What to do if you experience a dull pain in the stomach? What diseases cause pain in the epigastric region? Other types of pain starting with the letter "e"

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Stomach pain- These are pain sensations that are constant or paroxysmal in nature. Most often they are localized at the site of projection stomach on the anterior abdominal wall. This area is called the epigastric, or epigastric. It is located above an imaginary horizontal line that can be drawn through the navel. The part of the anterior abdominal wall, which is located directly in the center of the abdomen, and is limited by this line from below, and by the costal arch of the chest from above - is the area into which pain in the stomach is projected.

In addition, pain due to pathologies of the stomach can spread to the fourth intercostal space on the left, or to the left side under the stomach.

Causes of stomach pain

Pain in the stomach can be caused by diseases of the stomach itself, as well as pathologies of other organs and systems human body. The main question in this case is which organ disorders caused pain in the epigastric region. Qualified diagnostics can only be carried out professional doctor. Therefore, if you experience abdominal pain, it would be unwise, and sometimes even dangerous, to diagnose yourself and begin self-medication.

The best solution would be to consult a specialist. Its necessity is due to the fact that pain in the abdomen, which does not occur at the site of the projection of the stomach onto the anterior abdominal wall, most likely indicates a pathology of other organs. In this case, we recommend that you read our other articles on abdominal pain. But even if the pain is localized specifically in the epigastric region, it is still not necessarily caused by stomach diseases.

All causes of stomach pain can be divided into two large groups:
1. Pain in the stomach area caused directly by its pathology.
2. Pain in the stomach area due to damage to other organs.

The first group includes the following pathological conditions and diseases:

gastritis;
stomach ulcer;
stomach polyps;
stomach cancer;
viral and bacterial infections;
functional disorders of the stomach;
damage to the gastric mucosa;
food poisoning;
emotional and physical stress;
individual intolerance of some food products and allergies.

The second group includes the following diseases:

pancreatitis;
pathologies of the small intestine;
pathologies of the large intestine;
inflammation of the appendix;
diseases of the cardiovascular system;
diaphragm spasm.

Pain caused by stomach lesions

Pain in the stomach with gastritis

In patients with chronic gastritis, stomach pain is usually not very intense. For this reason, the patient may not pay attention to them at all for a long period of time. Pain in chronic gastritis with preserved secretory function of the stomach is often dull and aching.

It will be important to pay attention to the connection between pain and food intake, as well as the nature of the food taken. Usually with chronic gastritis there is enough early appearance pain - actually immediately after eating, especially in cases where the food is sour or has a rough consistency. These so-called early pains can provoke the patient to develop fear before eating. Such patients sometimes begin to refuse food.

In addition to pain, patients with chronic gastritis often experience a feeling of heaviness and fullness in the epigastric region.

Other local symptoms chronic gastritis:

heaviness, a feeling of pressure and fullness in the epigastric region, which arises or intensifies during or immediately after eating;
belching and regurgitation;
unpleasant taste in the mouth;
burning in the epigastrium, and sometimes heartburn, indicating a violation of the evacuation of food from the stomach and the reflux of gastric contents back into the esophagus.

To those listed symptoms signs of intestinal damage in the form of defecation disorders may occur. They are episodic in nature, but often become the basis for the development of irritable bowel syndrome.

General disorders in chronic gastritis are manifested by the following symptoms:

weakness;
increased fatigue;
irritability;
disorders of the cardiovascular system in the form of pain in the heart, instability of the heart rate, fluctuations in blood pressure;
drowsiness, pallor and sweating that occur after eating;
burning and pain in oral cavity and on the tongue;
symmetrical sensory disturbances in the upper and lower extremities.

Abdominal and stomach pain due to peptic ulcer

The main symptom of a stomach ulcer is pain in the epigastric region. The intensity of pain due to an ulcer can vary within a fairly wide range. Therefore, it is very difficult to judge this disease only by this characteristic of pain. For example, it is known that in patients who have undergone gastric surgery, pain even during exacerbations of peptic ulcer disease is very mild or absent altogether.

At the same time, in some cases, pain syndrome with peptic ulcer stomach pain can also have a fairly high intensity, forcing the patient to immediately take measures to alleviate his condition.

A more informative indicator is the connection of this pain with food intake. With a gastric ulcer, pain does not occur as quickly as with gastritis, but no later than an hour and a half after eating. Another symptom characteristic of peptic ulcer disease is its relapsing course, that is, alternating periods of exacerbations (usually in autumn or spring) and periods of remission.

In addition, the following manifestations are characteristic of stomach ulcers:
1. Frequent heartburn and belching of sour contents.
2. The occurrence of nausea and vomiting after eating.
3. Loss of body weight.

A dangerous symptom is a sharp, sharp, stabbing or cutting pain in the stomach, which is also called “dagger”. It may indicate perforation of the organ wall by an ulcer, that is, the formation of an opening through which gastric contents enter the abdominal cavity. In such conditions, the pain intensity is so high that the patient may develop pain shock. This is a life-threatening condition, so such a patient should be immediately taken to the hospital for emergency treatment. surgical intervention.

Aching and dull pain in the stomach with polyps

Polyps in the stomach are a fairly rare disease. As a rule, they are practically not determined by any specific signs or symptoms. In most cases, a polyp is diagnosed accidentally - during examinations for other reasons. But in some cases, the presence of a polyp may be indicated by a dull, It's a dull pain in a stomach. In addition, they can manifest as painful sensations when pressing on the abdomen, as well as bleeding, nausea and vomiting.

Constant stomach pain due to cancer

Gastric cancer is one of the most common cancers. One of their signs is mild, weak, but constantly occurring pain in the stomach. In addition, patients suffering from stomach cancer often note that the appearance of pain is not related to any specific causes.

If stomach pain occurs against the background of high physical or neuropsychic stress, possibly combined with nausea, vomiting or diarrhea, then this indicates stress gastralgia (stomach pain), and in such a situation it is necessary to contact psychotherapist (make an appointment), psychiatrist (make an appointment) or a neurologist. However, if for some reason it is impossible to get to these specialists, then it is recommended to contact a gastroenterologist or therapist.

If, soon after eating, a person develops spasmodic pain in the stomach, combined with nausea, vomiting, diarrhea, headache, dizziness and severe weakness (even fainting), then this indicates food poisoning, and in this case it is necessary to contact infectious disease doctor (make an appointment).

If spasmodic stomach pain is combined with diarrhea and vomiting, then this indicates a viral or bacterial intestinal infection, and in this case you should consult an infectious disease doctor.

If pain in the stomach appears against the background of pneumonia or sore throat, accompanied by nausea, vomiting or diarrhea, then you should contact pulmonologist (make an appointment)/therapist or otolaryngologist (ENT) (make an appointment).

If a person has been constantly experiencing mild pain in the stomach, combined with a deterioration in appetite, belching, heartburn, a feeling of fullness in the stomach after eating a small amount of food, anemia, an aversion to meat, a feeling of discomfort in the stomach, possibly vomiting “coffee grounds” or blood and melena (black feces), then this may testify about malignant neoplasm, in which case you should contact oncologist (make an appointment).

What tests and examinations can a doctor prescribe for stomach pain?

First, we will look at what tests and examinations gastroenterologists can prescribe for stomach pain caused by diseases of the stomach, intestines and pancreas. Then we will consider what tests and examinations doctors can prescribe for stomach pain that is not directly related to pathology of the stomach, intestines or pancreas, but is caused by a malignant tumor, bacterial or viral infection, pneumonia, sore throat, chemical poisoning, food poisoning, stress , allergies, appendicitis, dissection abdominal aorta, coronary heart disease or diaphragm spasm.

So, for stomach pain of various nature, combined with a variety of symptoms and arising due to diseases of the stomach, intestines and pancreas, gastroenterologists can prescribe the following tests and examinations:

General blood analysis ;
General urine analysis ;
Biochemical blood test (urea, creatinine, cholesterol, triglycerides, bilirubin, AST, ALT, LDH, alkaline phosphatase, amylase, lipase, etc.);
Scatological analysis of stool (including Gregersen's reaction to occult blood);
Stool analysis for dysbacteriosis (sign up);
Fecal analysis for helminths (worms);
Analysis for the presence of Helicobacter pylori (sign up)(For example, urease test (sign up), determination in a piece of stomach tissue taken during gastroscopy, etc.);
Ultrasound of organs abdominal cavity(sign up);
Intragastric pH-metry (sign up);
Electrogastroenterography (allows you to evaluate the motility and activity of movements of the stomach and intestines);
Esophagogastroduodenoscopy;
Colonoscopy (make an appointment);
Sigmoidoscopy (
For example, if it is suspected that stomach pain is caused by gastritis, then gastroscopy, ultrasound of the abdominal organs, pH-metry and analysis for the presence of Helicobacter pylori are prescribed. If a disease of the pancreas is suspected, then ultrasound, endoscopic retrograde cholangiopancreatography and biochemical blood tests are limited. The examination may be supplemented with computed tomography. If an intestinal disease is suspected, then sigmoidoscopy, colonoscopy, plain X-ray, and irrigoscopy are prescribed. Computed tomography in this case is not very informative, since the intestine is hollow organ, and tomography does not provide clear images of such structures containing gases in their lumen. When a functional disorder of the stomach or intestines is suspected (irritable bowel syndrome, etc.), electrogastroenterography is prescribed, which allows one to evaluate the entire range of movements of these organs. Histological examination biopsy is prescribed only after endoscopy (sign up) when suspicious lesions of cancer were discovered in the stomach, esophagus or intestines.
However, you need to know that if you suspect any disease of the stomach, intestines or pancreas, you must be prescribed general analysis blood test, general urine test, biochemical blood test, stool test for helminths, scatological stool test and ultrasound of the abdominal organs.
When pain occurs due to physical activity, mental stress or stress, and is localized either behind the sternum, extending into the stomach, or simultaneously both behind the sternum and in the stomach, combined with shortness of breath, a feeling of interruptions in the heart, weakness, swelling of the legs and a forced sitting position, the doctor suspects coronary heart disease and prescribes the following tests and examinations:
sign up) ;
Myocardial scintigraphy (sign up);
Coronary angiography (sign up);
Transesophageal electrocardiography.

If coronary heart disease is suspected, the doctor immediately prescribes all the tests on the above list with the exception of coronary angiography, scintigraphy and transesophageal electrocardiography, since they are used only as additional methods examinations when the necessary information about the condition of the heart and the whole body cannot be obtained using simpler, primarily used methods.

When pain in the stomach area of a sharp shooting nature appears with deep breath or a rapid change in posture after a long stay in bent position or the presence of an infectious-inflammatory process in the body, goes away after a light warm-up, then a spasm of the diaphragm is suspected, and in this case the doctor performs a manual examination and examination without using instrumental methods diagnostics (in such a situation they are not needed). Thus, during examination, with spasm of the diaphragm, movement of the shoulders and back is noted, as well as retraction of the abdomen during breathing. That is, during breathing, the chest takes a limited part in the act of inhalation and exhalation, and these acts occur due to the lowering and raising of the entire shoulder girdle. During a manual examination, the doctor feels the tense muscles with his hands, determining the level of their mobility and restrictions of movement.
, strawberries). First of all, the doctor prescribes a general blood test and an analysis for IgE concentration, as this is necessary to determine whether it is a true allergy or a pseudo-allergy, which manifests itself with almost identical symptoms, but the approach to its treatment and further examinations are somewhat different.

So, if it is found in the blood increased amount eosinophils and the concentration of IgE is higher than normal, this indicates that the person has a true allergic reaction. After this, a determination is made of the product to which the person is allergic, using skin testing or the method of determining the concentration of specific IgE in the blood. Usually, one method is chosen to determine a person’s sensitivity to food antigens - either skin tests or the concentration of specific IgE in the blood, since they provide the same range of information, but the former are cheaper, and the latter are more expensive and more accurate. Therefore, if you have the financial opportunity, you can donate blood to determine the concentration of specific IgE, but you can limit yourself to simpler and cheaper skin tests, since their accuracy is quite high.

If blood tests do not reveal an increase in the level of IgE and the number of eosinophils, then we're talking about about a pseudo-allergic reaction, which is caused by diseases digestive tract. In this case, allergy tests to determine sensitivity to food allergens by any method are not performed, but examinations are prescribed to diagnose diseases gastrointestinal tract.

When stomach pain develops against the background of high physical or neuropsychic stress, possibly combined with nausea, vomiting or diarrhea, stress gastralgia is suspected, and in this case the doctor prescribes a general blood test and esophagogastroduodenoscopy to exclude possible true stomach diseases. Other tests are not prescribed, since this is not necessary - the diagnosis is obvious from the characteristic clinical picture.

