Finding the Cause of Abdominal Pain

Left side abdominal pain may arise from the internal organs of the gastrointestinal and urinary tract, chest, pelvic cavity, abdominal wall muscles, bones (ribs, spine, pelvis), vessels, nerves or skin. The presence of other signs and symptoms are an important indication of possible causes of left sided abdominal pain and factors that exacerbate or ease the pain are a vital clue to the underlying condition.

If the pain is of a sudden onset, unbearable and associated with a high fever, dizziness, confusion or a loss of consciousness, immediate medical attention needs to be sought. Take note of whether the pain is related to eating, sleeping, bowel movements, flatulence (passing gas), movement or menstrual cycle in females.

The list of causes of  left side abdominal pain are listed below are arranged in order from the upper abdomen (above the navel) to lower abdomen (below the navel). It is intended to serve as a guide but ultimately a diagnosis by a medical professional is necessary so that the appropriate treatment can be commenced as soon as possible. An abdominal ultrasound, x-ray, CT scan or MRI are often necessary for a definitive diagnosis, along with specialized investigations like a flexible sigmoidoscopy, colonoscopy or double contrast barium enema for gastrointestinal conditions.

UPPER Left Abdominal Pain

Upper left abdominal pain is most often due to a condition afflicting one or more organs or structure in the LUQ (left upper quadrant) of the abdomen. It may also be due to conditions in the thoracic cavity or lower left abdominal area that either refers or radiates to the LUQ. Causes of upper left abdominal pain include:

LARGE INTESTINE

Also known as the large bowel, it is responsible for the final stages of water absorption which leads to the formation of a solid stool from liquid intestinal chyme from the small intestine. It houses a number of species of colonic bacteria which are necessary for normal functioning but can be pathological if there is an overgrowth or pathogenic bacteria replace it. The large intestine includes the cecum (junction between small and large intestine), colon, rectum and anus. Conditions of the large intestine that may cause left side abdominal pain includes :

  • Constipation
  • Volvulus – twisting of the transverse colon around its axis (rare)

ABDOMINAL MUSCLES

The abdominal muscles includes several types of muscles that make up the abdominal wall. It protects the abdominal organs which lacks a skeletal shield like the chest cavity and also plays various roles in movement of the legs and thorax. These muscle also stabilize the trunk during standing, walking and running and are prone to injury. Muscular conditions that may cause abdominal pain includes :

  • Muscle strain
  • Abdominal hernia
  • Strenuous exercise
  • Blow, blunt force trauma
  • Rectus sheath hematoma
  • Abscess in psoas muscle

PANCREAS

The pancreas is a large multipurpose gland which has exocrine functions that affects digestion and endocrine functions which control metabolism. It empties its digestive enzymes (exocrine component) into the duodenum, the first part of the small intestine, along with bile released by the gallbladder. Without these enzymes, the process of digestion is severely hampered. Pancreatic conditions that may cause left side abdominal pain include :

SPLEEN

The spleen is the largest lymph node in the body responsible for filtering blood and removing cellular debris and foreign microorganisms. Although the spleen can be removed without hampering life, it nevertheless plays several important roles in the body. Splenic conditions that may cause left side abdominal pain includes :

  • Splenic infarct
  • Ruptured spleen, often in car accidents
  • Enlarged spleen (splenomegaly) only in cases of massive splenomegaly.

KIDNEYS/URETER

The kidney is responsible for filtering the blood, removing wastes and passing it out in the urine while conserving essential electrolytes and water. It also plays other important roles in regulating several functions in the body that are not associated with urine, like stimulating the production of red blood cells. The kidney is located in the upper part of the abdomen and shielded by the ribcage. Urine from the kidney leads to the bladder via the ureter. Conditions affecting the kidney and/or ureter that may result in left side abdominal pain include :

  • Pyelonephritis – infection of the kidney
  • Glomerulonephritis (kidney inflammation), kidney cyst or tumor
  • Urinary stones

LEFT ADRENAL GLAND

The adrenal gland, also known as the suprarenal gland, is located on the top of the kidney. It has two distinct layers, the medulla and cortex, which secrete various hormones that play important roles in the body.

  • Adrenal adenoma (benign tumor)
  • Adrenal carcinoma also known as adrenocortical carcinoma. (malignant tumor)

LUNGS

The lungs are responsible for gas exchange between the air and blood stream. Although not often considered in abdominal pain, diseases affecting the base of the lung may affect the pleura lining around the lung) and diaphragm (main muscle of respiration) that can lead to pain. The lung itself cannot feel pain unless the surrounding structures are affected. Some conditions of the lung that may cause abdominal pain includes :

  • Pneumonia – usually bacterial or viral
  • Pleuritis – inflammation of the lung membrane
  • Pulmonary embolism – blood clots in the lungs

HEART

The heart is the muscular pump that circulates blood throughout the body. It is situated in the mediastinum, the centrally located cavity between the lungs and is in close proximity to the upper middle abdominal area. It often causes referred pain to the upper abdomen when diseased.

