Abdominal Pain in the Upper Abdomen

CLINICAL DIAGNOSTIC MANUAL

Abdominal pain in the upper abdomen encompasses a wide range of potential causes, from gastrointestinal conditions to cardiovascular pathologies. The following Table 1 outlines specific causes of this type of pain, including gallstones, acute cholecystitis, acute pancreatitis, acute cholangitis, gastric carcinoma, gastritis, oesophagitis, hiatal hernia, and acute coronary syndrome.

Condition	Causes	Symptoms and Signs	Confirmatory Diagnosis
Gallstones	Formation of stones in the gallbladder, usually due to concentrated bile.	Right upper quadrant abdominal pain, nausea, vomiting, pain after fatty meals.	Abdominal ultrasound visualises gallstones.
Acute Cholecystitis	Acute inflammation of the gallbladder, often secondary to obstruction by stones.	Severe right upper quadrant abdominal pain, fever, nausea, and positive Murphy’s sign on physical examination.	Abdominal ultrasound shows gallbladder inflammation and the presence of stones.
Acute Pancreatitis	Acute inflammation of the pancreas, typically related to excessive alcohol consumption or pancreatic duct obstruction.	Persistent upper central abdominal pain, nausea, vomiting, and signs of shock in severe cases.	Elevated blood amylase and lipase levels, along with abdominal CT, confirm pancreatitis.
Acute Cholangitis	Infection of the bile ducts, often secondary to obstruction.	Abdominal pain, fever, jaundice, and signs of sepsis.	Magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) are key for visualising the obstruction.
Gastric Carcinoma	Malignant growth in the stomach.	Persistent epigastric abdominal pain, unexplained weight loss, dysphagia, and vomiting blood in advanced stages.	Gastric endoscopy with biopsies confirms the presence of cancer.
Gastritis	Inflammation of the stomach lining, often related to Helicobacter pylori infection or nonsteroidal anti-inflammatory drug (NSAID) use.	Epigastric abdominal pain, nausea, vomiting, and a feeling of fullness.	Gastric endoscopy allows visualisation of inflammation and biopsy collection.
Oesophagitis	Inflammation of the oesophagus, usually due to chronic acid reflux.	Retrosternal pain, especially after meals, difficulty swallowing, and heartburn.	Oesophageal endoscopy and pH monitoring confirm the presence of oesophagitis.
Hiatal Hernia	Displacement of the stomach into the chest through the oesophageal hiatus.	Epigastric or retrosternal pain, heartburn, and regurgitation.	Endoscopy and imaging studies, such as barium X-ray, can confirm hiatal hernia.
Acute Coronary Syndrome	Reduced blood flow to the heart, including acute myocardial infarction.	Pressing chest pain, which may radiate to the left arm, jaw, or back, accompanied by sweating, nausea, and shortness of breath.	Electrocardiogram (ECG) shows characteristic changes, and cardiac biomarkers in the blood confirm acute coronary syndrome.