Organs that Cause Upper Left Abdominal Pain
- Stomach
- Pancreas
- Colon
- Lung
- Heart
- Spleen
- Kidney
Now we will discuss each organ, and the problems that arise to cause Upper Left Abdominal Pain. Recall, any word ending in – itis means inflammation of that organ. In general, a tumor involving any of these areas, whether benign or malignant, can cause pain deriving from the organ involved.
Stomach
The stomach usually causes pain in the Left Upper Quadrant, middle, and right side less so. The conditions of the stomach that will cause pain are: Stomach ulcer, gastritis, and some forms of hiatal hernia.
Pancreas
The pancreas lies in the middle abdomen, but pancreatic pain can refer to the Left Upper Quadrant (LUQ) or Right Upper Quadrant (RUQ), and often shoots into the back. Pancreatic conditions that can cause LUQ pain are: pancreatitis, pancreatic pseudocyst (pancreas digests itself and leaves fluid that appear like a cyst).
Small Intestine
The small intestine is about 20 feet long and fills the center of the abdominal cavity. It moves around, and pain from this organ can occur in any location. Typically, the pain is more diffuse and generalized, but ulcers, blockages, and infections can cause referred pain to the LUQ.
Colon
The colon, or large intestine is frequently a cause of abdominal pain. As the Colon runs up the R abdomen, across the upper abdomen, and down the L Abdomen, any problem along that route can cause pain in the overlying area. LUQ pain from the colon can be caused by the following problems: Infections such as diverticulitis (Infection in a dead end pocket off the large intestine), stool impaction, and blockages either from the intestine twisting on scar tissue, or obstruction from stool or a mass can all cause LUQ pain. If intestine is perforated, air from the bowel travels upward, and gets trapped under the diaphragm and can cause pain in LUQ, with referred pain to the shoulder.
Lung
Although the lungs are in the chest cavity, they are lined with thin membranes called the pleura, and right below this sits the diaphragm. Any problems in the lower lung fields, the pleura or something that touches the diaphragm can cause pain in the LUQ. The most common issues that cause pain in this area are: pneumonia, pulmonary embolus (blood clot in the lung), and empyema (collection of pus above the diaphragm).
Heart
Most cardiac pain is above the diaphragm, however, angina and even heart attacks can present with LUQ pain if a particular blood vessel in the heart is compromised. If such pain is cardiac, it may be accompanied by nausea, jaw pain, L arm pain, and/or sweating. If so, one should seek emergency care. A blood clot to the lung will cause the pain, shortness of breath, palpitations, and possible low grade fever.
Spleen
The spleen rests directly under the left rib cage, and splenic issues will typically present with LUQ pain. Such problems as a splenic abscess, splenic infection, splenic infarction (lack of blood to a part of the spleen), and a splenic rupture from trauma can all cause LUQ pain.
Kidney
Various kidney issues can cause pain. As a rule, the kidney has no pain receptors, but the capsule around it does. When the capsule is stretched, pain from the kidney itself can be felt in the LUQ. When there are kidney infections, or a polycystic kidney that cause the capsule to stretch, pain ensues on that side, in the LUQ if the L kidney is involved. Kidney stones in the kidney proper can cause this as well. Stones in the ureter will cause backup of urine into the kidney, and potentially dilatation with capsular stretch.
Other Causes of Left Upper Quadrant Pain
Trauma to the abdomen can cause obvious pain in the muscles and soft tissue of area. In addition, before the rash appears, shingles can cause pain on one side of the abdomen, radiating around from the back to the abdomen at the same spinal level. One final consideration, although unusual to present with high abdominal pain is a thoracic aortic aneurysm. When these leak, pain will be felt where the blood falls. Gravity makes blood pool in the pelvis which can cause both abdominal and back pain. The ripping of the vessel itself can cause referred pain to the LUQ. Other diseases such as diabetic ketoacidosis, Henoch-Schonlein purpura, hereditary angioedema, and porphyrias can also cause LUQ pain. More commonly, an elevated calcium level, and sepsis can also cause LUQ pain.
