Upper abdominal pain / discomfort or dyspepsia may be due to conditions affecting oesophagus, stomach, duodenum, gallbladder, bile duct, liver or pancreas. Dyspepsia is not typically related to intake of food.
When accompanied by other features such as nausea, weight loss, lethargy, jaundice etc., alarm should be raised, and referral for expedient work-up be made. Infrequently, the colon, abdominal aorta or spine may be the site of pathology. From the clinical history, the likely cause of pain is usually apparent, such as a bleeding ulcer or gallstones flatulence.
Clinical examination is helpful for differential diagnoses (eg. hepatomegaly suggests hepatocellular carcinoma), and in directing the investigations. Whilst empirical treatment such as anti-acid for presumed gastritis will usually be effective, recurrent or progressive symptoms warrant further work-up. The various procedures or imaging involved in the initial evaluation of dyspepsia or reflux may include some of the following. Common conditions which may be diagnosed are outlined.
Once the cause of the abdominal pain is found, treatment is relatively standard. For e.g., proton pump inhibitor and antibiotics are used for ulcer related to helicobacter pylori infection. It is important to appreciate that common conditions typically respond well to treatment. Hence when symptoms persist or worsen in spite of treatment, further clinical examinations and tests or procedures may be required. Some patients may in fact have functional disorders, which would require longer periods of treatment and monitoring.
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