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

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

Causes of stomach pain

Pain in the stomach can cause diseases of the stomach itself, as well as pathologies of other organs and systems. human body. The main question in this case is the violation of which particular organ caused pain in the epigastric region. Qualified diagnostics can only be carried out professional doctor. Therefore, if you feel pain in the abdomen, it will be unwise, and sometimes even dangerous, to self-diagnose 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, is most likely indicative of the 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 precisely in the epigastric region, then all the same, stomach diseases will not necessarily be its cause.

All causes of stomach pain can be divided into two large groups:
1. Pain in the region of the stomach, caused directly by its pathology.
2. Pain in the stomach, arising from lesions of 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 to some food products and allergies.

The following diseases can be distinguished in the second group:

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

Pain caused by lesions of the stomach

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 often has a dull and aching character.

It will be important to pay attention to the relationship of pain with meals, 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 texture. These so-called early pains can provoke the patient's fear of 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, feeling of pressure and fullness in the epigastric region, which occur or intensify 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 there may be signs of intestinal damage in the form of defecation disorders. They are episodic, but often become the basis for the development of irritable bowel syndrome.

Common 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 rhythm of heart contractions, fluctuations in blood pressure;
drowsiness, pallor and sweating after eating;
burning and pain in oral cavity and in the language
symmetrical sensory disturbances in the upper and lower extremities.

Pain in the abdomen and stomach with peptic ulcer

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

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

A more informative indicator is the relationship of this pain with meals. With 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 is its recurrent course, that is, the alternation of 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 eructations of sour contents.
2. Nausea and vomiting after eating.
3. Weight loss.

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 with an ulcer, that is, the formation of a hole through which gastric contents enter the abdominal cavity. In such conditions, the intensity of pain 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 a hospital for emergency 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 by chance - during examinations for other reasons. But in some cases, the presence of a polyp may be indicated by a blunt, It's a dull pain in a stomach. In addition, they can be manifested by painful sensations when pressure is applied to the abdomen, as well as bleeding, nausea, and vomiting.

Persistent stomach pain with cancer

Gastric cancers are one of the most common cancers. One of their signs are non-intense, weak, but constantly arising pains in the stomach. In addition, patients suffering from stomach cancer often note that there is no connection between the appearance of pain and any specific causes.

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

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

If pain in the stomach of a spastic nature is combined with diarrhea and vomiting, then this indicates a viral or bacterial intestinal infection, and in this case, you should contact an infectious disease specialist.

If the pain in the stomach appeared on the background of pneumonia or tonsillitis, accompanied by nausea, vomiting or diarrhea, then you should contact, respectively, to pulmonologist (make an appointment)/therapist or otolaryngologist (ENT) (make an appointment).

If a person has persistent symptoms for a long time weak pains in the stomach, combined with loss of appetite, belching, heartburn, a feeling of fullness in the stomach after eating a small amount of food, anemia, aversion to meat, a feeling of discomfort in the stomach, possibly vomiting "coffee grounds" or blood and chalk (black stool), then this may bear witness to 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 consider 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 pains that are not directly related to the pathology of the stomach, intestines or pancreas, but are caused by a malignant tumor, bacterial or viral infection, pneumonia, tonsillitis, chemical poisoning, food poisoning, stress , allergies, appendicitis, dissection abdominal aorta, ischemic heart disease, or spasm of the diaphragm.

So for stomach pain different nature, combined with a variety of symptoms and arising from 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, ASAT, ALT, LDH, alkaline phosphatase, amylase, lipase, etc.);
Scatological analysis of feces (including the Gregersen reaction to occult blood);
Analysis of feces for dysbacteriosis (sign up);
Analysis of feces for helminths (worms);
Analysis for the presence of Helicobacter pylori (enroll)(For example, urease test (make an appointment), 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 assess the motility and activity of the movements of the stomach and intestines);
Esophagogastroduodenoscopy;
Colonoscopy (make an appointment);
Sigmoidoscopy (
For example, if it is suspected that the pain in the stomach is due to gastritis, then gastroscopy, ultrasound of the abdominal organs, pH-metry and analysis for the presence of Helicobacter pylori are prescribed. If pancreatic disease is suspected, then ultrasound, endoscopic retrograde cholangiopancreatography, and a biochemical blood test are limited. Perhaps the examination is supplemented by computed tomography. If bowel disease is suspected, then sigmoidoscopy, colonoscopy, plain x-ray, irrigoscopy are prescribed. Computed tomography in this case is uninformative, since the intestine is hollow organ, and tomography does not give 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 you to evaluate the entire set of movements of these organs. Histological examination biopsy is scheduled only after endoscopy (make an appointment) when suspicious cancer lesions were found in the stomach, esophagus or intestines.
However, you need to know that if any disease of the stomach, intestines or pancreas is suspected, general analysis blood, general urinalysis, biochemical blood test, fecal analysis for helminths, scatological analysis of feces and ultrasound of the abdominal organs.
When pain occurs during physical activity, mental stress or stress, and is localized either behind the sternum, giving into the stomach, or both behind the sternum and in the stomach, combined with shortness of breath, a feeling of interruptions in the work of the heart, weakness, swelling of the legs and taking a forced sitting position, the doctor suspects coronary heart disease and prescribes the following tests and examinations:
register) ;
Myocardial scintigraphy (make an appointment);
Coronary angiography (make an appointment);
Transesophageal electrocardiography.

