ALGORITHMIC APPROACH TO EVALUATE PATIENTS WITH CHRONIC UPPER ABDOMINAL PAIN - See more at: http://www.journalijar.com/article/8279/algorithmic-approach-to-evaluate-patients--with-chronic-upper-abdominal-pain/#sthash.ehZ906Q7.dpuf

Introduction:- chronic upper abdominal pain , is the pain that persists for more than 3 months either continuously or intermittently .It is a common problem. There are at least 27 differential diagnoses in the middle upper abdomen,14 differential diagnoses in the right upper abdomen, and 17 differential diagnoses in the left upper abdomen. Nearly all patients with chronic abdominal pain have had a prior medical evaluation that did not yield a diagnosis after history, examination, and basic testing. Aim:- to assess the best diagnostic approach for the patient with chronic upper abdominal pain (whom has no leading signs or symptoms) starting from the history till more advanced investigations and to have an algorithm for this diagnosis. Patients and methods:- This prospective study is conducted in the consultant clinic of the Department of Surgery of Alkadhmiya Teaching Hospital in Baghdad, Iraq, between January 2007 and January 2013. It involves 1320 patients whom chosen by inclusion and exclusion criteria, and had full assessment by history, examination, investigations and then follow up for 6 months, for data input and analysis we use statistical social sciences using chi square. Results:- it is significant that most of the patients are females , the higher incidence at 30-39 y old , most common site is middle upper abdomen and most common final diagnosis is gall bladder and biliary problems. There is significant relationship between the age groups and the differential diagnosis for patients with chronic upper abdominal pain .Most of the patients were diagnosed in first step of investigations . There is difference in incidence between males and females for each disease. Conclusion:- Accurate history and examination can give clue about the diagnosis, but cannot give the final diagnosis. There is difference in differential diagnosis for each location of the pain. The diagnosis of the disease mostly is reached at simple investigation like ultrasound of the abdomen, and sometimes it need more specific investigations or interventional investigations. The gender differential diagnosis of chronic upper abdominal is the same unlike that of the lower abdominal pain which significantly varies. It is better to has algorithmic approach to diagnose patients with chronic upper abdominal pain. - See more at: