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- W4245132605 abstract "We have arranged the differential diagnosis in order of likelihood in a man of this age with more likely diagnoses in larger font and less likely diagnoses in smaller font in Figure 12.1. Pathologies that should be excluded at the earliest possible opportunity are shown in bold. Bear in mind that this differential diagnosis refers to epigastric pain as a presentation of ‘acute abdomen’ and thus differs markedly from epigastric pain presenting as outpatient dyspepsia. Note that although we have adopted a standard approach of history, examination, and investigations over the course of the following pages, you should use clinical judgement to deviate from this path if one of the ‘must exclude’ diagnoses is suspected, or if there is a need for urgent resuscitation. For example, if a 69-year-old male diabetic patient with known unstable angina presents with exercise-induced epigastric pain, you would be wise to perform an electrocardiogram (ECG) and obtain baseline observations at the earliest opportunity. Various characteristics of the pain will help to narrow our differential diagnosis of epigastric pain: Site: • Pain that has spread from the epigastrium to involve the rest of the abdomen may suggest peritonitis from a perforated GI tract (e.g. perforated gastric ulcer, which causes epigastric pain because the stomach is embryologically a foregut structure). • Pain that has spread from the epigastrium to involve the chest may be cardiac. • Biliary disease, although anatomically located in the right upper quadrant, may present with purely epigastric symptoms. Onset: • Pain that is of very sudden onset suggests perforation of a viscus (e.g. a perforated duodenal ulcer or Boerhaave’s perforation) or myocardial infarction. • Pain from acute pancreatitis and biliary colic develops maximal intensity over 10–20 minutes. • Inflammatory processes such as acute cholecystitis or pneumonia typically take hours to reach their peak. Character: • ‘Crushing’ or ‘tightness’ qualities are typical of cardiac pathology. • Sharp, ‘burning’ pain is typical of peptic ulcers, gastritis, and duodenitis. • Deep, ‘boring’ pain is typical of pancreatitis. Radiation: • Back pain is classically associated with pancreatitis, leaking abdominal aortic aneurysms, and sometimes seen with peptic ulcers." @default.
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- W4245132605 date "2015-10-08" @default.
- W4245132605 modified "2023-09-27" @default.
- W4245132605 title "Epigastric pain" @default.
- W4245132605 doi "https://doi.org/10.1093/oso/9780198716228.003.0018" @default.
- W4245132605 hasPublicationYear "2015" @default.
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