Upper Abdominal Pain
Upper Abdominal Pain. The upper abdomen connects directly to the two costal arches downwards and blurs into the middle abdomen . Important is this division of the abdomen with respect to lying in that area organs that can make appropriate pain. Pains that drag down from the costal arches and eventually stop at the level of the navel are called upper abdominal pain. There are many organs in this area that can cause discomfort. A subdivision of the pain localization in the area of the upper abdomen can still be carried out after the direct position, ie left upper abdomen , upper abdomen or right upper abdomen.
Upper Abdominal Pain
If pain is indicated in the upper abdomen, then in many cases in the upper abdomen on the right. If pain is reported there, the gallbladder is highly suspicious as the causative organ.
Above all, a sudden and stinging pain , which can remain the same or increase in strength, speaks most in the area of the right upper abdomen for a disease of the gallbladder. It can also cause pulling in the stomach .
Especially if the pain is reported after meals , the gall bladder comes as a cause in the shortlist of diagnoses. In many cases, it is gallstones that lie in the gallbladder and are initially completely symptom-free.
After eating, the gall bladder contracts to release bile acids in it. This leads to stone movements and contacts of the stones with the gallbladder wall. This leads to the described sharp pain in the area of the right upper abdomen .
If the pain occurs independently of the meals and is indicated at the site where the gallbladder is located, it may be that the gall bladder has become inflamed.
This happens in most cases in conjunction with gallstones. An inflamed gallbladder without gallstones is rare. Often it is the stones that have been lying in the gallbladder for many years, which ultimately ignite the gallbladder and lead to the described pain.
When talking about gallbladder inflammation, it is usually meant the gallbladder wall that is inflamed. In addition, gallstones that have matured in the gallbladder may leave the gallbladder and migrate through the bile ducts due to contraction of the gallbladder. If this stone then sticks to a constriction of the bile duct, usually very severe pain is caused, which are also referred to as dysentery and feared.
The diagnosis is carried out by ultrasound of the upper abdomen. With a view of the bile you can see gallstones in it. An inflammation of the gallbladder is visible in the ultrasound image by a uniform or uneven wall thickening. Stones in the bile ducts can often not be seen through the ultrasound.
Here, a so-called ERCP must be used, in which a gastroscopy isperformed and a contrast agent is injected into the bile duct. After that, an X-ray is taken performed and a corresponding bile duct patency can be controlled. It can also be seen by means of a blood test, whether an inflammation in the body is progressing or whether a bile-specific parameter in the blood is increased.
The treatment of choice in most cases is the surgical removal of the gallbladder when stones cause discomfort or when the gall bladder is inflamed. If a gallstone is found in the bile duct, it can either be recovered endoscopically or surgically removed by bile duct opening.
Furthermore, there is another organ in the area of the right upper abdomen – the liver . If right upper abdominal complaints are indicated, the liver must always be examined. As a rule, diseases of the liver, such as hepatitis , liver cirrhosis or liver carcinoma are not symptomatic by pain. But it can also happen over and over again that these diseases lead to a swelling of the liver.
The liver is surrounded by a stout capsule that does not leave enough space to yield to a corresponding enlargement of the liver . There is an increased pressure and thus a strong pull on the liver capsule, This leads to very severe pain. When examining the ultrasound, if the extent of the liver appears suspicious, the liver margins must always be measured.
Figure upper abdominal pain
- Right costal arch – Arcus costalis dexter
- Liver – hepar
- Duodenum – duodenum
- G allblase – Vesica biliaris
- Pancreas – Pancreas
- Large intestine – Intestinum crassum
- Pericardium – pericardium
- Spleen – Splen
- Left Ribbon – Arcus costalis sinister
- Stomach gaster
- Belly Button – Umbilicus
- Small intestine – intestinal tenue
Right upper abdominal pain:
A – liver cirrhosis (picture), hepatitis
B – gallstones (picture), gallbladder inflammation , biliary colic Central upper abdominal pain:
C – gastric ulcer (picture), gastritis ( gastritis ), inflammation of the pancreas ( pancreatitis), duodenal ulcer ( ulcer duodeni) Left-sided upper abdominal pain:
D – kidney stones (picture), inflammation of the spleen
Rather rare but just as urgent to clarify are upper abdominal pain . These can come from the stomachin this area and the pancreas . The most common cause of moderate upper abdominal pain is gastric diseases. Often there are acute inflammations of the gastric mucosa , which lead to the indicated central upper abdominal discomfort.
