The Epigastralgia Is an acute or chronic pain that is located in the epigastrium, that is, in that area of the abdomen that begins in the initial part of the sternum - the"mouth"of the stomach - and ends near the navel (see illustration below).
The epigastrium, in turn, is divided into three regions where this condition can occur: a superior ( epigastrium , Worth the change), a mean ( Mesogastrio , also called umbilical ) And an inferior one in the belly ( Hypogastrium ).
symptom
Epigastralgia has symptoms that depend on the specific pathology that causes it, but abdominal pain is the most common of them, which can be accompanied by nausea, vomiting, constipation, diarrhea, flatulence (compressed gases in intestinal and body cavities) And lack of stool at the time of evacuation.
In all cases it is well known that, as has already been said, the discomfort is felt more intensely in the epigastrium.
Causes
It is very important to emphasize that epigastralgia does not have a cause but many, which can be classified in two groups: the abdominals, which occur in the abdomen and involve mainly organs of the digestive system (esophagus, stomach and pancreas, for And the extra-abdominal muscles, which are located in the thorax and therefore have to see the organs of the circulatory and respiratory systems (eg, heart, lungs).
Both in abdominal and extra-abdominal causes there are a number of possible pathologies that result in this pain in the epigastrium. Some of them are:
- Abdominal Causes: Oesophagitis, hiatal hernia, ulcers, gastritis, pyloric stenosis, appendicitis, Crohn's disease, pancreatitis, biliary lithiasis, hepatomegaly, etc.
- Extra-Abdominal Causes: Myocardial infarction, pericarditis, osteochondritis, intercostal neuralgias, etc.
Epigastralgia, thus, manifests itself in several diseases. The only accurate and unambiguous way of determining what causes this pain is through the most modern diagnostic tools used by modern medicine.
Diagnosis
The diagnosis of epigastralgia can be made in three ways: by anamnesis, by physical examination and by complementary examinations. The first method compiles all clinical data of the patient that can serve to deal with the causes of the problem.
Data, of course, are often written in your medical history and therefore indicate if you have related cases in your family and other risk factors that need to be taken into account.
With the second method, a physical study of the patient is made both in the abdomen and outside it; The examination, therefore, is done by looking, touching and listening to the human body, in search of abnormalities.
Something similar is done with the third and last method, in which highly specialized, precise and rigorous tests are carried out with the aim of detecting those anomalies that escape the analysis mentioned previously.
The methods of diagnosis of epigastralgia are intimately related to each other, in order to obtain the highest possible precision of the patient and his state of health. Following the brief definitions just explained, each of them, applied one after another and in that order, increases in complexity and therefore in the amount of information, as well as in its level of objectivity when passing through a Medical evaluation.
Therefore, epigastralgia is diagnosed more specifically in this way:
- Anamnesis: In this step, the primary thing is a kind of interview in which the patient provides certain basic but important information, such as sex, age, food, previous surgical operations, recent trips, family history, medications that he habitually takes and even if he smokes or drinks alcohol. Also, the patient should tell the doctor how, where, when and how often the pain occurs, and if there is something that improves or worsens, such as the intake of a substance or vomiting.
- Physical exploration: In this step an exploratory study is made in the patient's body, both in the abdomen and outside the abdomen, especially the circulatory, nervous and respiratory systems. The vital signs (temperature, heart pulse, blood pressure, respiratory rate) are taken for irregularities. Then a more detailed observation is carried out which inspects with attention the striking aspects that occur during the pain. The area affected by touch (palpation and percussion) or by ear (auscultation) is also analyzed.
- Additional tests: In this step the clinical picture of the patient is analyzed with more rigor, because they use here instruments of high precision that clear any doubts that have left the anamnesis and the physical exploration. Laboratory tests, X-rays, advanced imaging studies (electrocardiogram, Computed axial tomography , Echocardiography and ultrasound, among others) and endoscopy serve to rule out or check for the presence of diseases that can cause this abdominal pain.
Treatment
There is no specific or unique treatment for epigastralgia, since everything will depend on what is causing it and the results obtained in the clinical diagnosis.
There is everything here, from changes in the patient's diet and abandonment of certain bad habits to the consumption of drugs of various kinds, such as paracetamol. Whatever the case, only the doctor has the authority to decide what steps will be taken to alleviate this pathology.
References
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- Kapural, Leonardo (editor, 2014). Chronic Abdominal Pain: An Evidence-Based Comprehensive Guide to Clinical Management . Berlin Germany. Springer.
- LeBlond, Richard; DeGowin, Richard and Brown, Donald (2004). DeGowin's Diagnostic Examination (8th ed.). New York, USA. McGraw-Hill Professional.
- Medical Gross Anatomy. Abdominal Viscera Basics [Web page] (2002). Michigan, United States. University of Michigan, Medical School. Accessed January 25, 2017, at: med.umich.edu.
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- Viniol, Annika; Keunecke, Christian Et al (2014). "Studies of the abdominal pain-a systematic review and meta-analysis". Family practice , 31 (5), pp. 517-29. Available at: fampra.oxfordjournals.org.
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