In a patient presenting with upper abdominal discomfort, one must consider not just the intra-abdominal organs that are related anatomically to that region, but recognize that org a ns that a re outside the abdominal cavity and systemic illness can also cause symptoms referable to the upper abdomen. The physical examination of a patient with upper abdominal symptoms follows the time-proven steps of observation, palpation, percussion and auscultation. The choice for the right investigations is crucial in investigating symptoms of the upper abdomen. Investigations must be based on the history, physical examination and list of possible diagnoses. It is important to remember that an inappropriate investigation with negative results does not exclude certain pathology. Upper abdominal pain is very common condition. It is not practical or required for every patient with this symptom to be thoroughly investigated before instituting treatment. Empirical treatment can be offered to most patients after a detailed history, physical examination and some basic investigations are found to be negative. Follow up of the patient to the resolution of symptoms is good practice. Referral may be needed if there are red flags or the patient is not improving as expected.