[70M] With epigastric pain radiating to the back

Patient Description

A 70-year-old male presents with a 4-day history of aching epigastric pain, rated 3 out of 10 in severity, that radiates to the back. The pain is alleviated when lying on the right side. The patient also reports associated symptoms of belching and gas. Bowel movements are described as normal with a Bristol 4 brown stool. There is no fever or chills. The patient has a significant past medical history of coronary artery disease (CAD) with coronary artery bypass grafting (CABG) performed previously. Currently, the patient is not on any medications and reports no known drug allergies.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Gastritis: Inflammation of the stomach lining, often caused by a bacterial infection or regular use of certain pain relievers or drinking too much alcohol. It can cause aching pain in the upper abdomen (epigastric area) that may radiate to the back. Belching and gas are also common symptoms.

    • Treatment typically involves antacids and other medications to decrease stomach acid, along with avoiding irritants such as alcohol, NSAIDs, and spicy foods.
  • Peptic Ulcer Disease: Sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain, along with belching and gas.

    • Treatment usually involves medications to decrease stomach acid, which allows the ulcer to heal. In some cases, antibiotics to treat H. pylori infection may be needed.
  • Gallbladder Disease: Conditions that affect your gallbladder, such as gallstones or inflammation (cholecystitis), can cause abdominal pain that radiates to the back, along with belching and gas.

    • Treatment depends on the specific gallbladder disease, but may include medications to dissolve gallstones or surgery to remove the gallbladder.
  • Pancreatitis: Inflammation of the pancreas, which can cause upper abdominal pain that radiates to the back. It's often worse after eating. Belching and gas can also occur.

    • Treatment typically involves hospitalization for intravenous (IV) fluids, medications to control pain, and nutritional support. If pancreatitis is caused by gallstones, gallbladder surgery may be needed.

Please note that these are potential explanations for your symptoms, but it's important to see a healthcare professional for an accurate diagnosis and treatment.

What you can do

  1. Schedule an appointment with your healthcare provider as soon as possible to discuss your symptoms.
  2. In the meantime, try to avoid foods and drinks that can irritate your stomach, such as spicy foods, alcohol, and caffeinated drinks.
  3. Over-the-counter antacids may help to relieve your symptoms, but they should not replace a visit to your healthcare provider.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Severe abdominal pain
  • Blood in your stool or black, tarry stools
  • Blood in your vomit or vomit that looks like coffee grounds
  • A high fever or shaking chills
  • Unexplained weight loss
  • Difficulty swallowing
  • Yellowing of your skin or the whites of your eyes (jaundice)

Remember, I'm an AI and this advice is based on the information you've given me. It's always important to consult with a healthcare professional for an accurate diagnosis and treatment.

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1 yr ago

People Also Ask


What are the common symptoms of gastritis?

Common symptoms of gastritis include upper abdominal pain or discomfort, nausea, vomiting, bloating, belching, and a feeling of fullness in the upper abdomen after eating. Some people may also experience loss of appetite or weight loss.


How is peptic ulcer disease diagnosed and treated?

Peptic ulcer disease is typically diagnosed through a combination of medical history, physical examination, and tests such as endoscopy or a barium swallow X-ray. Treatment usually involves medications to reduce stomach acid, such as proton pump inhibitors or H2-receptor antagonists, and antibiotics if an H. pylori infection is present.


What are the signs that gallbladder disease might be causing my symptoms?

Signs that gallbladder disease might be causing your symptoms include pain in the upper right abdomen that may radiate to the back or shoulder, nausea, vomiting, and belching. The pain often occurs after eating a fatty meal. An ultrasound or other imaging tests can help diagnose gallbladder issues.


What should I do if I suspect I have pancreatitis?

If you suspect you have pancreatitis, you should seek medical attention immediately. Symptoms include severe abdominal pain that radiates to the back, nausea, vomiting, fever, and a rapid pulse. Treatment often requires hospitalization for IV fluids, pain management, and nutritional support.


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