Pain in the upper abdomen is usually due to gall-stones or a duodenal or gastric ulcer. Pain due to uncomplicated cholelithiasis appears and disappears suddenly, without warning, and may recur at intervals of hours, days, months or years. Gall-stone colic may occur at any hour independent of, and unrelieved by, food. The pain may be from mild to agonizing, and may be associated with spasm of the diaphragm or pylorus. It is localized in the epigastrium and may radiate to the scapula; its duration and intensity depend on (a) the size of the calculus; (b) the rate of progress through the ducts; (c) impaction of the stone; and (d) amount of obstruction to the flow of bile. A large stone lodged in the common duct, causing complete obstruction, produces maximum pain and jaundice, and the gall-bladder region may be tender on palpation. The pain in severe gall-stone colic may be
DALAND J. THE DIAGNOSIS OF PAIN IN THE UPPER ABDOMEN. JAMA. 1912;LVIII(14):1002–1004. doi:10.1001/jama.1912.04260040018007
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