- Location of the
- zone Pain in the pathology of the stomach and duodenum
- How does the liver and gallbladder hurt?
- Pain in pancreatic disease
- Pain in spleen lesions
- Pain caused by hernia of white abdominal line
- Pain in the stomach area with myocardial infarction
- Pain in an aneurysm of the abdominal aorta
- Pain caused by osteochondrosis of the spine
If a person is concerned about pain in the centerin the upper part of the abdomen, the localization requires projection on the anterior abdominal wall of those organs that are located here. Assessing the pain syndrome, you need to think about the possibility of reflected sensations from the lower thoracic spine, chest organs.
The location of the
zone The median zone in the upper abdominal area is called epigastrium( nadchreviem).It starts from the sternum and extends down to a conventional line above the navel that connects the lower ribs. Left and right are limited by costal archs. The outer edge of the rectus muscles divides the upper part into the central zone and hypochondrium.
Topographic anatomy suggests that the epigastric zone includes:
- about a third of the stomach;
- bulb and upper duodenum;
- the place of passage of the duodenum into the skinny;
- left lobe of the liver;
- partially gallbladder and ducts;
- of the apex of the kidney;
- head and body of the pancreas;
- abdominal aorta with celiac trunk;
- small area of cardiac sac( pericardium);
- celiac plexus of nerve fibers and nodes;
- lower hollow vein.
Above the epigastrium and the entire abdominal cavity is separated from the thoracic by the powerful muscles of the diaphragm. Through it through the special hole to the stomach is the esophagus. Below closely fit the loops of the intestine.
The right upper hemisphere zone is projected: a liver with a part of the gallbladder, a bend of the colon, a right kidney with the adrenal gland. The left hypochondrium includes: the bottom, the cardiac compartment of the stomach and part of the body, the spleen, part of the left liver, the tail end of the pancreas, and the left kidney.
Abdominal pain above the navel covers the central and side zones of the upper floor. We will consider the features of acute and chronic lesions of the organs that cause this symptom.
Pain in the pathology of the stomach and duodenum
A sudden paroxysmal pain in the upper abdomen appears in the middle with acute gastritis, food poisoning, perforated ulcer. The intensity of gastritis pain is weaker than with ulcers. They follow the intake of food, alcohol, toxic substances and products.
Caused by contraction of muscle fibers, spasm. Accompanied by eructations, heartburn, vomiting with acidic contents. They can irradiate to the navel, in the hypochondrium.
Sharp "dagger" pain in peptic ulcer indicates perforation of the wall and exit into the abdominal cavity of
Patients are often in a state of painful shock when they penetrate: they turn pale, covered with a sticky cold sweat, blood pressure decreases, and a weak weak pulse is detected. Characteristic of the forced position with their hands pressed to the stomach. Because of the development of peritonitis with pressure on the abdomen, the muscles are felt to be stiff, tense.
Perforation often occurs during peptic ulcer exacerbation. But there are "mute" ulcers, which previously occurred unnoticed for the patient and are detected only in severe complications. In men, the perforation of ulcers is registered more often than in women 8 times. The young and middle age is affected.
In the chronic course of gastritis and peptic ulcer, exacerbations occur in the spring and autumn, with a violation of diet, stressful situations. Pain in the middle of the upper abdomen is felt as constant, aching, dull.
In case of inflammation in the stomach appear half an hour after eating, and with duodenitis, duodenal ulcer - no earlier than 1.5 hours or at night, in the morning on an empty stomach. The intake of food "calms" the stomach with increased acidity. Patients relieve night pains by drinking warm milk.
In hypoacid conditions, pain is less severe, but more severe. Violated bowel function. Disturbed frequent diarrhea, bloating, heaviness. Patients are prone to infection and development of gastroenteritis.
Peptic ulcer causes a violation of the motility of the stomach and intestines, so patients often develop constipation. Prolonged flow with stomach ulcer is accompanied by loss of appetite, nausea, weight loss, development of iron deficiency anemia, hypovitaminosis.
With the hyperacid state the flow is more favorable, the appetite is preserved. Typical nausea and vomiting at the height of the attack, relieving pain. Usually, with the accumulation of gastric juice during the night, it occurs in the morning. Young women even have a suspicion of pregnancy. Vomiting is more often observed in chronic alcoholics.
The probability of degeneration into a cancerous tumor is greatest against a background of atrophic gastritis, ulcers with reduced acidity. In this case, the pain in the abdomen above the navel is not associated with eating, constant, intensified at night.
How does the liver and gallbladder hurt?
Hepatitis - an inflammation of the hepatic parenchyma - does not cause severe pain, patients complain of a feeling of heaviness, bursting in the epigastrium and right hypochondrium. Disease causes loss of all body functions.
