Pain in epigastrium or middle upper abdomen

In the middle upper abdomen, esophagus and stomach are located. The esophagus transports food into the stomach and is actually protected by anatomical structures to ensure that the gastric acid rises into the esophagus. If this happens nevertheless, one speaks of a reflux esophagitis, which can be accompanied by heartburn and causes pain in the upper abdomen.

The most important differential diagnoses of stomach pain in this area are stomach ulcers, which can cause nausea and (bloody) vomiting. The situation becomes worse if such an ulcer perforates the stomach wall, i.e. the stomach is no longer “tight”. Stomach cancer can also cause pain in the upper abdomen, but is accompanied by weight loss, difficulty swallowing and loss of appetite.

The relatively centrally located pancreas (pancreas) can also cause pain in the middle upper abdomen as an expression of numerous different clinical pictures. In addition to acute and chronic pancreatitis (in addition to abdominal and back pain), a ruptured cyst of the pancreas or a tumor can also trigger the pain. In the area of the middle upper abdomen, the pain can still be caused by heart disease.

On the one hand, a heart attack can radiate into the upper abdomen. A heart attack can be recognized by the following very typical symptoms: severe pain, radiation into the left arm and lower jaw and a feeling of tightness in the chest. This differential diagnosis should always be taken into account in the case of epigastric upper abdominal pain, because the correct diagnosis can save lives in this case.

On the other hand, inflammation of the pericardium can also cause upper abdominal pain. In the case of pericarditis, however, the pain does not radiate into the arms. In addition to the heart, the large blood vessels can also trigger the pain.

The large vessels (e.g. abdominal aorta) can be dilated by aneurysms. Not every aneurysm is conspicuous by its symptoms. The typical complaints, however, are not only upper abdominal pain but also flank and back pain.

A dramatic emergency is the rupture of such an aneurysm because the affected person then loses a lot of blood into the abdominal cavity. This clinical picture must be treated immediately in a special clinic and still has a high mortality rate. A further clinical picture on the vessels is aortic dissection, in which the inner wall of the aorta ruptures and blood is found between different wall layers of the aorta.

Aortic dissection is expressed by a stabbing, knife-like pain, which also frequently occurs between the shoulder blades. The pulses in the arms and legs are also no longer palpable in aortic dissection. In most cases, this disease is an emergency and must be treated surgically.

The vessels of the abdominal organs can be affected by occlusion, as can the vessels around the heart or in the periphery. The ischemia that then occurs triggers a sudden very strong pain and is then followed by a pain-free interval. The thrombosis of the mesenteric veins is a very dramatic clinical picture, as one must act quickly to save the intestine.