If spasmodic pain in the stomach appears soon after eating, combined with nausea, vomiting, diarrhea, headache, dizziness and severe weakness to the point of fainting, then food poisoning is suspected, and the doctor prescribes bacteriological culture feces, vomit, gastric lavage, remains of a contaminated product to determine the type of bacteria that caused the poisoning. Additionally, a blood test may be prescribed to determine the presence of antibodies to various microbes that cause food poisoning using ELISA, RIF and PCR (sign up). In addition, if the symptoms of poisoning are similar to appendicitis, the doctor will prescribe a general blood test and an ultrasound of the abdominal organs. Other examinations for food poisoning are usually not prescribed, since this is not necessary.

When, for a long period of time, a person is constantly bothered by mild pain in the stomach, combined with a decrease in appetite, belching, heartburn, a feeling of fullness in the stomach after eating a small amount of food, anemia, an aversion to meat, a feeling of discomfort in the stomach, possibly vomiting “coffee grounds” or blood and melena (black stool), then it is suspected malignant tumor, and in this case the doctor prescribes the following tests and examinations:

General blood analysis;
General urine analysis;
Blood chemistry;
Coagulogram (blood clotting test) (sign up);
Fecal occult blood test;
Gastroscopy (sign up);
X-ray of the stomach with a contrast agent;
Ultrasound of the abdominal organs;
X-ray of the lungs (sign up);
Multislice computed tomography;
Positron emission tomography;
Histological examination of a piece of tissue taken during a biopsy.

Usually all of the listed examinations and tests are prescribed, as this is necessary to clarify the location, size, nature of tumor growth, as well as the presence of metastases in other organs and nearby lymph nodes.
Before use, you should consult a specialist.

Pain in the stomach area, i.e. in the epigastric (or epigastric) region, located under the xiphoid process and the corresponding projection of the stomach onto the anterior wall of the peritoneum, are a symptom large quantity various diseases and conditions, including diseases of the stomach, heart, lungs, liver, pleura, spleen, duodenum, bile ducts, pancreas; they can also be one of the signs of vegetative-vascular disorders and neurological diseases.

Signs that characterize pain are:

Her character;
Intensity level;
Localization;
Cause of occurrence;
Irradiation of pain (the degree of its prevalence from the source of occurrence);
Duration;
Frequency of occurrence;
Association with additional factors (for example, food intake or defecation, changes in body position, physical activity, etc.);
the influence of various medicines;
The emotional effect it causes (aching, cutting, stabbing, pressing, throbbing, burning, piercing pain, etc.).

The intensity of pain can vary from mild pain to the development of a state of pain shock (for example, with perforation of an ulcer). However, the intensity of pain cannot be a criterion for assessing the nature of the disease, since this factor is purely individual and is determined by the personal perception of pain (pain threshold).

The nature of the pain may indicate not only specific disease, but also allows us to identify possible complications. For example, people suffering from gastritis in chronic form and having a reduced secretory function, in most cases complain of a feeling of heaviness and fullness in the epigastric region. A feeling of fullness is also one of the characteristic signs of pyloric stenosis. In cases where cholecystitis, pancreatitis or colitis is associated with the disease, intense pain may occur. If the secretory function in chronic gastritis remains within normal limits, the resulting pain is usually dull and aching. With a stomach ulcer, sharp, contraction-like pain may occur. Duodenal ulcers and chronic duodenitis in the acute stage are accompanied by cutting, cramping, stabbing and sucking pains. Extremely intense pain, which can also result in painful shock, occurs when ulcers perforate.

At certain diseases there is a clear connection between the occurrence of pain in the epigastric region and food intake (especially if the food is spicy, coarse, fatty, sour). The pain can be early or late. Early ones usually occur after eating fairly rough foods (for example, marinades, plant foods, brown bread), late ones - after eating food characterized by a high degree of alkaline buffering (for example, boiled meat, dairy products). In some cases (with duodenitis or duodenal ulcer), pain may occur at night or on an empty stomach. As a rule, the patient's condition is facilitated by eating soft and liquid food or soda. Most often, pain in this category of patients is associated not with food intake, but with an increase in the level of physical activity or neuro-emotional overload.

Difficulties in tracing the cause-and-effect relationship between the occurrence of pain and any other factors arise in cases where the patient develops a malignant tumor in the stomach.

Causes of epigastric pain

The main causes of pain in the epigastric region are the following diseases: gastritis, polyps in the stomach, peptic ulcer (both stomach and duodenum), functional dyspepsia, gastritis, duodenitis, gastroesophageal reflux disease, malignant tumor in the stomach.

In addition, they can be triggered by the following factors:

binge eating;
increased abdominal muscle tone;
constipation;
indigestion;
increased physical activity;
diseases caused by a viral or bacterial infection (this pathology is usually called gastroenteritis or “intestinal flu”;
in this case, pain in the stomach area is usually accompanied by vomiting, nausea, abdominal muscle spasms, diarrhea);
food poisoning (manifested by abdominal pain and diarrhea);
appendicitis (pain is constant and accompanied by tension in the lower abdomen);
diseases of the reproductive system;
diseases of the urinary system;
damage to the cardiovascular system;
diaphragm spasm;
diseases of the gastrointestinal tract;
food allergies (for example, those resulting from lactose intolerance after eating milk and milk-based products);
psychogenic factor (stomach pain caused by this factor is most often observed in children, this syndrome is often called “school phobia”, it is characterized by the fact that the pain is of emotional origin and is caused by fear, quarrels, conflicts in the family, etc.);
stressful situations;
pregnancy (usually pain in the epigastric region that occurs in women during pregnancy is associated with changes and instability of their hormonal levels, increased sensitivity to infections and allergenic substances);
smoking;
excessive consumption of alcoholic beverages;
poisoning with heavy metals, mercury preparations, acids, alkalis.

Pain that accompanies diseases of the gastrointestinal tract occurs as a result of impaired motor skills and is a consequence of spasm or stretching. This creates ideal conditions for the occurrence of pain: the intensity of tonic contractions of fibers increases smooth muscle walls of the stomach, and the evacuation of its contents slows down significantly.

At inflammatory diseases stomach and duodenum are characterized by the occurrence of pain even due to minor changes in the motor function of these organs, to which the body healthy person I wouldn't react at all.

Pain in the stomach area, resulting from spasm or stretching of the walls of the duodenum and stomach, as well as ischemic disease affecting their mucosa, is called visceral pain. They are constant dull radiating pains that occur along the midline of the abdomen.

Treatment of epigastric pain

Pain in the epigastric region is a symptom that cannot be ignored. Before eliminating it, however, careful preliminary diagnosis and identifying the exact cause that caused it, since, as noted earlier, pain in the stomach can be the result of a fairly large number of different diseases.