Acute gastritis or even acute gastritiscomes about when especially fat food was taken or if especially much alcohol was taken the day before. In most cases, the discomfort becomes more severe when one presses on the upper upper abdomen or when the patients bend forward. Severe acute gastritis can also lead to severe pulling and burning pain in peace. In most cases, the symptoms disappear after one to three days.
If they do not do this, it is called chronic gastritis , the cause of which must be clarified. Often it is too much acidproduced by the stomach that causes pain on the stomach wall. In some cases, the cause of pain is a stomach ulcer, which initially grows unnoticed in the stomach and eventually leads to complaints.
If the abdominal pain is the strongest in the middle , this may be an indication of gastritis.
Central upper abdominal complaints can also be caused by the pancreas . These are usually inflammations of the pancreas ( pancreatitis ). Characteristically, the pain is indicated centrally and radiating in the back and described as burning, cutting or pulling.
The main cause of pancreatitis is chronic alcohol consumption . It is also usually the case that the area in the upper upper abdomen, similar to gastritis, is sensitive to pressure. The occurrence of pancreatitis is a serious condition and must be diagnosed and treated quickly. Mostly it is associated with severe general reactions of the body, such as fever and severe deterioration in the general state .
Patients with severe pancreatitis often can not stand upright and often show elevated levels of bilirubin in the blood, which stains the skin and the conjunctiva. Sometimes it comes for different biochemical reasons to a darkening of the urine and aBright colouration of bowel movements . In this case, it is important to examine the pancreas.
This is also done by ultrasound and by a blood test . In unclear cases, it may be necessary to perform a CT scan . Most of the time, unresolved condensed structures or structures without an actual boundary are visible in the image examinations.
Treated is a pancreatitis with antibiotics in the hospital. Gastritis can only be proven by gastroscopy. Here, a real image of the stomach can be made from inside and analyzed.
Reddish changes in the gastric mucosa indicate an acute or chronic course of gastritis. The treatment is carried out by high-dose acid inhibitors and gentle diet . Upper abdominal pain, whether in the middle, left or right, can always be an indirect radiation of the heart. In the case of an unclear organ finding, an ECG must always be written and the troponin value in the blood determined in order to exclude a heart attack .
In the area of the left upper abdomen, the spleen isa potential pain-causing organ. However, spleen infections are virtually non- existent . However, there are some blood disorders ( leukemia ) and infections ( glandular fever ) in which the spleen swells strongly and leads to a pull on the capsule of the spleen. This can then lead to severe pain in the area of the left upper abdomen.
Untrained athletes or those who have eaten before a workout can also complain of left upper abdominal pain. In this case, it is usually simple, straightforward side stitches, In the lower part of the left (and right) lower abdomen, the ureters lead from the kidneys forward to the bladder . If it comes to a kidney stone , which has left the kidney and gets stuck in the ureter, it can cause very severe left upper abdominal pain, which are also known as colic.
Even ascending urinary tract infections ascending from the urinary bladder can occasionally cause left (and right) pain on the side. The clarification of the pain is also done with ultrasound, The shape and size of the spleen are measured and assessed. In the case of spleen enlargement, it is important to look for the cause. Mostly this is ensured by a detailed physical examination and an examination of the blood.
Urinary calculi, which are stuck in a ureter, can not be seen by ultrasound in many cases. If the cause of left lower abdominal pain is unclear, a contrast agent application must be performed. As a result, appropriate patency of the ureter can be checked.
If, after a trauma, there is pain in the right, middle or left upper abdomen, it may be necessary to perform a CT scan in addition to an ultrasound scan, since a traumatic injury with appropriate hemorrhage would be possible.
An organ that is located in the left, middle and right upper abdomen is the intestine . This can lead to complaints at any point. Both the large intestine ( colon ), which lays along the upper abdomen as well as the small intestine that fills this frame, can cause discomfort. The most common and uncomplicated is bloating after a meal.
It can also always lead to changes in the colon, which can lead in the form of Aussackungen and their inflammation to discomfort in each area of the colon. It is true that the left lower abdomen is the more frequent localization of these so-called diverticulitis but in some cases this can also lead to complaints in the area of the left upper abdomen. Again, it should be looked at first by means of ultrasound or a colonoscopy , which is the cause.