Therefore, pronounced intoxication: high fever, nausea, dizziness. Diarrhea is a consequence of a violation of the synthesis of digestive enzymes. The failure of the hormonal balance during long-term hepatitis leads to infertility of adult men and women.
The defeat of the liver, in addition to pain, is characterized by the following symptoms. Yellowness of the skin, sclera, mucous membranes - is caused by a broken outflow of bile and destruction of hepatocytes. The feces become light, and the urine darkens due to the altered metabolism of the bilirubin pigment.
Manifestations of portal hypertension - increased pressure in the vessels of the portal vein( with cirrhosis):
- dilated veins of the esophagus, anterior abdominal wall( "jellyfish head");
- ascites in the abdominal cavity( fluid accumulation);
- enlarges the spleen by depositing part of the blood.
Hepatic encephalopathy - fatigue, apathy, drowsiness and impaired consciousness up to coma, are associated with the cessation of detoxification and the exposure of poisonous toxins to the brain. Hepatic colic is called a bout of pain caused by a spasm or violation of the patency of the gallbladder and ducts. They are caused by the progression of concrements or the breakdown of the nervous regulation of smooth muscles( dyskinesia).
Gallstone disease is manifested by cramping pains under the ribs on the right with irradiation into epigastrium, in the thorax to the level of the clavicle, in the shoulder, shoulder blade. At the same time, there is nausea, vomiting of bitterness, which does not bring relief to the patient. The attack can last several hours, accompanied by fever, chills, weakness, headache.
Disturbed central regulation causes too much spastic reduction of bile ducts or relaxation
Dyskinesia of hyper or hypokinetic type is characteristic of people who are nervous, emotional, prone to experience. The patient feels either cramping short-term pains, or stupid, caused by stretching and overflow of bile. Symptom is regarded as a harbinger of cholecystitis.
Acute cholecystitis - inflammation of the gallbladder wall, often combined with the presence of stones, then called calculous. The beginning is usually sudden, at night. The fullest women are most susceptible to the disease. In chronic course, attacks are provoked by a violation of diet( fatty and fried foods), physical activity, stress, jolting in transport.
Each aggravation causes bouts of pain in the upper abdomen on the right. In the interictal period, patients experience dull pain in the abdomen, back, nausea, suffer from heartburn, unstable stools, flatulence, itching of the skin. Joining headaches, insomnia, weakness, memory loss.
Special attention is paid to the possibility of injury to the liver. Doctors have to find out urgently why the abdomen hurts during accidents, body fall, road accidents. The organ is damaged by a fracture of the ribs, a capsule breaks from a mechanical impact.
Pain is localized in the victim in the upper abdomen, radiates to the right collarbone, scapula. The intensity depends on the severity of the lesion. Typical symptom "Vanka-Vstanka" - increased pain in the horizontal position and weakening in the sitting, so the victim always refuses to lie down.
Hepatic injury is dangerous due to the development of massive internal bleeding. It can not stop spontaneously, the blood is mixed with bile and loses its ability to coagulate. The person grows pallor, pressure decreases, on a skin sticky perspiration appears. The condition is life-threatening. Emergency measures are needed.
Pains of the pancreas
Pancreatic diseases give abdominal pain above the navel. They can irradiate in the right and left hypochondria, in the back, shoulder blades, spine, into the umbilical zone. Often described by patients as "shingles".
In case of acute inflammation( pancreatitis) appear suddenly. Preceding the intake of alcohol, fatty and fried foods, excessive overeating. The pain is very intense, accompanied by nausea and repeated vomiting without relief.
Severe intoxication is caused by enzymes entering the blood. Upon examination, cyanosis of the face and limbs, pinpoint hemorrhages on the abdomen, buttocks, sharp abdominal tenderness are revealed.
Chronic pancreatitis manifests itself depending on the degree of organ damage:
- inflammation in the gland and body - gives a picture of right-sided pains that give to the abdominal cavity, thorax, shoulder blade and back;
- when localized only in the tail and body - from the left hypochondrium and epigastric pain spread to the left side, scapula;
- for total inflammation is characterized by shingles.
Aggravation causes "cutting, drilling" painful sensations, increasing lying, by evening. Hunger helps relieve pain. Among the other symptoms, it should be noted:
- diarrhea several times a day with remnants of undigested particles and fatty film in fecal masses( patients notice that they are poorly washed off in the toilet);
- increased saliva formation;
- nausea and vomiting;
- loss of appetite with aversion to fatty foods;
- weight loss.
