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Epigastrium – Anatomy, Organs and Clinical Relevance

The epigastrium is the upper central region of the abdomen, located between the breastbone and the navel. It contains key organs such as the stomach, liver, and pancreas.

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Things worth knowing about "Epigastrium"

The epigastrium is the upper central region of the abdomen, located between the breastbone and the navel. It contains key organs such as the stomach, liver, and pancreas.

What Is the Epigastrium?

The epigastrium (also referred to as the epigastric region or upper abdomen) is an anatomical region of the abdomen. It is the central upper area of the belly, situated between the lower end of the breastbone (sternum) and the navel (umbilicus). In the standard nine-region division of the abdomen used in clinical medicine, the epigastrium occupies the central upper field, flanked on either side by the right and left hypochondriac regions.

Anatomical Location and Boundaries

The anatomical boundaries of the epigastrium are defined as follows:

Superior: Lower margin of the sternum and costal arch
Inferior: Horizontal plane at the level of the navel
Lateral: Lateral margins of the rectus abdominis muscle

Organs Located in the Epigastrium

Several important digestive organs and structures are located within or project into the epigastric region:

Stomach (Gaster): The primary digestive organ that receives and partially digests food
Liver (Hepar): The left lobe of the liver extends into the epigastrium
Pancreas: Lies transversely behind the stomach
Duodenum: The first section of the small intestine
Gallbladder (Vesica biliaris): Located near the border of the right hypochondrium
Abdominal aorta and celiac trunk: Major blood vessels supplying abdominal organs

Clinical Significance: Epigastric Pain

Pain or discomfort in the epigastrium, commonly referred to as epigastric pain, is a frequent medical complaint. It can indicate a wide variety of underlying conditions.

Common Causes of Epigastric Pain

Gastritis: Inflammation of the stomach lining, often associated with nausea and a sensation of pressure
Stomach ulcer (Peptic ulcer disease): An ulcer in the stomach wall causing burning pain
Heartburn and Gastroesophageal Reflux Disease (GERD): Acid from the stomach rising into the esophagus
Pancreatitis: Inflammation of the pancreas, often with belt-like radiating pain
Cholelithiasis (Gallstones): Gallstones can cause colicky pain in the upper abdomen
Functional dyspepsia: Digestive discomfort without an identifiable organic cause
Myocardial infarction (Heart attack): In some cases, a heart attack may present atypically as epigastric pain

When to Seek Medical Attention

Persistent, severe, or newly occurring epigastric pain warrants prompt medical evaluation. The following accompanying symptoms are particularly concerning:

Sudden, intense pain
Pain radiating to the back, shoulder, or chest
Nausea and vomiting with blood
Fever
Sweating and shortness of breath (possible heart attack)

Diagnosis

Several diagnostic procedures are available to evaluate complaints related to the epigastrium:

Physical examination: Palpation of the abdomen to localize the pain
Blood tests: Detection of inflammatory markers, liver enzymes, and pancreatic enzymes (lipase, amylase)
Ultrasound (Sonography): Imaging of the abdominal organs
Upper endoscopy (Esophagogastroduodenoscopy, EGD): Direct visual examination of the esophagus, stomach, and duodenum
Computed Tomography (CT scan): Detailed cross-sectional imaging for complex findings

References

Drake, R. L., Vogl, A. W. & Mitchell, A. W. M. (2019). Gray's Anatomy for Students. 4th edition. Elsevier.
Longo, D. L. et al. (2022). Harrison's Principles of Internal Medicine. 21st edition. McGraw-Hill Education.
Talley, N. J. & O'Connor, S. (2017). Clinical Examination: A Systematic Guide to Physical Diagnosis. 8th edition. Elsevier Australia.

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