Epigastric abdominal pain

Background

This page outlines the general approach to adult epigastric pain

Clinical Features

Differential Diagnosis

Epigastric Pain

Gastroesophageal reflux disease (GERD)
Peptic ulcer disease with or without perforation
Gastritis
Pancreatitis
Gallbladder disease
- Acute cholecystitis
- Cholangitis
- Symptomatic cholelithiasis
- Acalculous cholecystitis
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

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

Management

Treat underlying disease process
Consider PO antacid (e.g. Maalox Plus)
- The addition of viscous lidocaine 2% and/or Donnatol (i.e. "GI Cocktail") is no more effective than plain liquid antacid[1]

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.

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