Pain upper abdomen

definition

Pain in the upper abdomen is pain of various causes, which are indicated in the upper half of the abdomen.

location of pain

In medicine, the abdomen is divided into four quadrants, with a vertical and a horizontal line drawn through the umbilical region. The upper abdomen is thus divided into the right and left upper abdomen. Frequently, the epigastrium ( epigastrium ), in the middle upper abdomen, is also examined separately. In addition, some patients also describe pain in the diaphragm.
It should be noted that the cause of upper abdominal pain can not always be reliably deduced from the cause, as pain radiates in some diseases and, in addition, each patient perceives pain differently.

pain character

Abdominal pain can be somatic or visceral. While somatic pain is felt to be strong and pungent and can be precisely localized, visceral pain is rather dull and oppressive and barely localizable. The form of the pain often allows conclusions about the cause of upper abdominal pain.

Abdominal pain can be colicky or persistent. Colic leads to a pain that constantly increases and decreases, which is especially the case with the laying of a hollow organ the case (eg gallstones, intestinal obstruction).
Pain can be mild to very severe. The severity of pain is often stated on a scale of 0 - 10 (= visual analogue scale), where 0 means to have no pain and 10 means to have the strongest imaginable pain.

In addition, the upper abdominal pain may occur at night. The therapy depends on the triggering cause.

General causes

Certain diseases can lead to pain that can occur anywhere in the stomach, including in the upper abdomen. Which includes:

  • Gastrointestinal infections with abdominal pain, nausea, vomiting and diarrhea

  • Intestinal obstruction ( ileus ): Intestinal obstruction is either caused by adhesions in the abdomen (eg scarring after surgery), by an obstruction in the intestinal lumen (eg colon cancer) or by a reduced intestinal activity (eg in the context of intestinal inflammation or after surgery on the intestine)

  • Perforation: A hole or tear in the wall of a hollow organ (eg in the stomach), usually as a result of prolonged untreated inflammation or ulcer.

  • Intestinal infarction: This refers to a circulatory disorder of the intestine, possibly even with death of parts of the intestine, if the blood circulation can not be restored in time

  • Poisoning (eg with lead)

  • Endometriosis: Occurrence of uterine lining outside the uterus. This mucosa changes as part of the female cycle and therefore leads to pain.

  • Chronic inflammatory bowel disease: Crohn's disease and ulcerative colitis are most common.

  • Sometimes the abdominal pain can also be limited to a bowel loop.
    Continue reading under : Pain on a bowel loop

  • and much more

Upper abdominal pain - causes

The following diseases can occur in the right as well as in the left upper abdomen:

  • Kidney stones, pyelitis

  • Pneumonia, pleurisy (especially if the inflammation is located in the lower lung areas)

  • Abscess (pus) in the area of ​​the diaphragm

Right-sided upper abdominal pain - typical causes

The typical diseases that lead to right upper abdominal pain include:

  • Gallbladder inflammation, gallstone disease

  • Small bowel ulcer: Ulcer in the small intestine (usually in the duodenum) with defects in the mucous membrane of the intestine, eg due to hyperacidity or infection with the bacterium Helicobacter pylori

  • Liver diseases: eg inflammation (hepatitis), thrombosis (blood clots) or swelling due to backflow of blood (eg heart disease)

  • Pancreatic diseases in the area of ​​the head of the pancreas

  • Diverticulitis: colon disease with protuberances of the intestine, where inflammation forms

Pain in the epigastrium - typical causes:

  • Diaphragm disruption: intestinal or gastric components pass through the diaphragm into the thorax

  • Esophageal diseases: eg inflammation due to reflux of gastric acid into the esophagus

  • Gastric ulcer (see below), gastric tumor

  • Starting from the heart: eg myocardial infarction, especially in the case of posterior infarction

Left-sided upper abdominal pain - typical causes:

  • Gastric ulcer: Gastric ulcer with defects in the mucous membrane of the stomach, eg due to hyperacidity or infection with the bacterium Helicobacter pylori

  • pancreatitis

  • Aortic aneurysm: enlargement or bulging of the abdominal artery with the risk of a tear and bleeding in the abdomen

  • Splenic diseases: eg splenic infarction, splitting of the spleen

Upper abdominal pain after eating

If the upper abdominal pain always occurs after eating, the cause is often gastritis or gastric ulcer. If the pain, however, especially in the fasting state, is more likely to start from a small bowel ulcer. With a PDO (reflection of the esophagus, stomach and small intestine) these diseases can be diagnosed the safest.

