Tag Archives: Epigastric Pain

Main Clinical Manifestations of Bile-Duct Stones

Choledocholithiasis denotes the presence of calculi within the extra- or intrahepatic bile ducts. Symptoms arise when a stone obstructs flow, triggers inflammation, or provokes infection. The presentation ranges from silent imaging findings to life-threatening sepsis.

  1. Biliary colic
    Epigastric or right-upper-quadrant pain begins 30–60 min post-prandially, peaks for ≥30 min, and radiates to the inter-scapular region or right shoulder. Movement does not relieve the discomfort, and analgesics are often required.
  2. Nausea and vomiting
    Gastric stasis and vagal reflexes produce repeated retching that may transiently lessen pain.
  3. Fluctuating jaundice
    Intermittent elevation of conjugated bilirubin produces scleral icterus, dark urine, and clay-coloured stools that wax and wane as stones impact or disimpact.
  4. Cholangitis
    Complete obstruction plus bacterial contamination yields Charcot triad: spiking fever with rigors, constant RUQ pain, and deepening jaundice. Suppurative forms add hypotension and mental confusion (Reynolds pentad), indicating pus under pressure.
  5. Acute pancreatitis
    Impaction at the ampulla obstructs both bile and pancreatic flow, leading to epigastric pain radiating to the back, intractable vomiting, and elevated serum amylase/lipase.
  6. Tender hepatomegaly
    The liver edge is smooth, hot and exquisitely tender; inspiratory arrest on palpation (Murphy sign) is frequent when concomitant acute cholecystitis is present.
  7. Laboratory cholestasis
    Serum alkaline phosphatase and γ-glutamyl transferase rise early; total bilirubin climbs steadily as obstruction persists.
Symptom / SignTypical Presentation
Biliary colicPost-prandial RUQ/epigastric pain ≥30 min
Nausea/vomitingRepeated, may transiently relieve pain
JaundiceFluctuating, dark urine, pale stools
CholangitisFever + RUQ pain + jaundice (Charcot triad)
Acute pancreatitisEpigastric pain to back, ↑ amylase/lipase
Tender hepatomegalyHot, painful edge, positive Murphy sign
Laboratory↑ ALP, ↑ GGT, ↑ total bilirubin

Related articles：

  1. Main Clinical Manifestations of Extrahepatic Bile-Duct Stones
  2. How is bile-duct stone disease treated?
  3. Main Clinical Manifestations of Cholangitis
  4. Main Clinical Manifestations of Hepatic Hydatid Disease
  5. Main Clinical Manifestations of Biliary Tract Diseases
  6. Main Clinical Manifestations of Chronic Cholecystitis

Main Symptoms of Acute Gastritis

Acute gastritis is a sudden inflammation of the gastric mucosa, most often triggered by medications, alcohol, bile reflux, viral or bacterial toxins, and physical stress. The condition may range from mild erythema to erosive bleeding, with symptoms developing rapidly and usually resolving within days. Rapid recognition supports removal of the offending factor and prompt symptom relief.

  1. Core gastric complaints
    Epigastric pain: burning, gnawing, or dull soreness centered between the costal margins, often worsened by an empty stomach and partially relieved by food or antacids.
    Nausea: persistent urge to vomit, sometimes accompanied by hypersalivation.
    Vomiting: initially gastric contents; bile-stained or coffee-ground material appears when erosions bleed.
    Early satiety: feeling full soon after starting a meal, leading to reduced intake.
  2. Dyspeptic accompaniments
    Bloating and belching: excess gas from delayed gastric emptying or swallowed air.
    Heartburn or acid regurgitation: occasional reflux of gastric acid into the esophagus.
    Loss of appetite: fear that eating will reignite pain or nausea.
  3. Systemic and volume clues
    Low-grade fever <38 °C: may accompany infectious or toxin-mediated forms.
    Fatigue and malaise: cytokine-driven response to mucosal injury.
    Orthostatic dizziness: suggests bleeding when paired with coffee-ground vomitus or melena.
    Cold sweats and tachycardia: early signs of hypovolemia in hemorrhagic gastritis.
  4. Etiology-specific patterns
    NSAID or aspirin use: shallow erosions with little preceding pain, sometimes first noticed as dark stools.
    Alcohol binge: severe burning pain and repeated vomiting several hours after intake.
    Bile reflux post-surgery: constant dull ache and bilious vomiting without food relief.
    Stress-related (critical illness): painless coffee-ground aspirate in intensive-care setting.
  5. Red-flag combinations demanding urgent evaluation
    Persistent vomiting preventing oral hydration, hematemesis with fresh red blood or clots, melena with orthostatic hypotension, severe epigastric rigidity or rebound tenderness, and confusion plus cold clammy extremities.

