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Epigastric pain

  • Common ddx

    • GERD, gastritis, PUD
  • Don't miss

    • pancreatitis, MI, AAA, aortic dissection, stomach cancer
  • Labs

    • LFTs if nausea, vomiting
    • EKG if suspect cardio
    • CXR if suspect dissection
    • rehydration if vomiting, diarrhea
    • biopsy if suspect cancer
  • Other ddx

    • esophageal spasm, pericarditis, DKA
  • ROS

    • quality of pain (drilling, tearing, hunger-like)
    • radiation to back
    • alleviation (antacids, position)
    • reflux
    • nausea, vomiting, diarrhea, blood in stool
    • dysphagia
    • dyspnea
    • substernal chest pain
    • weight loss
    • EtOH
    • PMH diabetes
  • Px

    • distention, guarding
    • bowel sounds
    • palpation: tenderness, rebound tenderness, mass

  • Print | Citations

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