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Severe pain in the upper abdomen are common complaints, which may be caused by a number of possibilities. The upper abdominal region lies just below the chest, ribs, and diaphragm, where various organs may be found. These include portions of the digestive system, including the stomach, the small intestines, the liver, the pancreas, and the gallbladder. Muscles, blood vessels, nerves, and part of the spine are also in this region. Any trauma, infection, or disorder affecting any of these organs and tissues may cause upper abdominal pain. In addition, some disorders may cause referred pain (spread of pain) to this area, even if the cause is remote.

Common Causes of Severe Upper Abdominal Pain

The common causes of pain the upper abdomen include:

  • Acute gastroenteritis, which is caused by viral or bacterial infection, leading to vomiting, fever, and diarrhea. If vomiting is persistent, dehydration may occur. Pain in the upper abdomen may spread to the rest of the abdomen, resulting in cramping and bloating.

  • Gastritis, which is due to inflammation and erosion of the inner lining of the stomach. The pain may be a burning, gnawing type of pain, which may be associated with bloating, nausea and vomiting.

  • Stomach ulcer, which is due to erosion of the inner lining of the stomach. The pain may be a a sharp type of pain that spreads to the back, and is worsened by eating. It may cause you to wake up at night, and may lead to weight loss.

  • Duodenal ulcer, which is due to erosion in the inner lining of the upper part of the small intestine, may have similar symptoms as stomach ulcers, except that the pain may be relieved by food intake.

  • Gallstones in the gall bladder or ducts, which is accompanied by a sudden, colicky type of pain that may spread to the back, between the shoulder blades or right shoulder.

  • Cholecystitis, which is due to inflammation of the gallbladder, is linked to obstruction in the flow of bile from the gallbladder, and possibly infection. The pain is a dull, boring type of pain, accompanied by nausea, vomiting, fever, and spread of pain to the right side of the chest. The pain usually occurs after eating a fatty meal.

  • Acute pancreatitis, or inflammation of the pancreas, causes a severe upper abdominal pain that spreads to the back. The pain is worsened by eating and is accompanied by nausea, vomiting and abdominal tenderness.

  • Referred pain, which is pain that originates from another location. Inflammation of the appendix in the lower abdomen (appendicitis) can manifest as pain in the upper abdomen, and is often accompanied by nausea, vomiting, fever, and loss of appetite. Angina, or chest pain, may also spread to the upper abdomen, and may be accompanied by nausea and sweating. Symptoms lasts for a few minutes and are relieved by rest and medications. A heart attack may also manifest as a severe upper abdominal pain, instead of chest pain, and may be accompanied by sweating, nausea, shortness of breath, increasing heart rate, and cold, clammy skin.

When to Seek Help

Severe upper abdominal pain is always a good reason to seek medical help, especially if the pain is persistent or getting worse. Immediate consultation is recommended if you also experience persistent vomiting, vomiting blood, dark tarry stools, high fever, and enlargement of the abdomen.

Diagnosis may be made after thorough clinical evaluation, which may include laboratory tests such as blood tests, stool exams, imaging exams, and endoscopic procedures.

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