If coronary heart disease is suspected, the doctor immediately prescribes all the tests of 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 state of the heart and the whole body cannot be obtained by simpler, primarily used methods.

When pain in the stomach of a sharp shooting character 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, disappears after a slight 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). So, during the examination with a spasm of the diaphragm, the movement of the shoulders and back is noted, as well as the 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 probes tense muscles with his hands, determining the level of their mobility and movement restrictions.
, strawberries). First of all, the doctor prescribes a general blood test and an IgE concentration test, 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 a person has a true allergic reaction. After that, the determination of the product to which the person gives an allergic reaction is assigned, using skin tests or a method for 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, while the latter are more expensive and more accurate. Therefore, if there is a financial opportunity, you can donate blood to determine the concentration of specific IgE, but you can limit yourself to simpler and cheaper ones. skin tests, since their accuracy is quite high.

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

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

If spastic pains in the stomach appear shortly after eating, are combined with nausea, vomiting, diarrhea, headache, dizziness and severe weakness up to fainting, then food poisoning is suspected, and the doctor prescribes bacteriological culture feces, vomit, gastric lavage, residues of an infected product to determine the type of bacteria that caused poisoning. Additionally, a blood test may be prescribed to determine the presence of antibodies to various microbes that provoke 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 complete blood count and ultrasound of the abdominal organs. Other examinations for food poisoning are usually not prescribed, as this is not necessary.

When for a long period of time a person is constantly worried about 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 chalky (black feces), 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) (to sign up);
Analysis of feces for occult blood;
Gastroscopy (make an appointment);
X-ray of the stomach with a contrast agent;
Ultrasound of the abdominal organs;
X-ray of the lungs (make an appointment);
Multislice computed tomography;
Positron emission tomography;
Histological examination of a piece of tissue taken during a biopsy.

Usually, all of the listed examinations and analyzes 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 with a specialist.

Pain in the stomach, ie. 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 a large number a variety of 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;
Degree of intensity;
Localization;
The reason for the occurrence;
Irradiation of pain (the degree of its prevalence from the source of occurrence);
duration;
The frequency of occurrence;
Association with additional factors (for example, with food intake or defecation, changes in body position, physical activity, etc.);
the influence of various medicines;
The emotional effect that it causes (aching, cutting, stabbing, pressing, throbbing, burning, penetrating 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 you to identify possible complications. For example, people suffering from gastritis in chronic form and having a reduced secret function, in most cases complain of a feeling of heaviness and fullness in the epigastric region. The feeling of fullness is also one of the characteristic signs of pyloric stenosis. In cases where cholecystitis, pancreatitis or colitis joins the disease, intense pain may occur. If the secret function in chronic gastritis remains within the normal range, the resulting pain is usually dull and aching. With a stomach ulcer, sharp, contraction-like pain can occur. Duodenal ulcer and chronic duodenitis in the acute stage are accompanied by cutting, cramping, stabbing and sucking pains. Extremely intense pain, which can also result in pain shock, occurs when ulcers are perforated.

At certain diseases the connection between the occurrence of pain in the epigastric region and food intake is well traced (especially if the food is spicy, rough, fatty, sour). Pain may be early or late. The early ones usually occur after taking a fairly coarse food (for example, marinades, plant foods, black bread), the later ones - after eating a meal characterized by a high degree of alkaline buffering (for example, boiled meat, dairy products). In some cases (with duodenitis or duodenal ulcer), pain can occur at night or on an empty stomach. As a rule, the patient's condition facilitates the intake of 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 physical activity or neuro-emotional overload.

