DDx Epigastric pain

1. Dyspepsia syndrome
Epigastric pain + signs and symptoms associated with eat
- Mual
- Muntah  upper GI ( muntah + ), lower GI ( muntah - )
- Kembung  eat a bit feel full, full till sesak nafas
- Rasa panas
(if S&S not associated with eat,maybe problem doesn’t come from GI tract)
(all remain DD until we do endoscopy)

2. Epigastric pain + fever  GERD, ulcer, gastritis, pancreatitis, cholecystitis, hepatitis

3. Dyspepsia syndrome + hematemesis → peptic ulcer, varices esophagus, erosive gastritis

4. Site of Epigastric pain 

processus xyphoideus stomach + esophagus junction problem
left  corpus of stomach
Center  antrum
Lower right  duodenum

Cholecystitis + hepatitis can occur together

( reactive hepatitis  cause cholecystitis )

Hepatitis  *fever > 1 week, jaundice. Hepatomegaly

Peptic ulcer  food relief pain
Gastritis  food worsen pain
GERD  heartburn
Pancreatitis  vomit frequently, patient prefer perut kosong
Cholecystitis  triggered by high fat food, relief by ranitidine

Supporting exam for Abdomen

1. Dyspepsia syndrome eg kembung etc do Xray polos 3 posisi (tidur, duduk, miring)
- Perforation – free air out from intestinal
- Meteorismus – ileus paralytic/obstructive
- Cairan ascites
2. USG upper and lower abdomen
- Mass/tumour
- to visualize organ padat eg kidney, lien, hepar
 - visualize ascites
- visualize stone in kidney or bile duct
- not for intralumen organ egg aster and intestine!
3. If from USG no finding, do CT scan/MRI.
- It is useful for both solid organ and intralumen organ
4. Intraluminal organ malfunction eg dyspepsia, peptic ulcer, hematomesis, IBD, do Xray + Barium
a. OMD to see esophagus, gaster, and duodenum (wait 1 hour, 2 hours and 4 hours
respectively to visualize the organ)
b. Colon in loop – insert from anus
c. Barium follow through – continuous from OMD to visualize small intestine after 6-7 hours
d. Appendicogram— continuous from Barium follow through , wait 12 hours
5. If found any tumor in Xray, to confirm diagnosis do endoscopy. (lower/upper)
6. ERCP if there’s any icteric signs and symptoms.