Upper abdominal pain and nausea
introduction
Upper abdominal pain and nausea can related to very many different clinical pictures occur. Some of them are harmless and others pose an acute threat to those affected. That is why it is important that Abdominal pain and the nausea to examine closely and to be considered in connection with side effects. The upper abdominal pain can be as acute pain occur or over a longer period of time occur in connection with other circumstances, so chronic be. Acute pain are mostly from a Irritation of the peritoneum, Circulatory disorders and the Digestive tract motility accompanied. Depending on the intensity and general symptoms, a decision can be made between conservative and surgical therapy.
Organs of the upper abdomen
There are many different organs in the upper abdomen. First of all, of course Organs of the digestive tract. The End of the esophagus (Esophagus) goes in this area into the stomachwhich ends in the small intestine. A Part of the colon is also in this area above the stomach. But also other digestive organs, like that liver or the pancreas (pancreas) is associated with the upper abdomen.
In addition, these are heart and large vessels of the abdomen also connected to the upper abdomen and in the event of injuries and diseases of these organs, the pain is transmitted to the upper abdomen. Also the Kidneys lie in the upper part of the abdomen. This list shows how many organs or different structures can be responsible for pain in the upper abdomen or nausea. One can Divide the upper abdomen into three regionswho have it facilitate a correct diagnosis to ask: the right upper abdomen, an area in the center and the left upper abdomen.
Pain in the upper right abdomen
In the area of the right upper abdomen, the biliary tract is most frequently involved in the epigastric pain. Many people unknowingly suffer from gallstones, which over time can trigger biliary colic. Women with families who have a high-fat diet and regularly consume alcohol are most commonly affected. The stones obstruct the bile duct and the bile builds up in the gallbladder and triggers colic and attack-like pain in the right upper abdomen, which can even radiate into the right shoulder. If this obstruction of the bile ducts occurs frequently and over a long period of time, an inflammation of the gallbladder (acute cholecystitis) occur, which is also very painful. In contrast to biliary colic, this pain is persistent and a fever occurs.
Patients with gallstones often undergo an operation to remove the gallbladder to prevent complications such as gallbladder perforations, fistulas, and chronic inflammation of the gallbladder or pancreas. Associated with the bile duct system is the liver, which is also located in the upper right abdomen.The hepatitis can also cause upper abdominal pain with nausea, but the symptoms of jaundice (yellow skin and sclera, dark urine, discolored stool) often occur. The liver can also fail as a result of hepatitis or poisoning. Pain in the right upper abdomen can also be caused by a liver tumor or liver abscess. An emergency develops rapidly with a ruptured liver tumor. Very rarely is the liver of parasites (Echinococcosis), which are responsible for the upper abdominal pain.
In addition, the pain in the right upper abdomen can also be triggered by the intestines. On the one hand, appendicitis can radiate into the upper abdomen and manifest itself there painfully accompanied by a fever. On the other hand, a carcinoma can grow in the colon flexure in the right upper abdomen, which is responsible for the pain. Furthermore, diseases of the urinary system, such as stones in the kidney or ureter or inflammation of the renal pelvis, can trigger right-sided (and left-sided) upper abdominal pain.
If the urinary system is affected, the pain may also appear in the back. There is also blood in the urine and pain in the flank area. But the pain in the upper abdomen is not always triggered there in the organs of the abdominal cavity. In some cases, organs of the chest are also responsible. Pneumonia (pneumonia) or inflammation of the skin of the lungs (pleurisy) can be responsible for upper abdominal pain, but are accompanied by fever and breath-dependent pain, which makes it easier to differentiate. The heart can also cause epigastric pain on the right side. If the right heart fails, the pain can extend to the right upper abdomen, because the blood backs up to the liver. With this clinical picture, water retention also occurs.
Epigastric or middle upper abdominal pain
in the middle upper abdomen come Esophagus and stomach to lie. The esophagus transports food to the stomach and is actually responsible for it through anatomical structures protected, that the Stomach acid rises up into the esophagus. If this happens anyway, one speaks of one Reflux esophagitisthat of heartburn can be accompanied and trigger epigastric pain. The main differential diagnoses of the stomach if there is pain in this area Stomach ulcers, the Nausea and vomiting (bloody) can trigger. The situation is worsened when such an ulcer is the stomach wall perforated, so the stomach is no longer "tight".
Also a Gastric cancer can trigger upper abdominal pain, but goes hand in hand with it Weight loss, difficulty swallowing, and loss of appetite. The relatively centrally located pancreas (pancreas) can also trigger pain in the middle upper abdomen as an expression of numerous different clinical pictures. Besides the acute and chronic inflammation of the pancreas (in addition to stomach and back pain) can also be a burst cyst the pancreas or a tumor trigger the pain.