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

Causes of pain in the epigastric region

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

In addition, the following factors can provoke them:

binge eating;
increased tone of the abdominal muscles;
constipation;
indigestion;
increased physical activity;
diseases caused by a viral or bacterial infection (such a pathology is commonly called gastroenteritis or "intestinal flu");
while pain in the stomach, as a rule, is accompanied by vomiting, nausea, spasm of the abdominal muscles, diarrhea);
food poisoning (manifested by abdominal pain and diarrhea);
appendicitis (pain is constant and is accompanied by tension in the lower abdomen);
diseases of the reproductive system;
diseases of the urinary system;
damage to the cardiovascular system;
spasm of the diaphragm;
diseases of the gastrointestinal tract;
food allergies (for example, resulting from lactose intolerance after eating milk and products based on it);
psychogenic factor (stomach pain caused by this factor is most often observed in children, this syndrome is often called "schoolophobia", it is characterized by the fact that pains are of emotional origin and are 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 a change and instability of their hormonal background, increased sensitivity to infections and allergen substances);
smoking;
excessive consumption of alcoholic beverages;
poisoning with heavy metals, mercury preparations, acids, alkalis.

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

At inflammatory diseases stomach and duodenum characterized by the occurrence of pain even due to minor changes in the motor function of these organs, on which the body healthy person would not react at all.

Pain in the stomach, resulting from spasm or stretching of the walls of the duodenum and stomach, as well as coronary disease that affects their mucosa, are called visceral pain. They are constant dull radiating pain that occurs along the midline of the abdomen.

Treatment of pain in the epigastric region

Pain in the epigastric region is a symptom that should not be ignored. Before removing 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 various diseases.

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

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

Visceral pain associated with irritation of nerve endings and occurs on the basis of spasm of smooth muscles (spastic pains) or sprains (distension pain) hollow digestive organs, stretching capsules parenchymal organs, abdominal ischemia (vascular pain) or tension of the mesentery.

Spastic and distension pain may be based on organic tissue damage or a violation 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 on the basis of 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).

Radiating (reflected) pain occurs with visceral or parietal (somatic) pain as a result of the presence of proximity in the 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 cause a decrease in the pain perception threshold, due to a deficiency in the body of serotonin, norepinephrine, endorphins, enkephalins, features of higher nervous activity and psychological status of the patient.

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

Pain peptic ulcer more often it is relatively local, often radiating to the back or the region of the heart. The persistent nature of radiating pain in the back can be with the penetration of a duodenal ulcer into the pancreas. When the ulcer is localized in the cardia and lesser curvature of the stomach, the pain appears or intensifies 15-20 minutes after eating, and when localized in the region 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 shortly after eating and resumes or intensifies on an empty stomach, at night, in the autumn-spring period, after unrest and negative emotions.

With a pronounced 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 increase (chronic pancreatitis, cholecystitis, cholelithiasis, etc.).

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

Increased pain in the epigastric region with peptic ulcer disease can be caused by the use of juice food (meat and fish broths, jelly, spicy seasonings and spices, juicy meat cooked by immersing it in hot water).

It should be noted a possible decrease in pain due to peptic ulcers after drinking alcohol, which, apparently, is associated with its analgesic effect, however, in the future, these pains resume or even intensify to a greater extent. Similar effect often seen after smoking a cigarette.

Often, the presence of peptic ulcer in close relatives is stated.

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

With superficial palpation of the epigastric region above the localization of the ulcer, resistance is determined, and with deep palpation in patients with pyloroduodenal ulcer - painful tyazh.

The previously described pain under the xiphoid process as a manifestation of duodenal ulcer in the light of modern possibilities for the use of endoscopic techniques, apparently, indicates the presence esophagitis(With highly likely- 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 in patients with GERD is not traced.

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

At pyloric stenosis on the basis of peptic ulcer pain is usually late in relation to food intake. They are often combined with amplification gastric peristalsis and may be accompanied by late vomiting of long-eaten food.

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

At functional (non-ulcerative) 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 (feeling of fullness in the epigastrium after eating and early satiety, not proportional to the amount of food eaten). At the same time, there are no morphological changes in the stomach.

With chronic duodenitis pain is located in right half epigastric region, it appears 2-3 hours after eating, especially the use of rough, spicy food, and may 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 identification of a spastic state of the pyloroduodenal region is less regular.

With a combination of chronic gastritis and chronic duodenitis, which is observed very often, when they exacerbate, at first, 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 focuses mainly in the right half of the epigastrium (in pyloroduodenal zone) and sometimes in the upper left quadrant of the abdomen.