Upper abdominal pain in pregnancy

Even pregnant women often suffer from upper abdominal pain. Most of the abdominal pain is harmless and arise due to the stretching of the abdominal wall and the displacement of the abdominal organs by the growing child in the uterus. Upper abdominal pain in pregnancy can have the following reasons in addition to the causes mentioned:

  • Heartburn with upper abdominal pain often occurs during pregnancy. The reason for this is the reflux of gastric acid into the esophagus due to the altered position of the gastrointestinal tract during pregnancy. Since not all medicines are approved for pregnant women, the gynecologist should always be consulted first.

  • Hyperemesis gravidarum (pregnancy sickness / vomiting): Some pregnant women suffer from severe nausea, vomiting and upper abdominal pain, especially in the first trimester of pregnancy. These symptoms should be clarified promptly by the gynecologist.

  • HELLP syndrome: This is a life-threatening condition at the end of pregnancy, with upper abdominal pain often being the first sign. In addition, hypertension, elevated liver values ​​and decreased platelets occur together. The suspicion of suffering from HELLP syndrome should promptly lead to hospitalization.

see also: Upper abdominal pain pregnancy

diagnostics

1. First, the doctor will make an accurate pain history to narrow down the possible causes of upper abdominal pain:

  • How strong is the pain (0-10)?

  • How is the pain (dull or stinging)?

  • Where is he strongest? Where does he radiate?

  • Is the pain there permanently? Does the intensity fluctuate?

  • Since when does he exist? Was there a trigger for the pain? In which situations is the pain particularly strong?

  • What eases or aggravates the pain?

  • Are there any other symptoms?

2. Subsequently, the physical examination takes place:

  • Inspection: Attention is paid to protrusions, lesions, scars and hernias.

  • Auscultation (interception): Are the bowel sounds normal?

  • Percussion (knocking): Is air or fluid in the stomach?

  • Palpation: Are indurations to be felt? The situation is particularly threatening when it comes to a defense tension in addition to the abdominal pain. That is, if the stomach is "tough" in the investigation. In that case, a doctor should be consulted.

  • Rectal examination (palpation of the anal area): In abdominal pain, the rectum is often blanked out, for example, to detect bleeding as the cause of the abdominal pain.

3. When taking blood samples indications of inflammation and disturbed organ functions (liver, kidney, pancreas, heart) should be found. In addition, a pregnancy test should always be performed on women with abdominal pain.

4. For upper abdominal pain, an ECG should always exclude a heart attack.
5. Ultrasound examination / X-ray or computed tomography are used to immediately detect or exclude acutely life-threatening clinical pictures.

therapy

In order to be able to treat the upper abdominal pain adequately, the cause must first be clarified. In particular, it is important to immediately recognize or rule out life-threatening illnesses in order to decide, for example, if an operation is necessary immediately.

  • Urgent operation indication: perforation of a hollow organ or aortic aneurysm, intestinal infarction, splitting of the spleen

  • Not in need of acute surgery: aortic aneurysm (as long as there is no risk of a tear), diaphragmatic hernia, gallbladder inflammation / gallstone disease, abscesses

  • Conservative treatment with a temporary abstinence from diet or diet already leads to an improvement in most other causes of upper abdominal pain.

In addition, the following therapeutic principles are used, among others:

  • Antibiotics for inflammation (pancreatitis, diverticulitis)
  • Acid blocker in gastric / oesophageal inflammation

  • Special therapy including cortisone for inflammatory bowel disease

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