Tenderness in the Epigastrium or Central Area

CLINICAL DIAGNOSTIC MANUAL

Pain in the epigastrium or central abdomen is a clinical symptom that may indicate various gastrointestinal and vascular pathologies.

Disease	Causes	Symptoms and Signs	Diagnostic Tests
Gastritis	Inflammation of the gastric mucosa, H. pylori, NSAIDs, irritants	Epigastric pain, burning sensation, nausea, vomiting, abdominal discomfort	Gastric endoscopy to visualise the mucosa, biopsies to detect H. pylori
Duodenal and Gastric Ulcer	Mucosal erosion, H. pylori, NSAIDs	Epigastric pain, worsens with hunger, improves with food intake, heartburn, gastrointestinal bleeding	Endoscopy to visualise the ulcer and take biopsies, breath test or serology to confirm H. pylori
Pancreatitis	Inflammation of the pancreas, gallstones, alcohol	Intense epigastric pain radiating to the back, nausea, vomiting, abdominal distension	Elevated blood amylase and lipase levels, abdominal CT scan
Small Bowel Ischaemia	Reduced blood flow, embolism, arterial thrombosis	Severe epigastric abdominal pain, distension, vomiting, signs of shock	Mesenteric angiography to assess blood flow, abdominal CT scan to detect signs of ischaemia
Aortic Aneurysm Rupture	Dilation and rupture of the abdominal aorta, atherosclerosis	Severe, pulsating, and sudden epigastric pain, hypotension, shock	Abdominal ultrasound, CT scan to visualise aneurysm and confirm rupture