Pain in the epigastrium on the ground acute gastritis usually often combined with nausea and vomiting, fever, chills, enteral syndrome (bloating, rumbling, pain in umbilical region, diarrhea with remnants of undigested food).

At stomach cancer epigastric pain is usually a late symptom. It can acquire a permanent character with an increase after eating, especially the use of spicy and rough food, often combined with nausea and vomiting that does not bring relief, lack of appetite, weight loss, aversion to meat food, loss of interest in life.

Polyposis of the stomach may also be accompanied by the appearance of pain in the epigastrium, mainly shortly after eating. In contrast to chronic gastritis, dyspeptic disorders are less pronounced in most patients.

For such rare disease, How acute expansion 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 bound stomach. The general collaptoid condition of the patient is noted.

At torsion of the stomach due to its acute twisting, often in patients with a stomach in the form hourglass, there are severe pains in the epigastrium, which are accompanied by vomiting, bloating and tension in the upper abdomen.

At strangulated diaphragmatic hernia pain appears suddenly under the xiphoid process, may 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 stuck food behind the sternum.

For acute and chronic pancreatitis pains are 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 region of the heart. They are aggravated after eating, especially eating fatty, fried, smoked foods, muffins. There is pain on palpation in the areas of the projection 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 not very pronounced, 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 associated with gray-green jaundice, discolored stools, and itchy skin.

large tumors and pancreatic cysts often accompanied by bursting pains 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 found: transmission pulsation of the aorta and pain on palpation, radiating to the back, shoulders, spleen region and left costal arch.

At liver diseases(hepatitis, cirrhosis, hepatocarcinoma), accompanied by its increase, arching pains are often noted in the upper epigastric and right hypochondrium, often radiating to the right half of the chest and under the right shoulder blade. They can be aggravated after exercise, drinking alcohol, spicy, fatty and fried foods.

Pain due to cholecystitis, localized in the right half of the epigastrium, increases 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 Kerr, Murphy, Ortner, Georgievsky-Mussy symptoms, thickening of the GB wall > 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 the position on the left side, with sudden movements, jolting driving, shaking the body.

Gallstone disease (GSD) can "declare" itself with bouts 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) may manifest as pain in the right half of the epigastric region and the right upper quadrant of the abdomen. It is possible to associate this pain with the indicated diagnosis according to the criteria of the III Rome Consensus, provided that normal indicators liver enzymes (ALT, AST), conjugated bilirubin, amylase and lipase in the blood, exclusion of the effect of drugs 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 cystic bile during duodenal probing, and if cholescintigraphy or transabdominal ultrasound reveal violations of the emptying of the gallbladder when it is 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 with 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 can be concentrated in the epigastric region with myocardial infarction (status gastralgicus). The involvement of pain in the epigastric region with this disease may be indicated by the presence of other signs of myocardial infarction (fall blood pressure, the appearance of arrhythmias, signs of heart failure, fever, 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 the elderly, 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 amount of food taken. Pain is often accompanied by heaviness in the epigastrium, gastrointestinal bleeding is possible due to an erosive and ulcerative lesion of the gastroduodenal region, concomitant cardiovascular pathology(IHD, hypertension, myocardial infarction, atherosclerosis of the vessels of the lower extremities). In most of these patients, a painful and pulsating abdominal aorta is determined by palpation, systolic murmur in 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 area of the basal parts of the lungs. In this case, the pain may increase with a deep breath and coughing.

It is necessary to bear in mind the possible involvement of epigastric pain in the presence of 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 be thyrotoxic crisis starting diabetic coma, Addison's disease, poisoning with nicotine, lead, morphine, spinal tabes(tabetic crises), intercostal neuralgia.

The connection of the given pathology with pain in the epigastric region determines the ways of their proper treatment.

The above characteristic of epigastralgia with 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 pain in the epigastrium. However, it is also necessary to take into account modern possibilities pharmacotherapy of pain syndrome, taking into account its mechanism in each specific situation.

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

With the exclusion of the need for surgical treatment, the issue of diagnosis is resolved with the involvement of the necessary laboratory and instrumental methods of research. Taking into account the most probable 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 case.

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

Non-selective M-cholinolytics, along with the suppression of 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 with hydrochloric acid and pepsin. Thus, M-cholinolytics contribute to the reduction of pain due to a dual mechanism. However, non-selective M-cholinolytics have numerous side effects due to systemic action (dry mouth, disturbance of 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-cholinolytics is contraindicated in glaucoma, obstructive diseases urinary tract, hernia esophageal opening diaphragm, GERD, hypokinetic intestinal dyskinesia, bladder. Selective anticholinergics have almost no effect on the motility of the gastrointestinal tract, which limits the expediency of their use for the relief of spastic pain.

