Abdominal pain, indigestion, heartburn, and indigestion are common conditions that often manifest as nonspecific abdominal discomfort.

This pain can be associated with food intake, weight loss, minor changes in the usual bowel movement, blood in the stool, stress, or other psycho-emotional states..

Any pain or discomfort in the abdominal area is assessed according to the following criteria: duration, intensity, location, type, concomitant clinical manifestations such as nausea, vomiting, constipation, diarrhea, soreness, fever, tachycardia, bloating; the activity level of patients with severe pain, such as anxiety or inability to lie still.

Complaints of heartburn or indigestion are difficult diagnostic problems as they are often nonspecific:.

- specify the patient's complaints and symptoms;

- Perform a thorough physical examination to see if a referral to a specialist is needed.

Recurrent digestive disorders (heartburn, dyspepsia) can be associated with spicy and fatty foods, alcohol, carbonated drinks, drinking large quantities of coffee, excessive smoking, drug use, taking NSAIDs (ibuprofen, aspirin).

Differential diagnosis Differential diagnosis of abdominal pain includes the following diseases: stomach and duodenal ulcers, esophagitis, stomach cancer, pancreatitis, pancreatic carcinoma, gallbladder disease, helminthic invasion, laxative abuse, tumors of the small and large intestines.

In the differential diagnosis of chronic abdominal pain, it is necessary to take into account their localization, as well as the presence or absence of dyspepsia, intestinal disorders, and other accompanying symptoms.

Pain in the upper abdomen is usually not associated with intestinal dysfunction, but is often accompanied by signs of gastric dyspepsia. Their most common causes are gastric ulcer and duodenal ulcer, gastritis, duodenitis..

In the diagnosis of these pains, the doctor must remember one more important differential diagnostic rule - if a patient complains of pain in the epigastric region, it is necessary to exclude the pathology of the chest organs, not forgetting that the cause of pain may depend on inflammatory, vascular, tumor, metabolic-dystrophic. Based on the foregoing, one should point out the most common causes of pain in the upper abdomen.. These are angina pectoris, myocardial infarction, pericarditis, pleurisy, lower lobe pneumonia, pneumothorax.

When making a diagnosis, you should always remember about high small bowel obstruction, high and retrocecal location of the appendix.. Not quite typical signs can be observed with pyelonephritis, renal colic. With certain clinical manifestations and anamnesis data, one should not forget about the possibility of damage to the spleen..

Pain in the epigastric region can be a manifestation of diseases of the stomach (peptic ulcer, gastritis, tumor, functional dyspepsia), esophagus (diaphragmatic hernia, reflux esophagitis), sometimes biliary tract. Peptic ulcer disease is characterized by pain and soreness in a precisely defined limited area (the patient points to this place), their frequency (daily and seasonal), a clear connection with food intake.

Pain in the middle or left in the epigastric region shortly after eating is observed with localization of an ulcer in the stomach. Pain to the right of the midline, appearing on an empty stomach, at night and calming down from taking food, soda, in combination with acidism syndrome (sour belching, heartburn, vomiting with acidic contents), are characteristic of duodenal ulcer.

Non-recurrent pain, not very severe, with a predominance of dyspeptic symptoms, diffuse pain on palpation, a slightly disturbed general condition suggest chronic gastritis or functional dyspepsia.

Similar pain in the epigastric region, often constant or prolonged, pulling, pressing, with a feeling of fullness in the stomach in the elderly, accompanied by a decrease in appetite, weight loss, are highly suspicious for a malignant tumor of the stomach. Pain in the upper part of the epigastric region and heartburn, appearing or worsening while lying down and ameliorating when standing up, are characteristic of reflux esophagitis..

In diagnosing the cause of pain, careful questioning of the patient, examination of other organs and systems, the obligatory superficial palpation and deep sliding methodical palpation using the Obraztsov-Strazhesko method help.

The definition of palpation symptoms of lesions of the digestive system will also help to clarify the diagnosis (Fig.. 24), for example:.

1) Mendel's symptom - tapping fingers in the Shoffard zone - positive for duodenitis and exacerbation of duodenal ulcers;

2) Mayo-Robson symptom - pain in the left costal-vertebral angle with pancreatitis;

3) Kerte's symptom - muscle resistance and soreness over the navel with pancreatitis.

Sometimes we are talking about the soreness of only the xiphoid process (xyphodynia, xifalgia) of an incompletely clear origin.

To confirm or exclude these diseases, esophagogastroduodenoscopy with targeted biopsy and / or X-ray examination are of primary importance.. Cytological examination of biopsies is important for the diagnosis of a malignant process and the differentiation of gastritis and functional dyspepsia.. All other studies are less important.

Analysis of gastric juice is important mainly for the diagnosis of Zollinger-Ellison syndrome, in which there is a particularly high secretion and acidity of gastric juice, usually multiple ulcerative defects and a gastrin-producing tumor of the pancreas is determined. Fecal occult blood test can be positive for cancer, peptic ulcer disease and erosive gastritis.

Pain in the right hypochondrium is most often associated with pathology of the biliary tract (stones, dyskinesia, inflammation - cholangitis, cholangiocholecystitis, cholecystitis) or liver (hepatitis, cirrhosis, liver abscesses or subphrenic abscesses, metastatic liver lesions, congestive hepatomegaly), less often the colon,.

In addition to typical attacks of hepatic or biliary colic, in diseases of the biliary tract, mild unapproachable pains can be observed, and not only in the right hypochondrium, but also in the epigastric region, often with irradiation to the back and under the scapula, as well as dyspeptic symptoms. These pains, unlike peptic ulcer disease, are usually provoked not just by food, but by the intake of a certain type of food (fatty, gas-forming).

medbe. ru.