The heart is in the chest so that pain from the heart can radiate to the upper abdomen. Therefore, it is advisable to write an ECG in patients with severe upper abdominal pain in order to rule out a possible heart attack as a cause.
If the upper abdominal pain arises due to a heart attack , the pain characteristic is oppressive to stabbing and runs from the back of the sternum to the upper abdomen. The pain is very strong and patients often speak of the “annihilation pain”. Especially the back wall infarct causes such pain.
In addition to ECG diagnostics, laboratory parameters should be collected. The cardiospecific enzyme troponin is of particular significance, the values of which are greatly increased in the case of a heart attack and thus confirm the suspicion relatively reliably. Other key enzymes include myoglobin , creatine kinase (CK-MB), aspartate aminotransferase(AST), and alanine aminotransferase (ALT). In addition , a cardiacencephalography , a cardiac catheterization or an MRI of the heart can be made.
But there may also be an angina (“chest tightness”), which makes similar symptoms, but less intense. This is not the sinking of tissue of the heart muscle as in the case of a heart attack, but merely a temporary temporary lack of perfusion of the heart muscle.
Upper abdominal pain as the main symptom is a typical feature of so-called peptic ulcer disease . These are mucosal damage in the stomach and duodenum , which are at least half a centimeter in size and affect the muscle layer ( see: gastric ulcer ).
Genesis is based on factors that influence mucosal balance. This primarily includes the infection with the bacterium Helicobacter pylori and an altered acid production.
Other risk factors are:
- a genetic predisposition
- eating habits
- alcohol consumption
- Stress ( see: abdominal pain and stress ) and
- especially taking nonsteroidal anti-inflammatory drugs
In many cases, acute gastritis, an inflammation of the gastric mucosa , occurs asymptomatically.
But it can also lead to painful upper abdominal discomfort. Regardless of the actual cause, it is an imbalance between the mucosal protective factors and the aggressive stomach acid. Certain medications, such as acetylsalicylic acid , nonsteroidal anti-inflammatory drugs , cytostatic drugs and corticosteroids may cause such imbalance.
The gastric cancer remains asymptomatic for a long time until it becomes symptomatic, among others, with pain in the upper abdomen. The most important risk factor for its development is the infection with Helicobacter pylori.
Very severe, persistent epigastric pain is the leading symptom of acute pancreatitis, an inflammation of the pancreas .
By far the most common causes of pancreatitis are gallstone disease and chronic alcohol abuse .
Other triggers are:
- Medicines like glucocorticoids
- Antibiotics and estrogens
- Tumors and
- Autoimmune diseases such as Crohn’s disease
Excessive levels of fat in the blood, as well as high levels of calcium, may also promote acute pancreatitis. In every tenth case, the cause is unclear. The premature activation of pancreatic enzymes results in ” self-digestion ” of the pancreas.
Also, chronic pancreatitis is associated with recurrent upper abdominal pain in the early stages. Almost 80% of cases are preceded by chronic alcohol abuse.
Sudden, increasing and decreasing pain in the right upper abdomen occurs in symptomatic gallstone disease. The stones may be in the bladder itself or in the biliary tract.
They consist of components of bile. The most common are the pure and mixed cholesterol stones, while so-called pigment stones from degradation products of the red blood cells occur less frequently.
Risk factors include over forty years of age, obesity, female gender, many pregnancies, low-calorie and low-fiber diets, Chron’s disease, type 2 diabetes mellitus and certain genetic factors. Women are more than twice as likely to suffer from gallstones than men.
Acute cholecystitis, gallbladder inflammation, can be a complication of gallstone disease. A pinched stone causes an inflammatory reaction. Typically, there are also increasing and decreasing pain in the right upper abdomen.
The mere fact that one notices nocturnal upper abdominal pain already speaks for the intensity of the pain. Therefore, such upper abdominal pain is always in need of clarification , especially if the stomach is hardened at the same time and affected persons show a defense tension when touched . In children with nocturnal upper abdominal pain always thrives and growth disorders should be controlled.
Classical triggers for nocturnal pain are diseases that produce a ” sober pain “, as it is reached at night just such a state. These include the duodenal ulcer (= ulcer duodeni ) but also the gastritis ( gastritis ). Both show their pain characteristics after prolonged abstinence (usually from 4 hours after eating) and are therefore not only referred to as “fasting pain” but also as “hunger pain”. Usually, the acid gastric juice prepares with a pH from 1 no problems.
However, if it comes to disturbances in the gastric mucosa, it can be irritated by the acid and ignite, so we speak of the disease of gastritis. Especially if you have not eaten for a long time, or the dinner is long ago, the food in the stomach can not bind or buffer the acid. Therefore, this type of upper abdominal pain often occur at night.
In order to be able to differentiate between certain clinical pictures, the time when the pain occurs is an important differentiation factor. Patients complain of upper abdominal pain after eating, which is considered gastritis ( gastritis ) as a diagnosis of exclusion , because the stomach after food is less acidic and therefore the symptoms are rather relieved. Here, the pain is more likely to occur before eating , as the stomach acid at this time undisturbed attack the stomach lining (“hunger pain” / “fasting pain”).
In order to have pain after eating, there must therefore be reasons that create problems in the transport of food, impede the processing of food or are of mechanical origin.
The gallbladder is the most common place of origin of upper abdominal pain. This is explained by the contraction of the gallbladder wall muscles after eating, with the aim of transporting the bile salts through the bile ducts into the intestine. However, if gallstones are present in the gallbladder or in the bile ducts , they trigger a strong colicky pain as a result of the increased movement. This stinging pain is especially noticeable in the right upper abdomen.
Often, the cause of upper abdominal pain after eating is relatively harmless, although at the same time they are uncommon, because one has simply taken something difficult to digest. Very often, flatulence can be a harmless and uncomplicated cause of upper abdominal pain after eating. Certain foods are tolerated differently and can cause individual problems. However, carbonated drinks, legumes, onions and generally very greasy foods are generally predisposed.
In addition to upper abdominal pain, patients often experience a feeling of fullness and complain of abdominal cramps and constipation. However, too fast food and stress can lead to bloating.
However, if the upper abdominal pain occurs in all regularity and it comes in addition to complaints such as heartburn or increased belching, the presumption of reflux esophagitis (= reflux disease of the esophagus) is close.
A less harmless cause can also be a pancreatitis (= pancreatitis ).
The acute pancreatitis can be life threatening and from the chronic form out, an even cancer develop. Upper abdominal pain has a belt-shaped pain characteristic radiating into the back. In addition to the pain accompanying symptoms such as nausea, vomiting, fat and weight loss occur. The upper abdominal pain typically occurs after eating because just then the pancreas as the main digestive gland begins its work and secretes digestive enzymes.
Upper abdominal pain is a symptom that does not specifically indicate a specific condition. Rather, one must categorize the pain more precisely in terms of its nature ( piercing, burning, sharp, dull ) and its appearance ( permanent, attack-like, colicky ). In addition, additional accompanying symptoms can give an indication in a certain direction.
If abdominal pain and nausea come together, this is not enough for a diagnosis.
One possible cause can be a problem in the stomach . The pain is then often localized in the middle upper abdomen . It could be an inflammation of the gastric mucosa ( gastritis ), which can be either acute or chronic . The nausea is often more of a kind of uncomfortable feeling of fullness , the patients describe that the stomach inflates. Depending on the type of gastritis, treatment with drugs from the group of proton pump inhibitors(for example pantoprazole ) can provide relief for permanent complaints .
Another cause can Stomach ache after drinking alcohol . This form of upper abdominal pain is often accompanied by nausea.
If it is a chronic type B gastritis , then there is a bacterial colonization of the stomach with the germ Helicobacter pylori . In this case, a so-called eradication therapy should be done with a combination of antibiotics and proton pump inhibitors .
An ulcer of the stomach ( ulcer ventriculi ) or duodenum ( duodenal ulcer ) may cause upper abdominal pain with concomitant nausea. In duodenal ulcer pain often improves after food intake, whereas in gastric ulcer it is more independent of food intake. Depending on the extent of the ulcer, often a drug therapy may be sufficient. Again, proton pump inhibitors arethe drug of choice. They reduce the excessive acid production of the stomach, which causes the ulcer . In colonization with Helicobacter pyloriAn eradication therapy should also be performed in case of gastric ulcer or duodenal ulcer .
