Diagnostics
1 First, the doctor will take a detailed pain history to narrow down the possible causes of upper abdominal pain: How strong is the pain (0-10)? How is the pain (dull or sharp)? Where is it strongest?
Where does it radiate? Is the pain permanent? Does the intensity fluctuate?
Since when does it exist? Was there a trigger for the pain? In which situations is the pain particularly strong?
What relieves or aggravates the pain? Are there other symptoms? 2. the physical examination follows: inspection (viewing): attention is paid to bulges, skin changes, scars and hernias.
Auscultation (listening): Are the bowel sounds normally present? Percussion (tapping): Is there air or fluid in the abdomen? Palpation (palpation): Are hardenings to be palpated?
The situation is particularly threatening if there is a defensive tension in addition to the abdominal pain. This means if the abdomen is “hard as a board” during the examination. In this case a doctor should be consulted immediately.
Rectal examination (palpation of the anal region): In the case of abdominal pain, the rectum is often palpated, e.g. to identify bleeding as the cause of the abdominal pain. 3) Blood samples are taken to find indications of inflammation and disturbed organ functions (liver, kidney, pancreas, heart). Women with abdominal pain should also always have a pregnancy test performed.
4 In case of upper abdominal pain, an ECG should always be used to rule out a heart attack. 5) Ultrasound, X-ray or computer tomography are used to immediately detect or rule out acutely life-threatening clinical pictures. 6. further examinations: Gastroscopy, colonoscopy, imaging of the bile ducts (ERCP), etc.
- How strong is the pain (0-10)?
- How is the pain (dull or sharp)?
- Where is it strongest? Where does it radiate to?
- Is the pain permanent? Does the intensity fluctuate?
- How long has it existed?
Was there a trigger for the pain? In which situations is the pain particularly strong?
- What relieves or aggravates the pain?
- Are there any other symptoms?
- Inspection (viewing): Attention is paid to protrusions, skin changes, scars and hernial orifices.
- Auscultation (listening): Are the bowel sounds normal?
- Percussion (tapping): Is there air or fluid in the abdomen?
- Palpation (palpation): Is it possible to palpate hardenings? The situation is particularly threatening if there is a defensive tension in addition to the abdominal pain.
This means if the abdomen is “hard as a board” during the examination. In this case a doctor should be consulted immediately.
- Rectal examination (palpation of the anal region): In the case of abdominal pain, the rectum is often palpated, e.g. to identify bleeding as the cause of the abdominal pain.
In order to be able to treat upper abdominal pain adequately, the cause must always be clarified first. In particular, it is important to immediately detect or rule out life-threatening diseases in order to decide whether, for example, surgery is necessary immediately. Urgent indication for surgery: perforation of a hollow organ or aortic aneurysm, intestinal infarction, ruptured spleen Not acutely requiring surgery: aortic aneurysm (as long as there is no risk of rupture), diaphragmatic hernia, inflammation of the gallbladder/ gallstones, abscesses Conservative treatment with temporary abstinence from food or a light diet already leads to an improvement in most other causes of upper abdominal pain. In addition, the following therapeutic principles, among others, are applied: Acid blocker for inflammation of the stomach/esophagus
- Urgent indication for surgery: perforation of a hollow organ or aortic aneurysm, intestinal infarction, ruptured spleen
- Not in acute need of surgery: aortic aneurysm (as long as there is no danger of rupture), diaphragmatic hernia, gall bladder inflammation/ gallstones, abscesses
- Conservative treatment with temporary food abstinence or a light diet already leads to an improvement for most other causes of upper abdominal pain.
- Antibiotic administration in case of inflammation (pancreatitis, diverticulitis)
- Acid blocker for inflammation of the stomach/esophagus
- Special therapy with cortisone for chronic inflammatory intestinal diseases
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