Ask a doctor on the topic of Internal medicine

Pain in the upper abdomen.

December 31, 2010 | 35,00 EUR | answered by Dr. med. Ralf Berg

Hello, I have been experiencing a stabbing pain in the middle of my upper abdomen for the past few days, as if I had swallowed a sharp-edged pebble. The pain is not constant, but comes and goes. So far, I have not been able to identify any correlation between the time of day, rest vs. movement, or eating and drinking. I (44) do not drink alcohol, I do not smoke, and I am not overweight. The problems started back in October with stomach pressure (no vomiting, no diarrhea, no loss of appetite). Later, nausea started, sometimes quite severe. Omeprazole only provided temporary relief (coincidence?). Stomach and colonoscopy in November/December showed no major findings (mild chronic gastritis, which is not being treated). All cell samples were normal. Since the end of November, the stomach pressure has disappeared, leaving only nausea, almost all day. And now these pains. However, I feel like the nausea has almost disappeared. Since the pains are clearly always in the middle of the upper abdomen (also with back pain in the evening under the right shoulder blade), I am afraid that there could potentially be pancreatic cancer behind this. Since I could only get an ultrasound appointment in January, I am seeking advice through this channel.

Dr. med. Ralf Berg

Dear patient,

during an ultrasound examination, the bile ducts, bladder, and large blood vessels (abdominal aorta) should also be examined. An ultrasound appointment is usually the first choice to further narrow down the problem. Unfortunately, I cannot expedite this process from the internet. Perhaps you can inquire among acquaintances about which general practitioners can bill ultrasound examinations through insurance. In general, you can usually get an appointment faster there than in internal medicine practices.

Regarding your suspicion that the pancreas is the cause of the symptoms, you could quickly get an indication by having a blood test for amylase and lipase done by your primary care physician. Based on your description, the pain is more indicative of pancreatitis rather than a tumor.

In conclusion: Focus on the gallbladder, aorta, and pancreas. The gallbladder and pancreas can also be initially checked through (blood) laboratory values. An ultrasound examination is necessary, and a preliminary assessment through ultrasound may be quicker in primary care settings. I hope I could help you further.

Best regards,
Dr. R. Berg