Epigastric pain in the middle of the abdomen accompanied by nausea, may also by the pancreas ( pancreatic caused), for example by an acute or chronic inflammation of the pancreas ( pancreatitis ). Depending on the severity of the disease, inpatient monitoring and treatment of those affected is necessary, as pancreatitis can reach dangerous levels.
Upper abdominal pain, which is more localized in the right upper abdomen and accompanied by nausea, may indicate a problem with the gallbladder . Either in the form of inflammation ( cholecystitis ) or in the form of a stone (C hole cystolithiasis ). The pain – and also the nausea – often increases in gallbladder stones after eating, as the gallbladder then works harder and the stones start to move.
Furthermore, the liver is located in the right upper abdomen , but liver diseases in the early stages rarely cause symptoms such as pain or nausea.
Pain in the area of the left upper abdomen may indicate spleen swelling as part of an infection, but it is rarely accompanied by nausea.
Upper abdominal pain in combination with flatulence may be an indication of inflammation of the gastric mucosa ( gastritis ). Those affected often complain of pain in the middle upper abdomen , which are sometimes stronger, sometimes weaker. In addition, they often describe a feeling of fullness and the feeling that the stomach would bloat , especially after a meal . Do these symptoms for a prolonged period, can by means of a gastroscopy( gastroscopy more accurate diagnosis be made).
If it really is a gastritis – depending on the type of gastritis – among other things drugs from the group of proton pump inhibitors such as pantoprazole be prescribed to achieve a relief of complaining. In addition, the consumption of alcohol and nicotine should be kept as low as possible. In one type of gastritis there is a colonization of the stomach with a bacterium called Helicobacter pylori , in which case a special combination therapy with antibiotics and proton pump inhibitors should be carried out.
Even a so-called irritable stomach , popularly referred to as ” nervous stomach “, can cause upper abdominal pain and flatulence. In case of an irritable stomach no pathological changes can be detected despite existing complaints. Therapeutically, a change in lifestyle and eating habits can help here, and psychotherapeutic measures are one way to get the complaints under control.
Diarrheais a symptom that does not have the same disease value. It is not uncommon that diarrhea occurs 1-2 times and the discomfort stops afterwards. Nonetheless, the combination of abdominal pain and diarrhea may be indicative of a gastrointestinal infection . Most of these infections are self-limiting and do not require specific therapy. The affected person shouldpay attentionto a sufficient hydration and take care. If there are other symptoms such as fever and chillsor if the abdominal pain and diarrheapersistfor more than 2-3 days, adoctor should be consulted urgently.
Upper abdominal pain and diarrhea, which looks greasy-shiny , may continue to indicate chronic pancreatitis . By a permanent latent inflammation of the pancreas, this loses part of its function and no longer produces sufficient digestive enzymes, this leads to the relatively characteristic looking diarrhea (see also: pancreatic insufficiency ). In this case, often the missing pancreatic enzymes have to be replaced by drugs to ensure adequate digestion and metabolism.
The duration of the pain and the treatment is highly dependent on the underlying diseases. The most common complaints in the upper abdomen occur everyday and are related to the stomach and digestion . These problems usually resolve themselves within a few hours. If there are infections and inflammations requiring treatment, antibiotic therapy can sometimes take a few days to a few weeks . This applies to pathogen-related inflammations, as well as chronic gastritis , liver inflammation or inflammation of other upper abdominal organs.
In the case of surgically treated complaints, the duration of healing may increase. In gall bladder surgeries the recovery time is relatively low with just a few days . Diseases of the pancreas, as well as malignant diseases of all upper abdominal organs are very serious. Their healing is not always possible and therapy usually takes a long time.
The pain can be treated symptomatically with different medications . The pain medications usually work after a few minutes to a few hours. They provide a quick relief of pain.
Upper abdominal pain involves many different organs and clinical pictures. The most important cornerstone of the diagnosis is therefore the detailed medical history . Whether pain is chronic or acute, which side of the body it is on, or whether it is related to activities such as eating is important information. Based on the history, in most cases, a suspected diagnosis can be made, which should be secured by diagnostic means.
After the anamnesis, a physical examination of the abdominal area is carried out. Subsequently, an ultrasound examination can provide information about the coarse structure of the upper abdominal organs. It can also be used for ascites (Ascites ), which can occur ininflammation , diseases of the heart or liver.
