by Christine Bishundat
Med Ed Committee
Epigastric pain has many causes and can be characterized by different levels of pain. The epigastrium is the area in the upper abdomen that includes organs such as the stomach, pancreas, and parts of the intestine.
A 33 year old male patient comes in with complaints of epigastric pain, pointing to the location of the pain rather than describing it. For the exam, you would focus on the abdomen. Taking vital signs would be a good first step as epigastric pain could mean anything from a mild to critical condition. For example, the cause of pain could be pancreatitis or an ulcer.
If you are administering a physical exam and the patient cringes when you press down on the abdomen, it is called rebound pain. This could indicate that there is a perennial inflammation or if there is something perforated from a previous surgery. It would also be helpful to do a rectal exam. If the patient presents with blood there could be a GI bleed from a perforated ulcer, thus you would want to ask about things that contribute to peptic ulcers such as NSAID and alcohol use.
One pro tip is to have the differential diagnosis at hand to figure out during the exam what things to look out for.
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