  • Heart attack
  • Angina pectoris – pain behind the breastbone in heart or coronary arteries disease
  • Pericarditis, mycocarditis or endocarditis

Heart diseases are often considered as medical emergencies as the condition can be life-threatening. It should always be suspected when accompanied by symptoms such as pain to the left jaw or arm with dizziness and/or fainting.

DIAPHRAGM

The diaphragm is the largest muscle of respiration and separates the chest cavity from the abdominal cavity. During inspiration it pushes the abdominal contents downwards as the chest cavity expands. On the left side, the most prominent feature is the diaphragmatic opening which allows the esophagus (gullet) to pass to connect with the stomach.

  • Abscess – collection of pus below diaphragm

STOMACH

The stomach is the hollow sac that lies between the end of the esophagus and the first part of the small intestine known as the duodenum. It is prone to various diseases often associated with the corrosive gastric acid that it produces and holds. Some conditions of the stomach that may be responsible for left sided abdominal pain includes :

  • Gastritis
  • Stomach ulcers
  • Hiatal hernia
  • Stomach cancer
  • Stomach polyps – pain is more likely in large masses.

OTHER

LOWER Left Abdominal Pain

Lower left abdominal pain may be due to the organs or structures located in the LLQ (lower left quadrant) of the abdomen. As with upper abdominal pain, the pain may be referred or radiated from other sites. Due to the continuity of the many structures, particularly the gastrointestinal tract, urinary tract and large blood vessels (aorta or inferior vena cava).  The pelvic structures, particularly the ovaries, fallopian tubes and uterus, are common causes of lower left abdominal pain in women.

COLON

The colon is the largest part of the left intestine as described above.

  • Constipation
  • Trapped gas in the colon is more likely to occur in the left part of the transverse colon (splenic flexure syndrome).
  • Irritable bowel syndrome (IBS) is functional disorder particularly of the large intestine characterized by disturbances in bowel habit and intestinal cramps, hence the alternative name spastic colon.
  • Diverticulitis – inflammation of the last part of the colon (sigmoid colon).
  • Diverticulosis - non-inflamed pouches in the colonic wall
  • Clostridium difficile infection after antibiotic treatment
  • Inflammatory bowel disease (IBD): Crohn’s disease or ulcerative colitis
  • Ischemic or microscopic colitis
  • Colorectal polyps, or cancer
  • Volvulus of sigmoid colon

APPENDIX

This is an outpouching of the large intestine which may become obstructed, infected and severely inflamed. Appendicitis usually causes right lower but sometimes left lower abdominal pain.

FEMALE REPRODUCTIVE ORGANS

Various gynecological disorders are a  common cause of lower left abdominal pain in women particularly when associated with ovulation and menstruation (periods). Pregnancy may also account for pain due to the expanding uterus and uterine contractions seen in an otherwise healthy pregnancy.

  • Ovulation (mid-cycle pain, Mittleschmerz)
  • Gonorrhea
  • Twisted or ruptured ovarian cyst
  • Ectopic pregnancy
  • Pelvic Inflammatory Disease (PID)
  • Endometriosis (inflammation of the endometrium)
  • Miscarriage
  • Polycystic ovarian syndrome – PCOS
  • Fibroids

MALE REPRODUCTIVE ORGANS

Pain rarely occurs solely in the left lower abdominal area without pain, swelling or visible lesions in the pelvic area or on the genitalia.

  • Spermatic cord disorders
  • Testes disorders
  • Gonorrhea

ABDOMINAL MEMBRANE (PERITONEUM)

The peritoneum is the membrane that surrounds various abdominal organs, particularly those of the gastrointestinal tract, and encloses it within its own peritoneal cavity in the abdomen. Peritoneal fluid helps to lubricate the organs that are in constant contact with each other.

  • Peritonitis
  • Ascites

ABDOMINAL BLOOD VESSELS

The abdominal blood vessels include the abdominal portion of two of the largest blood vessels in the body – aorta (artery) and inferior vena cava (vein) – that carries blood to and from the heart. It is prone to a number of disorders and diseases which may also include its various branches and tributaries.

  • Aneurysm of abdominal aorta
  • Atherosclerosis or embolism of mesenteric arteries
  • Hereditary angioedema
  • Henoch-Schönlein-purpura

BLOOD

  • Porphyria
  • Sickle Cell Disease

SKIN

Most skin diseases are associated with itching but pain can occur with the following conditions :

  • Herpes zoster (shingles)
  • Dermatitis exacerbated by an infection, abscess formation or tears in the skin.

OTHER

Read detailed articles with causes, symptoms and diagnosis of left upper abdominal pain and left lower abdominal pain.


Article reviewed by Dr. Greg. Last updated on August 14, 2013