[74M] Experiencing intermittent upper abdominal pain with fatigue

Patient Description

A 74-year-old male reports intermittent dull and cramping upper abdominal pain, located below the ribcage to the left of the breastbone, with a severity of 5 out of 10. The pain has been present for 2 months and seems to improve after meals. The patient also experiences fatigue and occasional chills but no fever. Bowel movements occur daily with stools that are harder than usual but without any abnormal coloration. There is no reported nausea or vomiting, and appetite remains good with no weight loss. There is no jaundice or presence of black or bloody stools. No other symptoms were reported.

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Arora's Assessment

What might be happening

Based on your symptoms, here are a few possible conditions:

  • Gastritis or Peptic Ulcer Disease: These conditions are characterized by inflammation or erosion of the stomach lining, often causing pain that can improve after meals. Gastritis can be caused by long-term use of NSAIDs, excessive alcohol consumption, or infection with bacteria such as H. pylori. Peptic ulcers are sores that develop on the lining of the stomach, upper small intestine or esophagus.
    • Treatment typically involves medications to decrease stomach acid and, if H. pylori is present, antibiotics.
  • Gallstones: These are hard deposits in the gallbladder that can cause pain in the upper abdomen, particularly after meals. However, the pain is usually located on the right side or middle of the upper abdomen.
    • Treatment may involve medications to dissolve the stones or surgery to remove the gallbladder.
  • Gastroesophageal Reflux Disease (GERD): This is a chronic condition where stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus and cause upper abdominal pain.
    • Treatment typically involves lifestyle changes and over-the-counter medications. In severe cases, prescription medications or surgery might be needed.

What you can do

  1. Try to avoid foods and drinks that trigger heartburn. Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
  2. Eat smaller meals. Avoid overeating by eating smaller meals.
  3. Don't lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
  4. Elevate the head of your bed. If you regularly experience heartburn while trying to sleep, put gravity to work for you. Place wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches.
  5. Don't smoke, and if you already do, try to quit. Smoking decreases the lower esophageal sphincter's ability to function properly.

What you should look out for

If your symptoms persist or worsen, you should seek medical attention. More urgent symptoms that require immediate medical attention include:

  • Severe abdominal pain
  • Pain that radiates to your back
  • Vomiting blood or having bloody or black stools
  • Difficulty breathing
  • Unexplained weight loss

Remember, while I strive to provide accurate information, I'm not a doctor and this advice should not replace a consultation with a healthcare professional.

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9 mo ago


People Also Ask


What are the common causes of upper abdominal pain that improves after meals?

Upper abdominal pain that improves after meals can be caused by conditions like gastritis or peptic ulcer disease. These conditions involve inflammation or erosion of the stomach lining, which can be alleviated temporarily by food that buffers stomach acid.


How can gastritis or peptic ulcer disease be treated?

Gastritis or peptic ulcer disease is typically treated with medications that reduce stomach acid, such as proton pump inhibitors or H2 blockers. If an H. pylori infection is present, antibiotics may also be prescribed.


What lifestyle changes can help manage symptoms of GERD?

To manage GERD symptoms, avoid foods and drinks that trigger heartburn, eat smaller meals, avoid lying down after eating, elevate the head of your bed, and avoid smoking.


When should I seek medical attention for abdominal pain?

You should seek medical attention if you experience severe abdominal pain, pain that radiates to your back, vomiting blood, having bloody or black stools, difficulty breathing, or unexplained weight loss.


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