In the area of the middle upper abdomen, the pain can continue from Heart disease go out. For one, a Heart attack radiate into the upper abdomen. A heart attack can be recognized by the following very typical symptoms: extreme pain, radiation in the left arm and lower jaw and tightness in the chest. This differential diagnosis should always be considered in the case of epigastric upper abdominal pain, because the correct diagnosis can save lives here. On the other hand, a Inflammation of the pericardium Trigger upper abdominal pain. At a Pericarditis (Pericarditis) the pain does not radiate into the arms.
Next to the heart come those too large vessels trigger pain in question. The large vessels (e.g. abdominal aorta) can through Bulges, so-called Aneurysms be extended. Not every aneurysm is noticeable by symptoms. The typical complaints but are also next to the upper abdominal pain Flank and back pain. A dramatic emergency is the Rupture of such an aneurysm because the victim then loses a lot of blood to the abdomen. This clinical picture must treated immediately in a special clinic and still has a high mortality rate.
Another clinical picture of the vessels is Aortic dissectionwhere the Tears in the inner wall of the aorta and there is blood between different wall layers of the aorta. The aortic dissection pushes through one stabbing, knife-prick pain from that too often between the shoulder blades occurs. The Pulse on the arms and legs are also with an aortic dissection no longer palpable. This disorder is one in most of the cases emergency and have to surgically supplied become. The vessels of the abdominal organs can, like the vessels in the heart or in the periphery, from one Clasp be affected. Which then occurring ischemia triggers a sudden very severe pain off and then followed by a pain-free interval. The Mesenteric vein thrombosis is a very dramatic clinical picture because you have to act quickly to save the intestine.
Left upper abdominal pain
Some The cause of left upper abdominal pain can also trigger pain in the central or right-hand part at the same time. That count: lung infection (pneumonia), Inflammation of the lung membrane (pleurisy), Urinary stones (Urolithiasis), Pelvic inflammation (Pyelonephritis), acute and chronic pancreatitis (Pancreatitis), Pancreatic cancer, Pancreatic cysts and a Aortic aneurysm.
Overall, however, there are left-sided upper abdominal pain much rarer than right-sided or epigastric discomfort. Especially with the left side is that spleen connected. Sudden pain, the breath dependent occur and radiate into the left shoulder can through a Splenic infarction to be triggered. Stepping after trauma Ruptures of the spleen which also trigger pain in the left upper abdomen and through a Shock symptoms impress. There is also another part of the Colon in the left upper abdomen, the Attacked by a tumor and can therefore be painful.
Back pain
In addition to upper abdominal pain, some diseases also trigger back pain, which is usually the case due to the anatomical position of the organs is. They are in close association with the back and the spine Kidneys, as Result of a urinary tract infection as Pelvic inflammation for example, may be inflamed and painful. Kick at the same time Nausea, vomiting, and fever on. But also Diseases of the pancreas (Inflammation, tumor) can trigger back pain in addition to upper abdominal pain. In addition, the Gallbladder (Inflammation, gallstones, etc.) be responsible for back pain. As already mentioned shine also acute diseases of the vessels (mostly emergencies) in the back and cause back pain.
Vomit
Upper abdominal pain, nausea and vomiting join most often Gastrointestinal infections on that by Bacteria, viruses or spoiled food caused. The stomach can also be overloaded by meals that are too large and the feeling of fullness can be expressed in the above-mentioned symptoms. Similar to Irritable bowel syndrome the stomach can also be called Irritable stomach act and react sensitively to psychological sensitivities.
Questionable the vomiting will however when in the vomit To find blood is or the vomit discolored black is then most likely one Source of bleeding in the stomach or intestines is to be found. In addition to the gastrointestinal tract, the Liver responsible for epigastric pain, nausea and vomiting be: Inflammation of the liver (hepatitis), Biliary colic, acute liver failure. A Inflammation of the pancreas can also be noticeable through the symptoms already mentioned. A serious illnessthat must also be dealt with immediately is the Intestinal obstruction (Ileus). The ileus is calling worst abdominal pain, nausea and vomiting and must be treated.
diarrhea
If the Abdominal pain accompanied by diarrhea will come first Intestinal infection or inflammation into consideration. Lots Diarrheal diseasesthat are triggered by viruses or bacteria self-limiting, that means they disappear again by themselves. Care should be taken during illness that enough liquid because the diarrhea causes the body to lose a lot of fluid.
