deep palpation of the epigastric zone. The variety of causes of pain in the upper abdomen requires a gastroenterologist to use a whole range of laboratory and instrumental methods. The following studies are the most informative for diagnosis:
- Ultrasound of the abdominal cavity. A simple and non-invasive method that detects signs of inflammatory processes, ulcerative defects and neoplasms in the epigastrium. On ultrasound, the doctor evaluates the anatomical and functional features of the gastrointestinal tract, confirms or excludes typical diseases (calculous cholecystitis, pancreatitis, hernia).
- Radiological methods. An overview radiograph is not informative enough, therefore, radiography with oral contrast is used for examination. The study is necessary to detect ulcerative defects, pylorostenosis, diaphragmatic hernia. With this method, the motor function of the gastrointestinal tract is evaluated.
- EGD. The most informative method that allows you to visualize inflammatory and erosive changes in the wall of the esophagus, stomach and duodenum. EGD with biopsy is used for differential diagnosis of ulcers, benign and malignant neoplasms of the gastric zone.
- Laboratory methods. The standard complex includes clinical blood and urine tests, a coprogram, and glucose level measurement. For the detection of gastritis, peptic ulcer disease, the study of gastric juice, a rapid urease test for H. pylori is informative. To exclude chronic bleeding from the gastrointestinal tract, the Gregersen reaction is performed.
- Additional research. Intragastric pH-metry is required to confirm the diagnosis of hyperacid gastritis. The functional abilities of the stomach are assessed using electrogastrography, radionuclide scintigraphy. A CT scan is performed for detailed visualization of the abdominal organs.
With sharp pains resembling the symptoms of an “acute abdomen”, the patient is necessarily examined by a surgeon. If extra-abdominal processes are suspected, consultations of specialized specialists are appointed: a cardiologist, a pulmonologist, a neurologist. Patients with suspected psychogenic causes of upper abdominal syndrome should be examined by a psychiatrist.
Treatment
Help before diagnosis
With the sudden appearance of pain in the epigastrium, you should not take painkillers before a visit to the doctor, so as not to blur the clinical picture. If a chronic gastrointestinal disease is diagnosed, in order to reduce pain, it is necessary to adhere to dietary recommendations, avoid provoking factors. In case of food poisoning, it is necessary to wash the stomach, use sorbents.
Conservative therapy
Treatment begins with non-drug measures: diet therapy, normalization of the daily routine and rejection of bad habits, elimination of risk factors of the underlying disease. Medications are selected only after a full diagnosis and identification of the root cause of the pain syndrome. The main groups of medications that are prescribed for pain in the upper abdomen:
- Painkillers. In the absence of medicinal gastropathies, medications from the group of nonsteroidal anti-inflammatory drugs are used to relieve pain. They are supplemented with antispasmodics, prokinetics, which normalize the motility of the gastrointestinal tract, eliminate discomfort.
- Enzymes. Preparations of gastric juice and digestive enzymes are used for pain caused by malabsorption and maldigestion. Their long-term use improves a person’s well-being, eliminates the symptoms of nutritional insufficiency.
- Antisecretory agents. Drugs that reduce the acidity of gastric secretions quickly eliminate the pain caused by hyperacidity. They contribute to the healing of defects of the gastric mucosa.
- Antibiotics. Specific three- and four-component regimens with antibacterial drugs are indicated for H. pylori eradication. Antibiotics are recommended for bacterial pneumonia and pleurisy, exacerbation of cholecystitis.
Surgical treatment
Complicated forms of peptic ulcer disease, volumetric neoplasms require surgical treatment — gastric resection with anastomosis, gastrectomy. In case of ulcerative defect, the removal of part of the organ is combined with selective proximal vagotomy, which dramatically reduces the frequency of relapses. In acute calculous cholecystitis, cholecystectomy is prescribed. In case of hernias, hernioplasty is performed with own tissues or an allograft.
