Severe Pain in the Lower Chest and Upper Abdominal Area

CLINICAL DIAGNOSTIC MANUAL

Severe Pain in the Lower Chest and Upper Abdominal Area

Cause	Main Characteristics	Symptoms and Signs	Confirmatory Diagnostic Tests
Gastritis and Gastroesophageal Reflux	Burning pain in the epigastrium, associated with meals or stressful situations	Heartburn, acid regurgitation, abdominal discomfort	Upper gastrointestinal endoscopy to evaluate the gastric and oesophageal mucosa
Biliary Colic	Intense colicky pain in the right upper quadrant	Nausea, vomiting, pain radiating to the back	Abdominal ultrasound to evaluate the gallbladder and detect gallstones
Pancreatitis	Persistent abdominal pain, may be epigastric	Nausea, vomiting, abdominal distension, signs of shock	Blood tests (amylase and lipase), abdominal ultrasound, and in some cases, computed tomography (CT)
Acute Myocardial Infarction (Typically Inferior)	Crushing pain, a sensation of pressure or burning in the centre of the chest	Shortness of breath, sweating, pain radiating to the left arm or jaw	Electrocardiogram (ECG), cardiac enzymes (troponin), echocardiogram, and coronary angiography if necessary