Of the myotropic antispasmodics, it is possible to use drugs from the group of phosphodiesterase inhibitors (papaverine, drotaverine - no-shpa), slow channel blockers (pinaverium bromide - ditsetel, 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.

It should also be borne 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 (hepabene, gimecromon - odeston, cholagogum, cholagon).

Reducing the pain syndrome caused by pancreatitis is facilitated by natural (kontrikal, gordoks, trasilol, etc.) and artificial (epsilon-aminocaproic acid, pentaxyl, etc.) protease inhibitors due to inhibition of the activity of the kallikrein-kinin system. As a result of slowing down the synthesis of bradykinin, the edema of the pancreas decreases and, as a result, the pain syndrome.

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

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

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

Patients with acid-dependent diseases (GERD, peptic ulcer stomach and duodenum, functional gastric dyspepsia, Zollinger-Ellinson syndrome, etc.), pain relief is possible 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 rate 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, IPP deserve attention, in which the best way combination of 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 acid-inhibiting dose of lansoprazole is 4 times less than that of omeprazole. Lansoprazole is second only to rabeprazole in terms of the speed and persistence of inhibition of the acid-producing function of the stomach, affinity for cytochrome P450 isoenzymes, and the predictability of the effect. Lansoprazole reliably provides an optimal clinical effect in acid-dependent diseases. It is well tolerated by patients, side effects are rare.

As a means emergency care for short-term relief of pain due to acid-peptic activity, non-absorbable antacids (maalox, phosphalugel, etc.) can be used.

In patients with chronic pancreatitis, to reduce the severity of pain, it is possible to use novocaine (0.25% 100-200 ml intravenously). It inhibits the activity of phospholipase A 2, reduces the tone of the sphincter of Oddi. With insufficient effectiveness in eliminating the pain syndrome of pathogenetically based drugs, severe and persistent pain syndrome in patients with excluded acute abdominal pathology requiring surgical intervention, the use of analgesics (paracetamol, metamizol, tramadol, etc.) is justified.

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

A decrease in the severity of chronic abdominal pain can also be facilitated by psychotherapy and pharmacotherapeutic correction of the states of anxiety, depression, psychosomatization often associated with this 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. Characterized by discomfort in the epigastric region in the form of heartburn, dull pain.

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

Purulent peritonitis is an inflammation of the peritoneum. Infection most often occurs from some other internal organ. Pain in the epigastrium is sharp, intensifying, 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 an enlarged chest cavity is shifting lower section esophagus. When acidic stomach contents enter the esophagus. Epigastric pain, bloating and cramps. Increased intra-abdominal pressure.

Acute appendicitis is an inflammation of the appendix, the caecum. In this case, acute pain is located both in the epigastric region and below. On the left, there is a slight muscle tension and pain on palpation.

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

Perforation of the 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. Pain in the epigastric region is acute, "dagger", 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. Also, the pain may be associated with dysfunction of other internal organs, in addition to the digestive organs.

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

Renal colic occurs due to a violation of the outflow of urine. It is characterized by cramping pains. The attack begins suddenly, is not associated with physical activity. The pain is excruciating and sharp, nothing is relieved.

Pleurisy is an inflammation of the pleura that covers the inside of the sternum and lungs. Pain in the chest gives to the epigastric region. Increased by coughing. The body temperature rises, the patient feels a breakdown. Respiratory mobility of the lungs is limited.

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

Causes:

The following causes of vomiting are distinguished.
1. Infectious:
bacterial intoxication (salmonella, clostridium, staphylococcus, etc.);
viral infections (viral hepatitis, rotaviruses, caliciviruses).
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 (eufillin, opiates, cardiac glycosides, cytostatics, etc.).
6. Intestinal obstruction (invagination, 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 lesions of the gastrointestinal tract. Vomiting reflex caused by many factors.

Nervous vomiting associated with organic diseases the brain and its membranes, disorder of cerebral circulation.
In addition, it can occur with irritation or damage vestibular apparatus, eye diseases, febrile conditions. Psychogenic vomiting develops when psychosomatic illnesses or acute emotional disturbances.

