You are called to the ward because a male patient is complaining of epigastric abdominal pain.
- What are your initial steps?
The approach to abdominal pain in a patient should always begin with a history and physical exam.
- Onset pain, provoking/palliating factors, quality, severity, radiation, past episodes of similar pain
- Review patient chart for past medical history and information on current admission
- Physical exam
- Vitals – HR, RR, BP, T, SpO2
- Cardiac exam – r/o cardiac etiology
- Resp exam – r/o respiratory etiology
- Abdo exam + DRE
- What is your differential diagnosis?
Epigastric pain is foregut pain or foregut vascular pain until proven otherwise. The differential diagnosis includes:
- Esophageal – esophagitis
- Gastric – Gastritis, peptic ulcer
- Pancreatic – pancreatitis
- Biliary – biliary colic, cholecystitis, cholangitis
- Cardiac – pericarditis, MI (epigastric pain from a cardiac etiology is considered atypical angina, and is rare in male patients, yet more common in women. This can also be seen more commonly in diabetics)
- Respiratory – pneumonia, PE
- Vascular – abdominal aortic aneurysm, mesenteric ischemia
Cartwright SL and Knudson MP. Evaluation of Acute Abdominal Pain in Adults. American Family Physician. 2008, 77:971-978.