The diagnosis sometimes is difficult but the following clinical description may help. Children may not localize the pain very well. It is usually noted to be in the upper quadrants or the periumbilical area. The pain is usually constant, but it may be intermittent, and it may be made worse by eating. The knee-chest position will usually relieve the pain.
Vomiting is aggravated by eating or drinking.
It does not relieve the pain. Tenderness may be accompanied by guarding and rebound. Maximal tenderness is usually in the midepigastric region. Bowel sounds may be normal, hypoactive, or absent. Upper gastrointestinal hemorrhage.