Acute and Chronic Left Upper (LUQ) Abdominal Pain – Diagnosis

ACUTE Left Upper Abdominal Pain

Causes of acute (sudden, newly appearing) left upper abdominal (left upper quadrant or LUQ pain), lasting from few seconds to few weeks may arise from:

1. Injuries of Abdominal Wall Muscles

Injured abdominal wall muscles are tender to the touch and body movements affect the pain. A collection of blood (hematoma) may be sometimes seen as a bruise or small soft bulge. Detailed description of abdominal wall injuries is in upper middle abdominal pain.

2. Ribs-Related Pain

Pain from the fractured rib, costochondritis or pneumothorax is aggravated by breathing, coughing, moving of the trunk or pressure on the affected spot. Read details in right upper abdominal pain. X-ray of the chest is needed for diagnosis.

3. Acute Pancreatitis

Acute pancreatitis may cause upper middle or upper left abdominal pain, nausea, vomiting and fever.

4. Spleen Disorders

Splenic infarct is death of a part of the splenic tissue due to blockage of its blood supply due to blood disorders like leukemia, blood clots (from certain heart disorders), vasculitis, traffic accidents injuries and so on. Symptoms may include:

  • LUQ pain and, sometimes, chest and left shoulder pain
  • Fever, chills, nausea, vomiting

Diagnosis is made by contrast X-ray of splenic arteries (splenic arteriography) or CT.

Splenic abscess is a collection of pus in the spleen due to spread of infection (via blood) from anywhere in the body (endocarditis, pneumonia, urinary tract infection and so on) or direct spread from adjacent organs. Blood tests show elevated leukocytes. Main symptoms are LUQ and left shoulder pain and fever. Diagnostic procedures may include chest X-ray, ultrasound and CT.

Splenic rupture usually occurs in sport or car accidents – right after the accident or days or weeks later. It is also a known complication of infectious mononucleosis.  Symptoms are LUQ or diffuse abdominal pain, dizziness and paleness due to lost blood  from bleeding into abdominal cavity. Splenic rupture may (not always!) require urgent surgery, so diagnosis is often made on the basis of history of an injury and physical examination.

5. Left Kidney/Ureter Disorders

Symptoms are the same as on the right side and include pain in the flank and changed urine color.

6. Left Lung/Pleura Disorders

Symptoms are the same as on the right side and include cough and fever.

7. Heart Attack

Heart attack usually occurs in a person over 50 years of age as sudden severe LUQ or middle upper abdominal pain (and/or the pain behind the breastbone) lasting from few to several minutes, shortness of breath and anxiety (fear of death). Diagnosis is with ECG and changed levels of heart muscle enzymes.

8. Abscess Under the Diaphragm

LUQ and left shoulder pain and fever are main symptoms of the abscess under diaphragm on the left side. Causes and diagnosis are about the same as on the right side. 

CHRONIC Left Upper Abdominal Pain

Causes of chronic (lasting from weeks to years, or recurring) left upper quadrant (LUQ) pain:

1. Trapped Air in the Colon (Splenic Flexure Syndrome)

In constipation and other causes of bloating and gas, like lactose intolerance, fructose malabsorption, celiac disease or IBS, gas may be trapped in the part of the colon running near the spleen and cause “splenic flexure syndrome”: LUQ pain, aggravated by eating and relieved by passing the stool or gas. Pain may be quite severe and may mimic heart attack or pleurisy. The cause of pain may be colon distension or spasm.

2. Inflammatory Bowel Disease (IBD)

Crohn’s disease or ulcerative colitis may cause pain anywhere in the abdomen but mostly in the left lower or right lower abdomen. Other common symptoms are nausea, low grade fever, diarrhea, skin rash and mouth ulcers.

3. Chronic Colitis

Ischemic or microscopic (lymphocytic/collagenouscolitis (inflammation of the large intestine) mostly affect people after 60 years of age. Left upper or lower abdominal pain, diarrhea, blood in the stool and low grade fever are main symptoms. Diagnosis can be usually made from symptoms; in doubtful cases colonoscopy may be done.

4. Chronic Left Kidney/Ureter Disorders

Symptoms of chronic kidney/ureteral disorders resemble those in acute kidney disorders (see above).

5. Enlarged Spleen

Chronic blood disorders, like chronic leukemia or lymphoma, may result in massively enlarged spleen (splenomegaly), which can be easily detected by a doctor during a physical examination. Affected person feels pain in LUQ, early satiety (if spleen presses on the stomach) and symptoms of the original disease like tiredness and paleness due to anemia. Chronic infections, like malaria, are common in tropics. Check the list of causes of enlarged spleen. Diagnosis of the original disease is usually possible by blood tests (usually white cells are elevated). Spleen size and eventual damage can be evaluated by ultrasound and CT.

6. Chronic Pancreatitis and Pancreatic Cancer

Pancreatic disorders are described in middle upper abdominal pain. Beside pain, nausea, pale floating  stools, diabetes, chronic diarrhea, poor appetite and weight loss are main symptoms.

7. Stomach Disorders

Pain and other symptoms in chronic gastritis (often due to H. pylori infection), stomach (and duodenal) ulcer and stomach cancer may cause upper left or right abdominal pain but mostly middle upper abdominal pain. Nausea, belching, bloating, early satiety, poor appetite, pain during or after the meal and (in stomach cancer) weight loss are main symptoms. Diagnosis is with gastroduodenoscopy.

8. Left Adrenal Gland Disorders

Pain in the left flank, fatigue, brain fog, body swelling, dehydration, blood pressure changes and other changes may be due to disorder in the left adrenal gland. Symptoms are the same as on the right side.

9. IBS

The so-called irritable bowel syndrome (IBS) is irritation of the colon, supposedly due to a combination of stress and certain foods affecting people of any age, especially young people. Main symptoms are alternating diarrhea and constipation, abdominal pain or cramps, mainly in the upper or lower left abdomen, triggered by meal and relieved by a bowel movement. Foods to avoid in IBS.

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