Pain syndrome in the epigastric region is one of the most common signs a large number of abdominal pathologies and extra-abdominal diseases. Taking into account its features (nature, intensity, provoking circumstances, irradiation, factors favoring reduction or elimination) and additional clinical manifestations accompanying the occurrence of pain provides maximum information in terms of diagnosis various pathologies, occurring with pain, which seems important for adequate treatment of the patient. It is equally important to take into account the above circumstances to assess the mechanism of pain, and therefore its appropriate treatment.

Distinguish visceral, parietal (somatic) And irradiating (reflected) abdominal pain.

Visceral pain associated with irritation of nerve endings and occurs due to spasm of smooth muscles (spastic pain) or sprains (distension pain) hollow digestive organs, capsule stretching parenchymal organs, ischemia of the abdominal organs (vascular pain) or mesenteric tension.

Spastic and distensional pain may be based on organic tissue damage or a disorder neurohumoral regulation motor activity hollow organs.

Vascular (ischemic) pain is associated with restriction of blood flow in the abdominal organs due to spasm or vascular obstruction (atheromatous plaques, thrombus, compression).

Parietal (somatic) pain arise due to irritation of the nerve endings of the parietal peritoneum due to an aseptic inflammatory process (autoimmune genesis, metastasis cancerous tumor along the peritoneum), chemical irritation of the peritoneum (gastric and pancreatic secretions, due to pancreatic necrosis).

Referred (referred) pain occurs with visceral or parietal (somatic) pain as a result of the presence of proximity in spinal or thalamic centers afferent pathways innervation of the affected organ and the area to which the pain radiates. The appearance and stabilization of this pain can be caused by a decrease in the pain perception threshold, caused by a deficiency in the body of serotonin, norepinephrine, endorphins, enkephalins, and the characteristics of higher nervous activity and the psychological status of the patient.

One of the most common causes of epigastric pain is diseases of the stomach and duodenum.

Pain when peptic ulcer more often it is relatively local, often radiating to the back or the heart area. Persistent radiating pain in the back can occur when a duodenal ulcer penetrates into the pancreas. When the ulcer is localized in the cardiac region and lesser curvature of the stomach, pain appears or intensifies 15-20 minutes after eating, and when localized in the area of the greater curvature of the stomach - after 30-45 minutes, in the antrum of the stomach and duodenum - after 1-1. 5 hours after that. In the latter case, the pain subsides soon after eating and resumes or intensifies on an empty stomach, at night, in the autumn-spring period, after excitement and negative emotions.

With severe pain syndrome, vomiting can be observed, after which the pain usually subsides, unlike other diseases of the digestive system, when after vomiting the pain does not disappear, and may even intensify (chronic pancreatitis, cholecystitis, cholelithiasis, etc.).

Pain significantly decreases or disappears when peptic ulcers of the stomach and duodenum are complicated by bleeding, after using antacids.

Increased pain in the epigastric region with a peptic ulcer can be caused by eating juiced food (meat and fish broths, jellied meat, hot herbs and spices, juicy meat cooked by immersing it in hot water).

It should be noted that there is a possible reduction in pain due to peptic ulcers after drinking alcohol, which is apparently associated with its analgesic effect, but later these pains recur or even intensify to a greater extent. Similar effect often observed after smoking a cigarette.

The presence of peptic ulcer disease in close relatives is often stated.

During severe pain due to gastric and duodenal ulcers, patients can take a forced position, unlike biliary and renal colic, in which they exhibit motor restlessness.

With superficial palpation of the epigastric region above the area where the ulcer is located, resistance is determined, and with deep palpation in patients with pyloroduodenal ulcer - a painful cord.

The previously described pain under the xiphoid process as a manifestation of duodenal ulcer in the light of modern possibilities of using endoscopic technology, apparently, signals the presence of esophagitis(With high probability- with erosive changes in the esophagus). With concomitant belching and heartburn, this pain may be associated with gastroesophageal reflux disease (GERD). Although there is complete parallelism between morphological changes in the esophagus and clinical manifestations not observed in patients with GERD.

A marked increase in pain may be accompanied by ulcer perforation into the abdominal cavity (“dagger” pain). In this case, there is local rigidity of the abdominal wall muscles, an increase in body temperature, leukocytosis in the blood and an increase in ESR.

At pyloric stenosis due to peptic ulcer pain is usually late in relation to food intake. They are often combined with increased gastric peristalsis and may be accompanied by late vomiting of food eaten long ago.

Pain when chronic gastritis in contrast to local peptic ulcers, on the contrary, diffused in the epigastrium, occurs or intensifies soon after eating, especially eating coarse, spicy and thermally non-indifferent food, usually without irradiation. It is often accompanied by heaviness in the epigastrium after eating and nausea. The presence of vomiting gives reason to suspect concomitant erosive changes. The diagnosis of chronic gastritis is considered proven when corresponding changes are detected in a biopsy sample of the gastric mucosa.

At functional (non-ulcer) gastric dyspepsia epigastric pain appears or decreases after eating and can be on an empty stomach, without irradiation. It is often accompanied by a burning sensation (heat) in the epigastric region, as well as postprandial distress syndrome (a feeling of fullness in the epigastrium after eating and early satiety, not proportional to the volume of food eaten). In this case, there are no morphological changes in the stomach.

For chronic duodenitis pain is localized in right half epigastric region, it appears 2-3 hours after eating, especially eating rough, spicy food, and can radiate to left hypochondrium. However, unlike a duodenal ulcer, superficial palpation does not reveal local resistance in the right half of the epigastric region, and with deep palpation, the spastic state of the pyloroduodenal region is less likely to be detected.

With a combination of chronic gastritis and chronic duodenitis, which is observed quite often, during their exacerbation, initially, soon after eating, diffuse pain appears in the epigastric region, which does not disappear, as with isolated gastritis, 1-1.5 hours after eating, but remains and is concentrated mainly in the right half of the epigastrium (in pyloroduodenal zone) and sometimes in the upper left quadrant of the abdomen.

Epigastric pain due to acute gastritis usually often combined with nausea and vomiting, fever, chills, enteric syndrome (bloating, rumbling, pain in umbilical region, diarrhea with undigested food residues).

At stomach cancer Epigastric pain is usually a late symptom. It can become permanent, worsening after eating, especially eating spicy and rough foods, and is often combined with nausea and vomiting that does not bring relief, lack of appetite, weight loss, aversion to meat foods, and loss of interest in life.

Gastric polyposis may also be accompanied by the appearance of epigastric pain, mainly soon after eating. Unlike chronic gastritis, most patients have less pronounced dyspeptic disorders.

