Left Upper Quadrant Abdominal Pain

Causes and Management

 Left upper quadrant (LUQ) abdominal pain refers to discomfort located beneath the left rib cage. Since this region houses several critical organs, pain here may arise from minor issues or serious, potentially life-threatening conditions. A sound understanding of the anatomy and possible causes is essential for proper evaluation and treatment.

Anatomy of the Left Upper Quadrant (LUQ)

Organs and structures within or near the LUQ include:

• Stomach
• Spleen
• Pancreas (body and tail)
• Left kidney and adrenal gland
• Splenic flexure of the colon
• Jejunum (part of the small intestine)
• Left diaphragm and lower ribs
• Heart and lungs (via referred pain)

Pain in this region may also be linked to systemic, vascular, or referred disorders.

Frequent Causes of LUQ Pain

  Gastrointestinal Conditions

 Gastritis and Peptic Ulcer Disease

·        Cause: Irritation or erosion of the stomach lining, often from H. pylori, NSAIDs, or alcohol.

·        Symptoms: Burning LUQ pain, nausea, bloating, vomiting.

·        Diagnosis: Endoscopy, H. pylori testing, ultrasound, blood work.

·        Treatment: PPIs, antibiotics (for H. pylori), avoiding NSAIDs/alcohol.

 GERD (Acid Reflux)

·        Cause: Stomach acid entering the esophagus.

·        Symptoms: Burning LUQ or chest pain, worse after meals or lying down.

·        Diagnosis: Clinical assessment, pH monitoring, endoscopy.

·        Treatment: Lifestyle modifications, PPIs, H2 blockers.

       Splenic Flexure Syndrome

·        Cause: Gas trapped in the bend of the colon.

·        Symptoms: Bloating, flatulence, intermittent LUQ pain.

·        Diagnosis: Clinical, X-ray may help.

·        Treatment: Dietary adjustments, simethicone, antispasmodics.

   Inflammatory Bowel Disease

·        Includes: Crohn’s disease, ulcerative colitis.

·        Symptoms: LUQ pain, diarrhea (may contain blood), weight loss.

·        Diagnosis: Colonoscopy, stool studies, imaging.

·        Treatment: 5-ASA drugs, steroids, immunomodulators, diet changes.

        Splenic Disorders

Enlarged Spleen (Splenomegaly)

·        Cause: Infections, liver disease, blood disorders, malignancy.

·        Symptoms: Dull LUQ pain, early fullness.

·        Diagnosis: Exam, ultrasound, CT.

·        Treatment: Manage underlying disease; avoid trauma.

Splenic Infarction

·        Cause: Arterial blockage (clot, embolism), e.g., in sickle cell disease.

·        Symptoms: Sudden sharp LUQ pain, fever.

·        Diagnosis: CT with contrast, ultrasound, labs.

·        Treatment: Pain relief, anticoagulation, addressing cause.

Splenic Rupture

·        Cause: Trauma, or rarely spontaneous (infection, leukemia).

·        Symptoms: Severe LUQ pain, left shoulder pain (Kehr’s sign), shock.

·        Diagnosis: FAST scan, CT.

·        Treatment: Emergency surgery or close monitoring.

         Pancreatic Causes

Acute Pancreatitis

·        Cause: Gallstones, alcohol, high triglycerides.

·        Symptoms: Severe LUQ or upper abdominal pain radiating to the back, nausea, vomiting.

·        Diagnosis: Elevated enzymes (amylase/lipase), CT.

·        Treatment: Hospital admission, IV fluids, NPO, analgesia, treat cause.

Chronic Pancreatitis

·        Cause: Alcohol, autoimmune, genetics.

·        Symptoms: Ongoing LUQ pain, fat malabsorption, steatorrhea.

·        Treatment: Pancreatic enzymes, pain control, no alcohol.

          Kidney and Adrenal Conditions

Kidney Stones

·        Symptoms: Sharp LUQ/flank pain radiating to groin, blood in urine.

·        Diagnosis: Non-contrast CT, urinalysis.

·        Treatment: Fluids, analgesia, possible surgical intervention.

Pyelonephritis (Kidney Infection)

·        Symptoms: LUQ/flank pain, fever, dysuria, nausea.

·        Diagnosis: Urinalysis, urine culture, imaging (USG,CT Abdomen) if needed, CBC, KFT.

·        Treatment: Antibiotics, Analgesics, hydration.

Adrenal Tumors (e.g., Pheochromocytoma)

·        Symptoms: LUQ mass, episodic hypertension, palpitations, headaches.

·        Diagnosis: CT/MRI, hormone tests.

·        Treatment: Surgery, BP management.

        Musculoskeletal and Diaphragmatic Causes

Rib Fractures / Costochondritis

·        Symptoms: Localized LUQ pain, worse with movement or pressure.

·        Diagnosis: Clinical exam, X-ray chest.

·        Treatment: Rest, analgesics.

Diaphragm Irritation

·        Cause: Subdiaphragmatic abscess, referred pain from lungs/pleura.

·        Symptoms: LUQ pain, possible shoulder pain.

·        Diagnosis: Imaging (CT Abdomen, chest X-ray).

·        Treatment: Treat underlying condition.

          Cardiac and Respiratory Causes

Myocardial Ischemia

·        Symptoms: LUQ or epigastric pain, chest tightness, nausea, shortness of breath.

·        Diagnosis: ECG, cardiac enzymes.

·        Treatment: Urgent cardiac management.

               Pneumonia / Pleurisy (Left Lung Base)

·        Symptoms: LUQ pain with cough or breathing, fever.

·        Diagnosis: Chest X-ray, lab tests, ECG.

·        Treatment: Antibiotics, supportive care.

      Diagnostic Approach

1.   History: Onset, duration, triggers, associated symptoms, medical history.

2.   Physical Exam: Abdominal palpation, signs like Kehr’s sign (splenic rupture), CVA tenderness (kidney).

3.   Labs: CBC, LFTs, renal profile, Lipid Profile, amylase, lipase, urinalysis, cardiac work-up if needed.

4.   Imaging: Ultrasound, CT, endoscopy, chest X-ray, ECG depending on provisional diagnosis.

Management Principles

• Initial care: NPO if vomiting/pancreatitis suspected, IV fluids, pain relief, antiemetics.
• Targeted treatment:

·        Antibiotics for infections.

·        Steroids or immunosuppressants for IBD.

·        Surgery for emergencies (e.g., splenic rupture).

·        Lifestyle and long-term therapy for chronic conditions.

When to Seek Immediate Help

• Sudden, severe LUQ pain
• Signs of bleeding (dizziness, low BP)
• High fever with abdominal pain
• Pain spreading to chest, back, or shoulder
• Persistent vomiting or blood in stool/vomit

Conclusion

LUQ abdominal pain has many potential causes, ranging from mild gastrointestinal problems to serious cardiac, renal, or splenic conditions. A systematic approach using history, examination, and targeted investigations is crucial for accurate diagnosis and effective treatment. Recognizing emergency signs early can be life-saving.