Stomach-ache is not just “tummy hurt”. The same spot can mean opposite diseases depending on how the pain feels and what comes with it. Here is a rapid field-map.
1. Map by quadrant
- Epigastrium: stomach, duodenum, gall-bladder, liver, pancreas
- Peri-umbilical: small bowel, early appendix, mesenteric nodes
- Right lower: appendix, right adnexa, right ureter
- Left lower: sigmoid colon, left adnexa, left ureter
- Flank / back: kidneys, retro-peritoneum
- Diffuse: obstruction, peritonitis, metabolic or functional disorders
2. Listen to the “voice” of pain
- Colicky (waves): spasm of hollow viscus – gastro-enteritis, stones, early obstruction
- Burning / dull: mucosal lesion – gastritis, reflux
- Sudden knife-like: perforation – ulcer, diverticulum rupture
- Persistent boring: capsular stretch – hepatitis, cholecystitis, pancreatitis
- Referred: appendix umbilicus→RLQ; gall-bladder→right scapula; kidney→groin
3. Decoding companions
- Nausea / vomiting: infection, pancreatitis, pyloric obstruction
- Diarrhoea + fever: food-borne infection
- Jaundice: biliary obstruction or hepatitis
- Haematuria: urolithiasis
- Missed period + pelvic pain: ectopic pregnancy, ovarian torsion
- Zoster rash: neuropathic pain often misdiagnosed
4. Age & sex quick hints
- Children: intussusception, mesenteric adenitis, Henoch-Schönlein purpura
- Women of child-bearing age: ectopic pregnancy, corpus luteum rupture, endometriosis
- Elderly: mesenteric ischaemia, diverticulitis, cancer-related obstruction / perforation
5. Functional vs organic
Pain ≥ 3 months, weekly episodes, normal tests → think irritable bowel or functional dyspepsia; night-pain absent, weight stable, pain relieved by defaecation or flatus.
6. Red-flag call-999 list
Sudden excruciating pain with rigid board-like abdomen, lasting > 6 h, plus high fever, haemodynamic instability, melaena or visible abdominal wall bruising – suspect perforation, massive bleeding, severe pancreatitis or gut necrosis.
At-a-glance table
| Site | Usual suspect | Pain character | Key red-flag add-ons |
|---|---|---|---|
| Epigastrium | Gastritis / ulcer | Burning, meal-related | Acid regurgitation |
| Right upper | Acute cholecystitis | Constant ache → right shoulder | Fever, positive Murphy sign |
| Left upper | Acute pancreatitis | Steady boring to back | Persistent vomiting, high serum amylase |
| Umbilicus → RLQ | Appendicitis | Migrating colic → steady | Local tenderness, rebound |
| Flank | Renal stone | Colic radiates to groin | Blood on dip-stick, costo-vertebral angle tenderness |
| Female pelvis | Ectopic pregnancy | Sudden stabbing | Missed period, shock |
| Generalised | Bowel obstruction | Colicky → distension | Bile vomiting, absent flatus / stool |
| Variable | Irritable bowel | Cramp relieved by gas | No weight loss, no night pain |