For such rare disease, How acute dilatation stomach, characterized by intense “bursting” pain in the upper abdomen. They are accompanied by profuse vomiting, bloating of the upper abdomen and significant prolapse lower limit stomach. The patient's general collapsed state is noted.

At gastric volvulus due to its acute twisting, often in patients with stomach in the form of hourglass, severe pain appears in the epigastrium, which is accompanied by vomiting, bloating and tension in the upper abdomen.

At strangulated diaphragmatic hernia pain appears suddenly under the xiphoid process and can radiate to the left shoulder and back.

Cardiospasm characterized by the presence of pain behind the sternum and in the upper part of the epigastric region with possible irradiation into the interscapular space, a feeling of swallowed food getting stuck behind the sternum.

For acute and chronic pancreatitis pain is localized in the middle part of the epigastric region and the upper part of the left half of the abdomen with irradiation to the back, under the left shoulder blade, to the heart area. They intensify after eating, especially eating fatty, fried, smoked foods, and baked goods. There is pain on palpation in the projection areas of the pancreas (PG). In this case, the pain may radiate to the back.

At pancreatic tumors with localization in its head, the pain is little expressed, in contrast to its localization in the body and tail of the pancreas, when there is constant severe pain in the left half of the epigastrium and the upper part of the left half of the abdomen with irradiation to the back. Tumors of the head of the pancreas are often combined with jaundice with a gray-green tint, discolored stools and itchy skin.

Large tumors and pancreatic cysts often accompanied by bursting pain in the epigastric region and the upper part of the left half of the abdomen, asymmetrical, dense when palpated, protrusion in this area. Two characteristic signs are detected: transmission pulsation of the aorta and pain on palpation, radiating to the back, shoulders, spleen area and left costal arch.

At liver diseases(hepatitis, cirrhosis, hepatocarcinoma), accompanied by its increase, there is often bursting pain in the upper epigastrium and right hypochondrium, often radiating to the right half of the chest and under the right scapula. They can intensify after physical activity, drinking alcohol, spicy, fatty and fried foods.

Pain due to cholecystitis, localized in the right half of the epigastrium, intensifies soon after eating, especially fatty, fried, spicy, spicy foods, radiates to the right half of the chest, right shoulder, under the right shoulder blade. The involvement of pain in the inflammatory process in gallbladder(GB) can be verified by the presence of positive symptoms of Kehr, Murphy, Ortner, Georgievsky - Musi, thickening of the wall of the gallbladder > 4 mm according to ultrasound.

About availability pericholecystitis may indicate the appearance or intensification of pain in the right half of the epigastric region in a position on the left side, with sudden movements, shaking, or shaking the body.

Gallstone disease (GSD) can “declare” itself with attacks of severe pain in the right half of the epigastric region (biliary colic) with irradiation to the right half of the chest, right shoulder, under the right shoulder blade. They can be provoked by the same factors as with cholecystitis.

Functional disorder (dysfunction) of the gallbladder may manifest as pain in the right half of the epigastric region and the right upper quadrant of the abdomen. This pain can be associated with the specified diagnosis according to the criteria of the III Rome Consensus, provided normal indicators liver enzymes (ALT, AST), conjugated bilirubin, amylase and lipase in the blood, eliminating the influence of medications taken on the motility of the gallbladder, structural changes in it (according to ultrasound), organic pathology of the esophagus, stomach and duodenum (according to endoscopy), IBS, the presence of cholesterol crystals (microlithiasis) or calcium bilirubinate granules in a freshly extracted portion of gallbladder bile during duodenal intubation and when cholescintigraphy or transabdominal ultrasound reveals disturbances in gallbladder emptying when stimulated by intravenous infusion of cholecystokinin or food intake (ejection fraction< 40 %).

It should be borne in mind the possible localization of pain in the epigastric region for the first 2-3 hours during acute appendicitis with its subsequent concentration in the right iliac region.

Pain in the epigastric region may occur with thrombosis in the system portal vein . It is usually accompanied by signs of portal hypertension.

It is well known that pain may be concentrated in the epigastric region during myocardial infarction (status gastralgicus). The involvement of pain in the epigastric region in this disease may be indicated by the presence of other signs of myocardial infarction (falling blood pressure, the appearance of arrhythmias, signs of heart failure, increased body temperature, leukocytosis, increased ESR, etc.).

Causal relationship of pain in the epigastric region with aortic aneurysm may be suspected based on the detection of intense pulsation in the specified area. In this case, the pain is not associated with eating and usually radiates to the back.

At ischemic abdominal syndrome (AIS), which is more often observed in older people, pain in the epigastric region due to ischemic gastropathy is often aching, mainly after eating (at the height of digestion), and to a greater extent its severity depends not on the quality, but on the quantity of food taken. Pain is often accompanied by heaviness in the epigastrium, gastrointestinal bleeding is possible due to erosive and ulcerative lesions of the gastroduodenal section, concomitant cardiovascular pathology(IHD, hypertension, myocardial infarction, atherosclerosis of the lower extremity vessels). In most of these patients, a painful and pulsating abdominal aorta is determined by palpation, systolic murmur in the area of the projection of the abdominal aorta 3-4 cm below the xiphoid process in the midline. In AIS verification important role belongs to Dopplerography of the abdominal aorta and its branches.

Epigastric pain may occur with dry pleurisy, especially with localization in the basal regions of the lungs. In this case, the pain may intensify with deep inspiration and coughing.

It is necessary to keep in mind the possible involvement of epigastric pain in the presence hernia of the white line, myositis of the rectus abdominis muscles. In the latter case, the pain intensifies when you try to raise your legs while lying on your back.

Pain in the epigastric region may occur with thyrotoxic crisis starting diabetic coma, Addison's disease, poisoning with nicotine, lead, morphine, tabes dorsalis(tabetic crises), intercostal neuralgia.

The connection of the above pathology with pain in the epigastric region determines the ways of their correct treatment.

The characteristics of epigastralgia presented above for different pathological conditions, undoubtedly, can help clarify its cause, and therefore, determine adequate approaches to its elimination. The main thing in this case is the treatment of the disease that caused epigastric pain. At the same time, it is necessary to take into account modern capabilities pharmacotherapy of pain syndrome, taking into account its mechanism in each specific situation.

In case of acute abdominal pain, accompanied by symptoms of peritoneal irritation and/or gastrointestinal bleeding, the patient should be examined by a surgeon to decide whether surgical intervention is necessary.

If the need for surgical treatment is excluded, the issue of diagnosis is resolved using the necessary laboratory and instrumental research methods. Taking into account the most likely diagnosis, treatment is prescribed, which, in particular, should include measures to relieve pain. They are aimed at counteracting the mechanisms involved in the formation of pain in each specific case.