Summary table

SymptomTypical qualityAlarm threshold
Epigastric burnGnawing, meal-related>2 h after food or night pain → endoscopy
Coffee-ground vomitDark granulesAny amount → rule out bleeding
Bilious vomitingYellow-green fluidPersistent bile → check bile reflux
Early satietySudden fullnessWeight loss >5 % → further work-up
Orthostatic dizzinessStanding faintPlus dark stool → urgent hemoglobin check

Related articles：

  1. Main Symptoms of Acute Enteritis
  2. Main Symptoms of Functional Dyspepsia
  3. Symptoms and Manifestations of Bile Reflux Gastritis
  4. Main Symptoms of Functional Gastrointestinal Disorders
  5. Main Symptoms of Duodenal Injury
  6. Main Symptoms of Primary Biliary Cholangitis

Main Symptoms of Functional Dyspepsia

Main Symptoms of Functional Dyspepsia

Functional dyspepsia is a chronic upper-gut disorder in which epigastric pain or discomfort is not explained by structural disease, medications, or metabolic causes. Symptoms fluctuate over months, often begin in early adulthood, and may coexist with anxiety, migraine, or irritable bowel syndrome. Recognising the typical pattern avoids unnecessary imaging and guides targeted therapy.

  1. Core epigastric complaints
    Post-prandial fullness: a heavy, bloated sensation that starts soon after the first bites and may last more than two hours.
    Early satiation: feeling “suddenly full” before finishing a normal-sized meal, leading to reduced food intake and sometimes weight concern.
    Epigastric pain: burning, gnawing, or vague soreness localized between the costal margins; not relieved by acid suppression alone in many patients.
    Epigastric discomfort: a dull, pressure-like sensation that can spread to the xiphoid or lower ribs, often mistaken for cardiac pain.
  2. Associated upper-gut features
    Belching and visible gastric distension: swallowed air and delayed fundic relaxation contribute to repetitive, involuntary eructations.
    Nausea: mild to moderate, rarely progressing to vomiting; tends to appear when pain peaks.
    Regurgitation of sour or bitter fluid: usually without heartburn, distinguishing the condition from typical reflux disease.
    Hypersensitive bloating: patients describe “a balloon” in the upper abdomen even when objective distension is minimal.
  3. Timing and triggers
    Symptoms are present at least three days per week for the last three months, with onset six months before diagnosis. Meals, stress, poor sleep, and menstrual phase often amplify complaints, while fasting or small-volume snacks may provide temporary relief.
  4. Exclusion clues (red flags)
    Persistent vomiting, dysphagia, overt gastrointestinal bleeding, unintentional weight loss >5 % within six months, iron-deficiency anemia, or palpable epigastric mass—these warrant endoscopy and imaging to rule out organic disease.

Summary table

SymptomQualityTypical timingFirst-line patient action
Post-prandial fullnessHeavy, bloatedStarts within minutes of eatingSmaller, low-fat meals; chew slowly
Early satiationSudden stopMid-mealSplit meals; avoid carbonated drinks
Epigastric painBurning/gnawingEmpty or full stomachWarm compress; acid-suppressant trial
BelchingRepetitive, involuntaryDuring and after foodEat upright; limit gum, straw use
NauseaMild, no vomitingPeaks with painGinger tea, paced breathing


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  3. Symptoms and Manifestations of Alcoholic Liver Disease
  4. What are the symptoms and manifestations of acute gastroenteritis?
  5. What are the symptoms and manifestations of proctitis?
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