If behind the Occurrence of diarrhea and the stomach ache certain pattern or one regularity is recognizable should be investigated whether not one Food intolerance present (lactose, fructose, glucose, etc.). A further clinical picture in which upper abdominal pain is accompanied by diarrhea is the Inflammation of the pancreas. Psychological causes, such as emotional stress or fear, can trigger abdominal pain and diarrhea (irritable bowel syndrome).
heartburn
The Key symptom "heartburn" describes a burning, painful feeling behind the breastbonethat can rise up to the throat. Often this occurs along with heartburn Eructation which is felt to be extremely uncomfortable. Often, heartburn occurs with the so-called Reflux disease (Reflux esophagitis) where the Stomach acid rises up into the esophagus and thereby trigger the pain. The lining of the esophagus is covered by the strongly acidic pH stomach acid irritated and attacked.
At increased activity of the bowel and weak sphincter muscles of the stomach can also be a Backflow of secretions from the small intestine Trigger heartburn. But eructation is rather bilious here. Also through Food or drink gastric acid reflux can occur. Especially fatty, acidic or spicy foods or drinks trigger reflux, which occur more frequently when lying down can.
The heartburn will too caused by addictive substances such as alcohol, coffee or nicotine. Before heartburn is treated with medication, it should be tried through Changes in eating habits to be regulated. A Therapy with proton pump inhibitors aimed at the Inhibits acid production in the stomach. It is important to get the reflux under control permanently, otherwise the esophagus will be damaged too much and even the growth of ulcers is possible.
pregnancy
At the beginning of pregnancy is the Nausea is a side effect of hormonal changes and des altered metabolism. Especially in first trimester so are nausea and vomiting quite normal. Through the pregnancy hormones progesterone and estrogen is the entire muscles more relaxed, which makes heartburn and reflux more common during pregnancy. In addition, dmoves the growing child in the womb the others Abdominal organs upwards. As a result, upper abdominal pain can also occur after meals during pregnancy. The stretching of the stomach is restricted, which is why it is advisable to eat smaller meals.
Upper abdominal pain can occur in pregnancy too triggered by child movements and kicks become. Of course everyone can other diseases also come into consideration as a cause of the upper abdominal pain and should therefore clarified by the doctor become. Any medication should, however, be checked to ensure that it is harmless to the unborn child. Upper abdominal pain can also occur during pregnancy Expression of a serious complication, the so-called HELLP syndrome be. The symptoms include Pain in the upper right abdomen as a result of liver dysfunction, but also unspecific syndromes such as Nausea, vomiting, diarrhea, headache and blurred vision. The latter symptoms also occur with the Preeclampsia Pregnancy Emergency (Edema, proteinuria, hypertension). With HELLP syndrome, on the other hand, that is Blood and blood clotting changes in the pregnant woman and the liver function is severely restricted. The HELLP syndrome is a serious emergency in gynecology, as 3-5% of women and up to 40% of children die from it.
fatigue
Fatigue and upper abdominal pain can after Consumption of particularly heavy meals occur because the stomach needs a lot of energy to digest this meal. But many people also react to Food intolerance with unspecific symptoms and fatigue. Fatigue can also be a Expression of liver disease be. At malicious processes are symptoms of how Fatigue, exhaustion and weight loss often observed as accompanying complaints.
After eating
Are upper abdominal pain and nausea in connection with food intake to bring and above all to observe afterwards comes one Inflammation of the stomach lining or Inflammation of the pancreas as a cause. Closely associated with post-food pain Diseases of the biliary tract, as a Gallstone in the gallbladder, for example. Only rarely solve Food intolerance Upper abdominal pain. Most of the time then kick cramping abdominal pain in the lower part of the abdomen, the caused by flatulence and disappear by going to the toilet. If no causes can be found even through imaging procedures, a possible psychosomatic origin of the symptoms should be clarified.
Diagnosis
The doctor will try one before examining Working diagnosis through the anamnesisto establish a conversation between patient and doctor. Then the Belly viewed, palpated and with the stethoscope auscultatedto check if abnormal noises can be found. Furthermore, the Body temperature, of the Pulse, Blood pressure and the Blood sugar checked. When a Imaging is necessary is that Ultrasonic the first choice for quickly establishing a diagnosis. Depending on the illness, you can then still X-ray examinations or one CT be requested. By a Examination of the blood important knowledge can also be obtained. In addition to the classic blood count, you can also specific enzymes for the respective organs are examined, which provide information about the health of the organs.
Summary
Many diseasesthat cause epigastric pain and nausea no dramatic developments and can go through simple therapeutic measures get under control. At sudden onset of severe pain and shock symptoms should especially urgently consulted a doctor or hospital become. The distinction between non-life-threatening and life-threatening diseases can be made quickly by a doctor in that he gets information about the patient in a conversation and makes a sonographic imaging of the abdomen. Important is at acute epigastric pain always one Rule out a heart attack by having a EKG makes and the Blood values checked. In some cases, other imaging tests such as X-rays or CT are needed. The therapy for the upper abdominal pain depends on the individual illness.