With a spastic mechanism of pain, it is possible to prescribe M-anticholinergics or myotropic antispasmodics.

Non-selective M-anticholinergics, along with suppressing the tone and peristaltic activity of smooth muscles, suppress nausea and vomiting, and inhibit the secretory activity of the stomach. The latter weakens the irritation of ulcers and erosions by hydrochloric acid and pepsin. Thus, M-anticholinergics help reduce pain through a dual mechanism. However, non-selective M-anticholinergics have numerous side effects due to systemic action (dry mouth, impaired accommodation, increased intraocular pressure, tachycardia, atony Bladder and urinary retention, atonic constipation, headaches, dizziness, increased gastroesophageal reflux, impaired gastric emptying, etc.). Therefore, the use of M-anticholinergics is contraindicated in glaucoma and obstructive diseases urinary tract, hernia hiatus diaphragm, GERD, hypokinetic dyskinesia of the intestine, bladder. Selective anticholinergics have almost no effect on the motility of the gastrointestinal tract, which limits the advisability of their use for the relief of spastic pain.

Among myotropic antispasmodics, it is possible to use drugs from the group of phosphodiesterase inhibitors (papaverine, drotaverine - no-shpa), slow channel blockers (pinaverium bromide - dicetel, otilonium bromide - spasmomen) and sodium channel blockers (mebeverine - duspatalin). The latter causes relaxation of spasmodic smooth muscles, but does not affect intestinal motility and biliary tract. It should be noted that the antispasmodic effect of slow channel blockers is more pronounced in comparison with phosphodiesterase inhibitors.

You should also keep in mind the presence of an antispasmodic effect in some choleretic drugs, indicated for the treatment of patients with chronic cholecystitis with hypermotor dyskinesia of the gallbladder (gepabene, gimecromon - odeston, holagogum, holagon).

Natural (contrical, gordox, trasylol, etc.) and artificial (epsilon-aminocaproic acid, pentaxyl, etc.) protease inhibitors help reduce the pain syndrome caused by pancreatitis by inhibiting the activity of the kallikrein-kinin system. As a result of slowing down the synthesis of bradykinin, swelling of the pancreas and, in connection with this, pain syndrome are reduced.

Suppression of pain in patients with pancreatitis can be facilitated by the use of pancreatic enzyme preparations before meals with a sufficient content of proteases and without an acid-resistant coating in combination with the use of antisecretory agents (to prevent inactivation of pancreatic enzymes by hydrochloric acid). An alternative can be preparations of pancreatic enzymes with an enteric coating, which quickly and easily dissolves in the duodenum at pH 5.5-6.0. The drug Creon meets these requirements. Use of the specified medicines provides by mechanism feedback inhibition of pancreatic secretory activity (inactivation of cholecystokinin-releasing peptide by proteases leads to a decrease in the synthesis of cholecystokinin, which stimulates exocrine activity and the synthesis of pancreatic enzymes).

To reduce pain in patients with pancreatitis, it is important to eliminate spasm of the sphincter of Oddi by using nitrates, myotropic antispasmodics and anticholinergics, which improves the outflow of pancreatic secretions and, thus, helps eliminate pain.

For ischemic pain, nitrates (isosorbide mononitrate, isosorbide dinitrate), calcium antagonists, antiplatelet agents, low molecular weight heparins (fraxiparin) are indicated.

In patients with acid-related diseases (GERD, peptic ulcer stomach and duodenum, functional gastric dyspepsia, Zollinger-Ellinson syndrome, etc.) it is possible to relieve pain by reducing acid-peptic activity with H2 blockers and especially inhibitors proton pump(IPP).

In terms of their final effect in comparable doses, all PPIs are approximately the same. Their differences relate mainly to the speed of onset and duration of the acid-lowering effect, which is due to their pH selectivity, interaction with other simultaneously taken drugs that are metabolized in the cytochrome P450 system. In this regard, IPPs deserve attention, in which the best way combines price and efficiency. Among them is the drug lansoprazole, which at a dose of 30 mg inhibits the production of hydrochloric acid by approximately 80-97%. The drug has 4 times greater anti-Helicobacter activity compared to omeprazole. The minimum dose of lansoprazole inhibiting acid production is 4 times less than that of omeprazole. In terms of the speed and persistence of inhibition of the acid-producing function of the stomach, affinity for cytochrome P450 isoenzymes and predictability of the effect, lansoprazole is second only to rabeprazole. Lansoprazole reliably provides optimal clinical effect in acid-related diseases. It is well tolerated by patients, side effects are rare.

As a means emergency care For short-term relief of pain caused by acid-peptic activity, non-absorbable antacids (Maalox, phosphalugel, etc.) can be used.

In patients with chronic pancreatitis, novocaine (0.25% 100-200 ml intravenously) can be used to reduce the severity of pain. It inhibits the activity of phospholipase A 2 and reduces the tone of the sphincter of Oddi. If pathogenetically based drugs are insufficiently effective in eliminating pain, severe and persistent pain in patients with excluded acute abdominal pathology requiring surgical intervention, the use of analgesics (paracetamol, metamizole, tramadol, etc.) is justified.

Correction of pain in diseases of the digestive system can be facilitated by following the indicated therapeutic diets, short-term hunger and cold on the pancreas during exacerbation of pancreatitis.

Psychotherapy and pharmacotherapeutic correction of the states of anxiety, depression, and psychosomatization that often accompany this pain can also help reduce the severity of chronic abdominal pain (transformation of emotional overstrain into bodily sensations) .

Gastritis of autoimmune origin. In this case, the gastric mucosa suffers from increased aggressiveness immune system. It begins to work against the cells of the body, and not against foreign microorganisms. Mucosal cells are destroyed, resulting in the development of inflammatory process. Discomfort in the epigastric region in the form of heartburn and dull pain is typical.

Pancreatitis - inflammation glandular tissue pancreas. In this case, the pain is girdling, accompanied by nausea and vomiting. Occurs most often after eating. If the head of the pancreas is affected, the pain is in the epigastrium on the right, if the tail is on the left. The pain has a boring, burning character.

Purulent peritonitis is inflammation of the peritoneum. Infection most often occurs from some other internal organ. Pain in the epigastrium is sharp, intensifying, and fever is noted. Nausea and vomiting do not make you feel better; the muscles of the anterior abdominal wall are tense all the time.

Hiatal hernia - through the dilated chest cavity shifts lower section esophagus. When acidic stomach contents enter the esophagus. Epigastric pain, bloating and cramps. Intra-abdominal pressure increases.