Pancreatitis may be associated with signs of dysfunction of the gallbladder, stomach, intestines
Malignant pancreatic tumor is more often localized in the head. The growth of education serves as a mechanical obstacle to the outflow of bile, the enzymes of the gland itself. Therefore, clinical symptoms are detected early on attacks of hepatic colic, long jaundice with a bronze hue.
The location of the cancer in the body or region of the gland's tail makes it possible to get sick much later. Sometimes, before the development of severe pain, the patient notes a decrease in appetite, a feeling of heaviness in the epigastrium and just above the navel, nausea, eructation, bloating.
Pain in spleen lesions
Pains are formed by stretching the capsule of the spleen. It is distinguished by massive innervation, reacts to puffiness and body enlargement. An abscess and a spleen infarction are also capable of causing pain. Intensity is more suitable for feeling heaviness in the left hypochondrium and epigastrium.
Spleen enlargement occurs:
- for acute and chronic infectious diseases( tuberculosis, infectious mononucleosis, malaria, septic condition);
- massive hemolysis of erythrocytes( hemolytic anemia, prolonged hemodialysis);
- blood deposition and stagnant increase due to portal hypertension;
- autoimmune diseases( systemic lupus erythematosus);
- blood diseases( lymphomas, lymphocytic leukemia, myeloid leukemia).
In addition to pain, hypersplenism syndrome manifests itself: a decrease in all blood cells( pancytopenia), expressed by anemia( pallor, dyspnea, weakness, dizziness), a tendency to infections and bleeding.
The spleen deposits a portion of the blood to discharge the hepatic network
Pain caused by a hernia of the white abdominal line
A white line refers to the interweaving of tendon tufts of broad abdominal muscles. It stretches from the sternum vertically to the pubic articulation. Weak places are the holes where the vessels and nerves pass.
Pain in the upper part in the center of the abdomen mask any listed diseases. A significant difference in diagnosis is the lack of connection with the time of reception and the nature of food, strengthening after a load on the muscles of the press, coughing, straining, laughter.
First, the defect is penetrated by fatty tissue. Together with it, nerve endings from the solar plexus can enter the hernial gates. So the cause of pain is formed. Further development is accompanied by the bulging of the peritoneal sheet and the formation of a hernial sac.
Epigastric hernia does not reach large dimensions. Revealed when infringement, when, after lowering intra-abdominal pressure, a part of the hernial sac does not have time to recover into the entrance opening. In the "trap" can get the wall of the stomach, intestines, omentum, gall bladder. Palpable local painful formation. Eliminate the infringement is necessary until the formation of necrosis.
Pain in the stomach with myocardial infarction
Myocardial infarction is a disease of the heart muscle, devoid of blood and oxygen. A site is formed in the myocardium with zones of necrosis and ischemia. One of the variants of the atypical current is the gastralgic form. It is most typical for the lesion of the posterior wall of the left ventricle.
The nature of pain can not be distinguished from epigastric diseases. The diagnosis is helped by additional symptoms:
- the patient's dyspnoea appears at rest or at low physical exertion;
- heartbeat, arrhythmia;
- blood pressure response;
- no communication of pain with food intake.
Pain in aneurysm of the abdominal aorta
If the person complains of epigastric pain after 50 years, it can be assumed that he has significant atherosclerotic damage in the form of cholesterol plaque deposition in the wall of the abdominal part of the aorta.
Another cause of an aneurysm is chronic syphilis
The loss of elasticity of a portion of a large vessel passing through the epigastric zone promotes the gradual formation of an expansion with thin walls. Around the aneurysm the tissues become inflamed. At large sizes, it is able to squeeze the stomach, lower vena cava, intestine, liver.
With pressure on the spine, sensitivity and paralysis in the legs may be impaired. Pain worries for several hours. Appear closer to the evening or at night. Aneurysm is revealed when palpation of the abdomen in the form of a large pulsating tumor.
Pain caused by osteochondrosis of the spine
Osteochondrosis - is formed by degenerative changes in the discs between the vertebrae. In this case, a person has chronic pain in the upper abdomen, reminiscent of gastritis. They are not enhanced by eating, but when you turn your body, physical work, noticeably subside after a rest. The doctor reveals the most painful points during palpation of the near-vertebral zone.
Deformation in the lower thoracic region promotes clamping of the spinal canal of the nerve root
Special attention is required for pain in the abdomen and spine in pregnant women for a long time. If the woman's spine is not accustomed to physical exertion, then the severity of the fetus is perceived with difficulties. Pain is caused by sprains of intervertebral joints. They pass after childbirth.
Modern types of examination can identify the cause and clarify the nature of the defeat of the organs of the upper abdomen. Patients are not recommended to tolerate and try to be treated independently. This can provoke complications and hampers further treatment.