Epigastric and Right Subcostal Pain

Pain in the upper central part of the abdomen called the epigastrium, can be caused by various pathologies in numerous organs. Answering mode, duration of pain, its increase or serving in certain circumstances, as well as directions of the spread may indicate that the body is affected by pathological process. A wide range of disorders in various organs can give epigastric pain of changes in the stomach and duodenum (gastritis, peptic ulcers, tumors) over a pathological condition of the gallbladder (nephrolithiasis), colon, pancreas. Epigastric pain may in some cases be a sign of myocardial infarction. A feeling of discomfort or mild epigastric pain is the main symptom of functional dyspepsia. A large number of patients with hiatal hernia and gastroesophageal reflux disease in the presence of heartburn and regurgitation states and presence of epigastric pain. Therefore, a detailed history in terms of time and process of the pain, its intensity, duration and expansion may lead doctors to suspect about whom the primary cause of pain is about.

The most common cause of epigastric pain dyspepsia, gastritis and peptic ulcer disease existence, or ulcers of the stomach or duodenum. In duodenal ulcer pain classically occurs in the epigastrium, often after food, milk or medicines. The most important characteristic of this pain is that they are intense 2-3 hours after a meal or during sleep. This type of pain is worse after food intake, irritants or spicy foods, which leads to fermentation (tomatoes, hot sauce, fried foods, onions, slack-test or raw fruit). The pain tends to return, and painful episodes in patients with duodenal ulcer may be periodically present several weeks or months. Changing quality of the pain, especially when it becomes constant, with inability to be reduced by drugs that inhibit gastric acid secretion, suggests ulcer complications, mainly in terms of its penetration into the surrounding organs.

The gastric ulcer pain is less distinctive and characteristic, than in patients with duodenal ulcer. It u sually appears to the left of the abdominal middle line. After food intake in these patients, the pain does not stop, but even enhances, and the medication do not have the same effect as in duodenal ulcers.

Acute inflammation of the gall bladder, which is most commonly caused by the presence of stones is manifested by sudden onset of epigastric pain, and under the right rib cage. It is characteristic that this pain usually spreads to the back, to the right shoulder blade and is often accompanied by nausea and vomiting. Acute inflammation of the pancreas is characterized by strong, constant epigastric pain, which is usually propagating as a wider band (ring) in the back and is usually accompanied by nausea and vomiting. Often the significant information that is preceding excessive pain, is intake of greasy meal or alcohol.

Given the multitude of causes that can cause pain in epiagstrijumu or below the right rib cage, the diagnosis is not easy. Epigastric pain like any other pain is a protective mechanism, or represents a warning signal indicating that a patient needs to see the doctor, which will define specific diagnostic methods to determine its cause and initiate appropriate treatment.
According to the famous British surgeon John Hilton “every pain has a specific and important meaning, if we are persistent enough to find its cause.” Pain can be defined as an unpleasant sensory and emotional experience caused by actual or potential tissue damage or dysfunction of organs. Although basically unpleasant experience, the pain was a great friend of the patient and the warning signal, because it forces you to see the doctor, often indicate where the pathological process, contributes to the early diagnosis, and enables timely decision about the treatment, which is invaluable especially in critical cases.



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