Acute appendicitis is inflammation of the appendix, the blind intestinal appendage. In this case, acute pain is located both in the epigastric region and below. On the left there is slight muscle tension and pain when palpated.

Acute duodenitis is inflammation of the mucous membrane of the duodenum. In addition to epigastric pain, nausea, vomiting and weakness are noted. It usually develops against the background of acute inflammation of the stomach and intestines.

Perforation of an ulcer of the posterior wall of the stomach - the occurrence of a through defect in back wall stomach with the release of contents into the abdominal cavity. The pain in the epigastric region is sharp, “dagger-like”, the muscles of the abdominal wall are painful and tense. The slightest movement increases the pain.

Other reasons

The causes of pain in the epigastric region can be quite commonplace. For example, constipation or food poisoning. Pain may also be associated with dysfunction of other internal organs, in addition to the digestive organs.

With myocardial infarction, pain in the epigastrium is acute, radiating to the heart and the area of the shoulder blades. Also in this area for pyelonephritis, inflammation of the kidney tubules. Also with left-sided pneumonia.

Renal colic occurs due to obstruction of urine flow. Characterized by cramping pain. The attack begins suddenly and is not associated with physical activity. The pain is excruciating and acute, and cannot be relieved by anything.

Pleurisy is an inflammation of the pleura covering the inner surface of the sternum and lungs. Chest pain radiates to the epigastric region. Worsened by coughing. The body temperature rises, the patient feels a loss of strength. Respiratory mobility of the lungs is limited.

Vomit is a complex reflex act associated with excitation of the vomiting center of the brain, which occurs when various changes external environment(sickness, bad smell) or the internal environment of the body (infections, intoxications, diseases of the gastrointestinal tract, etc.).

Causes:

The following are the causes of vomiting.
1. Infectious:
bacterial intoxication (salmonella, clostridia, staphylococcus, etc.);
viral infections (viral hepatitis, rotavirus, calicivirus).
2. Diseases of the central nervous system (infections, increased intracranial pressure, vestibular disorders).
3. Pathology endocrine system(hyperthyroidism, diabetes mellitus, adrenal insufficiency).
4.
Pregnancy.
5. The influence of drugs (aminophylline, opiates, cardiac glycosides, cytostatics, etc.).
6. Intestinal obstruction (intussusception, adhesions, strangulated hernia, volvulus, foreign body, Crohn's disease).
7. Visceral pain (peritonitis, pancreatitis, myocardial infarction, cholecystitis).
8. Neurogenic factors.
9. Other factors (poisoning, burns, acute radiation sickness).

Vomiting is not specific symptom damage to the gastrointestinal tract. Vomiting reflex caused by many factors.

Vomiting of nervous origin is associated with organic diseases brain and its membranes, cerebrovascular accident.
In addition, it can occur due to irritation or damage vestibular apparatus, eye diseases, feverish conditions. Psychogenic vomiting develops when psychosomatic diseases or acute emotional disorders.

Vomiting can be a manifestation of irritation of the mucous membranes of internal organs - the stomach, intestines, liver, gall bladder, peritoneum, internal genital organs in women, kidney damage, as well as irritation of the root of the tongue, pharynx, pharynx. In addition, the vomiting center may be affected by various infections and intoxication (bacterial toxins and own toxic substances, accumulating in severe pathology of the kidneys, liver or deep metabolic disorders for endocrine diseases). Vomiting is characteristic of toxicosis in the first half of pregnancy (vomiting of pregnancy).

It may appear as a symptom of drug overdose or hypersensitivity the body to them, as well as when taking incompatible medications.

Symptoms of vomiting:

In most cases, vomiting is preceded by nausea, increased salivation, and rapid, deep breathing.
Consistently, the diaphragm descends, the glottis closes, the pyloric part of the stomach contracts sharply, the body of the stomach and the lower esophageal sphincter relax, and antiperistalsis occurs.

Spastic contraction of the diaphragm and abdominal muscles leads to an increase in intra-abdominal and intragastric pressure, which is accompanied by the rapid release of gastric contents through the esophagus and mouth to the outside. Vomiting, as a rule, occurs against the background of pale skin, increased sweating, severe weakness, rapid heartbeat, decreased blood pressure.

Differential diagnosis:

Vomiting often accompanies many infectious diseases. Moreover, it can be one-time during the manifestation of the disease, as, for example, with erysipelas, typhus, scarlet fever, or longer and more persistent (intestinal infections, food poisoning). Moreover, it is accompanied by other common infectious manifestations: fever, weakness, headache. It is usually preceded by nausea.

Vomiting with meningitis has a special place - it has a central genesis. Vomiting of central origin occurs when the brain and its membranes are damaged, is not associated with food intake, is not accompanied by previous nausea, and does not alleviate the patient’s condition. As a rule, there are other signs of pathology of the central nervous system.

At meningococcal meningitis a triad of symptoms is known: headache, meningeal signs(rigidity occipital muscles) and hyperthermia. An important sign is the occurrence of vomiting without preceding nausea against the background of severe headache and general hyperesthesia.

When the vestibular apparatus is damaged, systemic dizziness occurs in combination with vomiting. With Meniere's disease, there may be both nausea and vomiting with concomitant hearing loss and frequent dizziness. With intracranial hypertension syndrome, vomiting often occurs in the morning, against the background of a sharp headache, and is provoked by turning the head, changing the location of the patient’s body in space.

Vomiting during migraine also occurs against the background of headache, but at its peak, it somewhat alleviates the patient’s condition, and can be one or two times. Vomiting during a hypertensive crisis is combined with headache and occurs with a significant increase in blood pressure. Against the background of a hypertensive crisis, with a significant increase in headache, repeated vomiting may appear without preceding nausea, which is a threatening symptom of a developing hemorrhagic stroke.

Vomiting when endocrine diseases- enough common symptom. In a diabetic coma, vomiting can be repeated, does not bring relief to the patient, and can be combined with acute pain in the abdomen, which is the reason for hospitalization of the patient in a surgical hospital.

Vomiting, which is persistent and causes severe dehydration, may be the first and most characteristic symptom of a hypercalcemic crisis in hyperparathyroidism.

Chronic adrenal insufficiency in the decompensation stage can occur in the presence of nausea, vomiting, and abdominal pain. Usually, in addition to these symptoms, there is muscular asthenia, fever, and later cardiovascular disorders occur.

Poisoning with various substances most often initially manifests itself as vomiting. Suspicion of poisoning requires urgent measures, as well as studies of vomit and gastric lavage.