Vomiting can be a manifestation of irritation of the mucous membranes of internal organs - the stomach, intestines, liver, gallbladder, 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 can be affected by various infections and intoxication (bacterial toxins and own toxic substances that accumulate in severe pathology of the kidneys, liver or deep metabolic disorders with endocrine diseases). Vomiting is typical for toxicosis of the first half of pregnancy (vomiting of pregnant women).

It may appear as a symptom of a drug overdose or hypersensitivity 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 section of the stomach contracts sharply, the body of the stomach and the lower esophageal sphincter relax, and antiperistalsis occurs.

Spasmodic contraction of the diaphragm and abdominal muscles leads to an increase in intra-abdominal and intragastric pressure, which is accompanied by a rapid release of gastric contents through the esophagus and mouth out. Vomiting, as a rule, proceeds against the background of blanching of the skin, increased sweating, severe weakness, palpitations, lowering blood pressure.

Differential diagnosis:

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

In a special place is vomiting with meningitis - 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 known triad of symptoms: headache, meningeal signs(rigidity neck muscles) and hyperthermia. An important sign is the occurrence of vomiting without previous nausea against the background of severe headache and general hyperesthesia.

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

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

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

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

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

Poisoning by a variety of substances is most often primarily manifested by 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. With intestinal obstruction, the composition of the vomit depends on the level of the obstruction: high ileus 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 bloating, sometimes asymmetric, spastic pain, lack of stool, as well as signs of intoxication, dehydration.

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

In the event of thrombosis of the mesenteric vessels, vomiting is preceded by a sharp pain in the abdomen and a collaptoid state. There may be blood in the vomit.

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

For acute appendicitis and appendicular infiltrate is 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:

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

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

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

Esophageal vomiting can be divided into early and late. Early vomiting develops during meals, often with the first swallowed pieces, associated with dysphagia, discomfort and pain behind the sternum. Such vomiting can be a symptom of both organic damage to the esophagus (tumor, ulcer, cicatricial deformity), and neurotic disorders.

In the first case, pain, vomiting, discomfort behind the sternum, dysphagia directly depend on the density of the swallowed food. The denser and coarser the food, the more pronounced esophageal disorders. With neuroses with functional disorders there is no such dependence on swallowing food, on the contrary, often denser food does not cause any problems with swallowing, and liquid leads to vomiting.

Late esophageal vomiting develops 3-4 hours after eating, indicating a significant expansion of the esophagus. It appears if the patient takes a horizontal position or leans forward (the so-called lace symptom). Usually such a symptom is characteristic of achalasia of the cardia.

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

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

With reflux esophagitis, vomit consists of a large amount of undigested food debris, as well as a large amount of acidic 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 with the patient in a horizontal position, as well as with a sudden tilt of the torso forward, a sharp increase in intra-abdominal (straining with constipation, pregnancy, etc.) and intragastric pressure. Vomiting at night during sleep can lead to the ingress of vomit into 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 eating, usually occurs after eating, with regular intervals between them. With duodenal ulcer, vomiting most often occurs 2-4 hours after a meal or at night against the background of severe pain in upper half abdomen, it accompanies severe nausea. A characteristic feature is the subsidence of pain after vomiting, sometimes such patients cause vomiting intentionally in order to alleviate their well-being.

With stenosis of the pyloric part of the stomach due to after ulcerative cicatricial deformity or cancer, vomiting is frequent and profuse, in the vomit there are remnants of food eaten a few days ago, which have a putrid odor.

With pylorospasm, which is more often caused by functional disorders of the motor function of the stomach (reflex effects in peptic ulcer, 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 abundant as with organic pyloric stenosis; moderate amount gastric contents, eaten recently, there is no specific smell of putrefaction. Fluctuations in the frequency of vomiting are associated with the severity of the underlying disease and the instability of the patient's psyche.

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

For chronic gastritis, vomiting is not the most hallmark except gastritis with normal or increased secretion. In addition to severe pain syndrome ( sharp pains in the epigastric region after eating), there are heartburn, sour belching, a tendency to constipation, the tongue is coated with abundant white bloom. 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 recurrent, bile in the vomit is typical, staining them yellow-green. Chronic calculous cholecystitis is characterized by pain in the right hypochondrium, sometimes even short-term icteric staining of the skin and sclera. These phenomena provoke 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 bile ducts, stenosis of the major duodenal papilla. Vomiting of bile always accompanies a painful attack along with others. typical features: bloating, nausea, fever, etc. Vomiting brings temporary relief.

Vomiting with an admixture of bile occurs at the height of a painful attack in acute or exacerbation of chronic pancreatitis. It does not bring relief, it can have an indomitable character.

Treatment:

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