For further diagnostics, X-ray , CT or MRI scans may be helpful. In case of inexplicable, persisting problems, invasive measures can also be used as a diagnostic tool. These include gastroscopy or biliary tract mirroring ( ERCP ), as well as minimally invasive diagnostic procedures. These are called exploratory laparoscopies.
The treatment of upper abdominal pain varies with the cause of the pain. In most cases it is safe to take a non-prescription analgesic for the pain. Here are ” NSAIDs” such as ibuprofenor diclofenac in question. However, these only treat the symptoms and not the cause. In some cases, the cause of the pain needs to be resolved. For digestive problems or similar complaints, treatment is not mandatory. Here is often enough a change in diet .
However, if the pain is very severe or persists for a long time, a doctor should determine the cause in order to start a targeted therapy. Some diseases, such as bacterial infections, can be treated with anti-inflammatories and antibiotics . Problems of the liver and bile can often be remedied by endoscopic intervention, but also by surgery, for example, removal of the gallbladder. Malignant changes of the upper abdominal organs must be treated intensively, often also surgically.
A signal word for physicians in pregnant women in the last trimester (gestation month 6-9) is the right upper abdominal pain . This may be a sign of an incipient so-called HELLP syndrome . In addition to high blood pressure ( hypertension ) there is a liver function disorder in HELLP syndrome . This is shown by an increase in liver values and a drop in blood platelets ( platelets ) in the blood.
In addition, red blood cells are excessively degraded, resulting in a so-called hemolysis, This is described by the abbreviation HELLP ( H = hemolysis, EL = elevated liver enzymes, LP = low platelet count ). In addition to the usually severe right upper abdominal pain can cause nausea and vomiting , blurred vision and headache . The condition is dangerous for both mother and child and must lead to immediate hospitalization .
Furthermore, pregnant women may have upper abdominal pain for the same reasons as non-pregnant women and men.
These include, for right-sided abdominal pain diseases of the gallbladder as an inflammation ( cholecystitis ) and stones of the gallbladder ( cholecystitis ) with gall bladder stones, the pain often increases after food intake since then the gallbladder emptied their secretion and thereby come the stones in motion.
Upper abdominal pain in the middle abdomen can also indicate in pregnant women on diseases of the stomach . These include stomach inflammation ( gastritis ), which is often also accompanied by a feeling of fullness, and the gastric or duodenal ulcer ( gastric ulcer and duodenal ulcer ).
In pregnant women, heartburn often occurs . This is explained by the altered location of the gastrointestinal tract with more pressure on the lower esophageal sphincter . The heartburn may also be accompanied by mild upper abdominal pain.
Furthermore, diseases of the pancreas ( pancreas ) in the sense of inflammation in pregnant women and not pregnant women can lead to pain in the middle upper abdomen.
Pain in the left upper abdomen may also be an indication of a spleen swelling in pregnant women , which in turn may give an indication of an infection.
Children who suffer from abdominal pain may find it difficult to localize, depending on their age, and the type and intensity of the pain. Severe pain, however, can usually still be reasonably roughly localized, for example, on the upper abdomen.
Pain in the left upper abdomen may be an indication of massive splenomegaly (enlarged spleen) in children , which may be a nonspecific symptom of chronic myeloid leukemia (CML = a form of blood cancer).
In addition, gallstones (= cholelithiasis) lead to colicky upper abdominal pain. The stones are located either in the gallbladder or the laxative bile ducts and cause a characteristic radiating pain that can pull from the right upper abdomen into the back. The pain is usually associated with nausea and vomiting and as a complication it can lead to gang obstruction by possible gallstones.
A very special upper abdominal pain is that of acute pancreatitis (= inflammation of the pancreas). The pain is belt-shaped , can radiate to the back and typically occurs quite suddenly. Nausea and vomiting also count as concomitant symptoms. After food intake, the upper abdominal pain can even intensify, so that after the diagnosis is often the indication of the food shortage is made, as long as that it comes to a freedom from pain.
With children one should keep in mind that upper abdominal pain is not always due to organic causes, but that they are often of a psychological nature. Children like to project emotional suffering and anxiety as pain on the stomach. For example, stress can cause abdominal pain in children.