In acute surgical pathology of the abdominal organs, vomiting is usually preceded by severe abdominal pain and nausea. In case of intestinal obstruction, the composition of the vomit depends on the level of obstruction: high intestinal obstruction is characterized by the presence of stomach contents and a large amount of bile in the vomit; obstruction of the middle and distal intestines is accompanied by the appearance of a brownish tint in the vomit and fecal odor. In addition to vomiting, there is abdominal bloating, sometimes asymmetrical, cramping pain, lack of stool, as well as signs of intoxication and dehydration.

“Fecal” vomiting is most often associated with the presence of a connection between the stomach and the transverse colon, or develops in the terminal stage of long-existing intestinal obstruction.

When thrombosis of mesenteric vessels occurs, vomiting is preceded by severe abdominal pain and a collapsing state. There may be blood in the vomit.

Most often, however, bloody vomiting is a symptom of bleeding from the esophagus, stomach or duodenum. Less commonly, the vomit may contain blood swallowed by the patient in the presence of pulmonary or nasal bleeding (for details, see bleeding syndrome).

For acute appendicitis and appendicular infiltrate are characterized by the occurrence of vomiting against the background of diffuse or localized (infiltrate) abdominal pain. Peritonitis in the toxic stage is accompanied by vomiting in combination with abdominal pain and symptoms of peritoneal irritation.

Vomiting in diseases of the gastrointestinal tract:

Important for correct diagnosis have the time of onset of vomiting, the presence of previous nausea, the connection of vomiting with food intake, pain during vomiting, the amount and nature of vomit.

Most often, in diseases of the gastrointestinal tract, nausea precedes vomiting. However, this does not always happen. For example, esophageal vomiting is not accompanied by nausea. Vomiting occurs when various diseases esophagus, usually associated with a violation of its patency and the accumulation of food masses.

Esophageal stenosis can be caused by tumor process, peptic or post-burn stricture. In addition, esophageal vomiting can lead to achalasia cardia, diverticulum, esophageal dyskinesia, as well as gastroesophageal reflux due to insufficiency of the cardiac sphincter (lower esophageal sphincter).

Esophageal vomiting can be divided into early and late. Early vomiting develops during food intake, often with the first pieces swallowed, and is associated with dysphagia, discomfort and pain in the chest. Such vomiting may be a symptom of organic damage to the esophagus (tumor, ulcer, scar deformity), and neurotic disorders.

In the first case, pain, vomiting, chest discomfort, and dysphagia directly depend on the density of food swallowed. The denser and coarser the food, the more pronounced the esophageal disorders. For neuroses with functional disorders When swallowing food, no such dependence is observed; on the contrary, denser foods often do not cause any problems with swallowing, and liquids lead to vomiting.

Late esophageal vomiting develops 3-4 hours after eating, which indicates a significant expansion of the esophagus. It appears when the patient assumes a horizontal position or leans forward (the so-called lace symptom). Typically, this sign is characteristic of achalasia cardia.

In addition to late esophageal vomiting of food eaten mixed with mucus and saliva, more often when bending forward (for example, when washing floors), patients complain of chest pain. They resemble those of angina pectoris and also disappear when taking nitroglycerin, but are never associated with physical activity.

Late vomiting can also develop in the presence of a large esophageal diverticulum. However, the amount of vomit is much less than that with achalasia cardia. The composition of vomit in esophageal vomiting is undigested food with a small amount of mucus mixed with saliva.

With reflux esophagitis, vomit consists of a large amount of undigested food debris, as well as a large amount of sour or bitter liquid (gastric juice or its mixture with bile).

Vomiting can occur both during meals and some time after it, in some cases at night when the patient is in a horizontal position, as well as with a sudden tilt of the torso forward, a sharp increase in intra-abdominal (straining during constipation, pregnancy, etc.) and intragastric pressure. Vomiting at night during sleep can lead to vomit entering the respiratory tract, and then to the development of chronic, persistently recurrent bronchitis.

In diseases of the stomach and duodenum, vomiting is a constant symptom. It is closely related to food intake and occurs, as a rule, after meals, with regular intervals between them. With duodenal ulcer, vomiting most often appears 2-4 hours after eating or at night against the background of severe pain in the stomach. upper half belly, it accompanies severe nausea. A characteristic symptom is the subsidence of pain after vomiting; sometimes such patients deliberately induce vomiting in order to make themselves feel better.

With stenosis of the pyloric part of the stomach due to ulcerative scar deformation or cancer, vomiting is frequent and profuse; the vomit contains remnants of food eaten several days ago, which have a putrid odor.

With pylorospasm, which is often caused by functional disorders of the motor function of the stomach (reflex effects in peptic ulcers, diseases of the biliary tract and gallbladder, neuroses) and in some cases intoxication (lead) or hypoparathyroidism, patients also often complain of frequent vomiting.

However, vomiting with pylorospasm is not as profuse as with organic pyloric stenosis; moderate amount Gastric contents eaten recently do not have a specific smell of rotting. Fluctuations in the frequency of vomiting are associated with the severity of the underlying disease and the mental instability of the patient.

Vomiting in acute gastritis is repeated; the vomit has an acidic reaction. Vomiting is accompanied by sharp, sometimes excruciating pain in the epigastric region. It occurs during or immediately after eating and brings temporary relief to the patient.

For chronic gastritis, vomiting is not the most characteristic feature, except for gastritis with normal or increased secretion. In addition to severe pain ( sharp pains in the epigastric region after eating), heartburn, sour belching, a tendency to constipation are noted, the tongue is covered with a copious white coating. Vomiting in this form of the disease can appear in the morning on an empty stomach, sometimes without the characteristic pain and nausea.

Vomiting in chronic diseases of the liver and biliary tract:

Vomiting in chronic diseases of the liver, biliary tract and pancreas is repeated; bile in the vomit is typical, coloring it yellow-green. Chronic calculous cholecystitis is characterized by pain in the right hypochondrium, sometimes even short-term icteric discoloration of the skin and sclera. These phenomena are provoked by the intake of fatty, spicy and fried foods.

In biliary colic, vomiting is characteristic as one of the typical symptoms diseases. Biliary colic occurs with cholelithiasis, acute and chronic cholecystitis, dyskinesias and strictures of the biliary tract, stenosis of the major duodenal papilla. Vomiting bile always accompanies a painful attack along with other typical signs: bloating, nausea, fever, etc. Vomiting brings temporary relief.

Vomiting mixed with bile occurs at the height of a painful attack during acute or exacerbation of chronic pancreatitis. It does not bring relief and can be indomitable.

Treatment:

There is no specific treatment for vomiting; it is associated only with the treatment of the underlying disease.