Sudden epigastric pain with nausea and vomiting is common in the following diseases: the first one is acute gastritis, which occurs with paroxysmal pain in the left upper abdomen with nausea and vomiting when there is an unclean diet. The second is acute cholecystitis, which is usually persistent (painful), and a more typical sign is a positive Murphy’s sign. The third one is acute pancreatitis, which usually occurs after overeating or drinking a lot of alcohol, and the pain in the upper abdomen is persistent and very severe. Fourth, we need to exclude perforation of the upper gastrointestinal tract, which causes sudden epigastric pain.