Epigastric abdominal pain: Difference between revisions
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==Background== | ==Background== | ||
*This page outlines the general approach to adult epigastric pain | *This page outlines the general approach to adult epigastric pain | ||
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{{Abdominal pain location}} | {{Abdominal pain location}} | ||
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==Clinical Features== | ==Clinical Features== | ||
*Pain in the epigastrum | *Pain in the epigastrum | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Template:Abdominal Pain DDX Epigastric}} | {{Template:Abdominal Pain DDX Epigastric}} | ||
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==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*CBC | *CBC | ||
*Chem | *Chem | ||
*[[LFTs]] | *[[Special:MyLanguage/LFTs|LFTs]] | ||
*Lipase | *Lipase | ||
*Coags | *Coags | ||
*[[Urinalysis]] | *[[Special:MyLanguage/Urinalysis|Urinalysis]] | ||
*Urine pregnancy (females) | *Urine pregnancy (females) | ||
*?[[ECG]] (if >50 or at risk for cardiac disease) | *?[[Special:MyLanguage/ECG|ECG]] (if >50 or at risk for cardiac disease) | ||
*?[[RUQ US]] | *?[[Special:MyLanguage/RUQ US|RUQ US]] | ||
*?[[CXR]] | *?[[Special:MyLanguage/CXR|CXR]] | ||
**Consider if at risk for perforated ulcer | **Consider if at risk for perforated ulcer | ||
===Diagnosis=== | ===Diagnosis=== | ||
==Management== | ==Management== | ||
*Treat underlying disease process | *Treat underlying disease process | ||
*Consider PO antacid (e.g. [[Bismuth subsalicylate|Maalox]] Plus) | *Consider PO antacid (e.g. [[Special:MyLanguage/Bismuth subsalicylate|Maalox]] Plus) | ||
**The addition of viscous [[lidocaine]] 2% and/or Donnatol (i.e. "GI Cocktail") is no more effective than plain liquid antacid<ref>Berman DA, Porter RS, Graber M. "The GI Cocktail is no more effective than plain liquid antacid: a randomized, double blind clinical trial." J Emerg Med. 2003 Oct;25(3):239-44.</ref> | **The addition of viscous [[Special:MyLanguage/lidocaine|lidocaine]] 2% and/or Donnatol (i.e. "GI Cocktail") is no more effective than plain liquid antacid<ref>Berman DA, Porter RS, Graber M. "The GI Cocktail is no more effective than plain liquid antacid: a randomized, double blind clinical trial." J Emerg Med. 2003 Oct;25(3):239-44.</ref> | ||
==Disposition== | ==Disposition== | ||
*Disposition per underlying disease process | *Disposition per underlying disease process | ||
==See Also== | ==See Also== | ||
*[[Abdominal Pain]] | |||
*[[Abdominal Pain (Peds)]] | *[[Special:MyLanguage/Abdominal Pain|Abdominal Pain]] | ||
*[[Special:MyLanguage/Abdominal Pain (Peds)|Abdominal Pain (Peds)]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Symptoms]] | [[Category:Symptoms]] | ||
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Latest revision as of 22:51, 4 January 2026
Background
- This page outlines the general approach to adult epigastric pain
Classification by Abdominal pain location
| RUQ pain | Epigastric pain | LUQ pain |
| Flank pain | Diffuse abdominal pain | Flank pain |
| RLQ pain | Pelvic pain | LLQ pain |
Clinical Features
- Pain in the epigastrum
Differential Diagnosis
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
Evaluation
Workup
- CBC
- Chem
- LFTs
- Lipase
- Coags
- Urinalysis
- Urine pregnancy (females)
- ?ECG (if >50 or at risk for cardiac disease)
- ?RUQ US
- ?CXR
- Consider if at risk for perforated ulcer
Diagnosis
Management
- Treat underlying disease process
- Consider PO antacid (e.g. Maalox Plus)
Disposition
- Disposition per underlying disease process
See Also
External Links
References
- ↑ Berman DA, Porter RS, Graber M. "The GI Cocktail is no more effective than plain liquid antacid: a randomized, double blind clinical trial." J Emerg Med. 2003 Oct;25(3):239-44.