Most Common Causes of Upper Left Abdominal Pain
Peptic Ulcer Disease
Ulcers in the stomach and duodenum are top causes. They can be caused by a myriad of problems, most related to use of Anti-inflammatory medication or steroids. Helicobacter Pylori is an infection that causes ulcers as well and requires antacid as well as antibiotic therapy. Alcohol is also a major cause.
Gastroenteritis
This is a contagious infection of the GI tract and is heralded by nausea, vomiting, diarrhea, dehydration and anorexia. Pushing oral fluids to avoid dehydration, and eating a diet that is bland and gradually increasing the amount will help recovery. Over the counter treatments such as Bismuth Subsalicylate (Pepto Bismol) and use of Loperamide to avoid diarrhea are the most common treatments along with strict hand washing and tincture of time.
Pancreatitis
This is when the pancreas inflames and secretes enzymes that cause damage to the pancreas and fluid/electrolyte/hormonal problems result. Most people have abdominal pain, nausea and vomiting, diarrhea, fever and chills, as well as anorexia, and require hospitalization if they cannot maintain their hydration status or manage their pain with oral medication. The cause of this problem is either due to excessive alcohol intake, or a stone in the common bile duct or lower biliary tree. Stones will form from hypertriglyceridemia. These issues must be addressed or the condition will become chronic.
Irritable Bowel Syndrome w/Diarrhea, Constipation or Both
Irritable Bowel is a condition affecting the colon; that is commonly seen in younger women, but it can present in anyone at any time. It is characterized by abdominal cramping, constipation and/or diarrhea. Symptoms can be relatively severe, and are brought on by stress, certain foods, and a diet low in fiber.
Pyelonephritis
This is a very common infection of the kidney that presents with abdominal and flank pain with fever, chills, and anorexia. Often the patient starts with burning on urination, and frequency, and then the infection ascends from the bladder to the kidney. It is treated acutely with antibiotics, pain relief and fluids. If the patient can keep down oral medication and liquids, hospitalization is usually not necessary.
Symptoms of Gas
Air in the colon can move and shift, and cause pain anywhere along the route. Simethicone is used to reduce gassy symptoms and pain. If severe this can be due to a bowel obstruction which will be evident on x-ray.
Pneumonia
A patient with a large lower lobe pneumonia, or lung infection, can present with LUQ pain. Typically, there will be other symptoms with cough, fever, shortness of breath, wheezing, chills, and anorexia. The patient that is not low on oxygen and can hold down orals will usually respond to oral antibiotics. If unable to hold down orals, or if the patient is hypoxic, they will typically require hospitalization.
Splenomegaly
An enlarged spleen due to any cause will stretch the splenic capsule and cause LUQ pain. This can be due to infection, blood disorders, or liver disease, among others. Treatment is to try to resolve the primary problem, and if the issue remains, the spleen can be surgically removed.
Evaluation of Upper Left Abdominal Pain
When a patient present with acute LUQ pain, there is a basic evaluation done. 90% of the diagnosis lies in the history, so an adequate history of the acute problem needs to be taken. Then a complete exam. After these, most providers with have an idea of what the issue is at hand. If these do not reveal the issue, a basic workup is needed. The patient should have a urinalysis and culture, a complete blood count, liver function tests, electrolytes and renal function, blood culture if febrile, and a C-reactive protein to assess inflammation and possible sepsis. A chest x-ray is prudent for all cases of upper quadrant pain. If the diagnosis is suspected to be an obstructed bowel, an abdominal series x-ray should be done looking for air-fluid levels. Considering all other diagnoses, the best test overall is a CT scan of the abdomen. For any patient sick enough to require the ER, a CT is prudent. All patients will have IV placed, and given fluids while the work-up is done. Most diagnoses will respond well to IV fluid. Depending on the diagnosis suspected, the patient will be given antibiotics, or other instructions as noted.
