Abdominal pain ranks among the most common symptoms that leads people to seek medical care. This symptom, however, is woefully nonspecific -- meaning it occurs with a broad array of conditions that range from mild to life-threatening. Doctors narrow the list of possible causes by considering the location of the pain. Left upper quadrant (LUQ) pain can occur with many conditions affecting a variety of organs, including the stomach, colon, spleen, pancreas, kidneys, lungs and heart. The timing and nature of the pain, accompanying symptoms, physical findings, and laboratory and imaging test results help the medical provider home in on the likely cause.
Stomach and Colon Conditions
The stomach sit just under the lower left ribs at the front of the body and extends toward the middle of the upper abdomen. Disorders of the stomach commonly cause LUQ or upper midline pain. Common causes include stomach ulcers and gastritis, or inflammation of the stomach lining. Stomach cancer is a less common possibility.
A portion of the large intestine called the transverse colon crosses the upper abdomen, passing below the stomach on the left side of the body. Disorders affecting this portion of the colon can cause LUQ pain. Examples include:
-- inflammatory bowel disease
-- severe constipation
-- irritable bowel syndrome
-- colon cancer
Heart, Lung and Chest Conditions
The left chest and LUQ of the abdomen are separated by the diaphragm, the large muscle that helps move air into and out of the lungs. Given their close proximity, it's relatively common for ailments involving the left chest to cause LUQ pain. Heart-related pain is an important consideration. Angina refers to pain caused by insufficient blood flow to the heart. It is the most common symptom of a heart attack. This pain, which typically has a crushing nature, usually occurs in the chest but can be felt in the LUQ. Infection or inflammation of heart can also sometimes cause LUQ pain.
Pneumonia of the left lower lobe of the lung, which sits atop the diaphragm, is another consideration in people with LUQ pain. Cough, fever and difficulty breathing point to this cause. Pleurisy -- inflammation of the tissues that surround the lungs and line the chest wall -- can also cause sharp LUQ pain when the left lower lung is involved. The pain is typically sharp and occurs with deep inhalation, coughing and sneezing. Injuries to the ribs or muscles of the lower left chest might also be to blame for LUQ pain.
Spleen and Pancreas Conditions
The spleen sits high in the LUQ near the top of stomach. It is situated just below the diaphragm and is protected by the lower rib cage. Disorders of the spleen characteristically cause LUQ pain, which often radiates to the left shoulder. Blunt trauma to the left chest or upper abdomen can rupture the spleen, causing pain and tenderness of the LUQ, and potentially life-threatening bleeding. Enlargement of the spleen, or splenomegagly, can also cause LUQ pain, which is often described as fullness. Splenomegaly can occur with a variety of conditions, including:
-- sickle cell disease
-- leukemia or lymphoma
-- hepatitis or cirrhosis
-- infectious mononucleosis
The pancreas is an elongated organ that sits deep in the abdomen. It cross the midline, with the head to the right and the tail extending into the LUQ behind the stomach. Because of its location, diseases of the pancreas can cause pain centrally or on either side of the upper abdomen. Pancreatic pain commonly radiates to the central back. Pancreatic tumors and inflammation of the pancreas, or pancreatitis, can trigger LUQ pain.
Kidney Conditions and Causes
The kidneys reside in front of the rear abdominal wall to either side of the spine. The upper end of each kidney sits within the lower end of the rib cage at the rear of the body. An infection or stone involving the left kidney typically causes moderate to severe pain of the left flank, commonly extending into the LUQ and left groin. A tumor of the left kidney is another, less common possibility.
Several other disorders not already mentioned can sometimes provoke LUQ pain, usually along with other symptoms. For example, tearing or rupture of an aortic aneurysm -- a ballooning weakness of the largest artery of the body -- can cause pain in various sites of the abdomen and back. Certain conditions of the spine or spinal nerves can also cause pain that might be experienced in the LUQ. Abdominal bleeding, infection or inflammation that irritates the diaphragm merits consideration if other causes of LUQ have been ruled out.
Warnings and Precautions
Mild LUQ pain that goes away quickly may not be cause for concern. Persistent or recurring pain in this location, however, warrants a visit with your doctor to determine the cause and appropriate treatment. Seek urgent medical care if your abdominal pain is severe or accompanied by other alarming symptoms, including:
-- vomiting or coughing up blood
-- persistent nausea and vomiting
-- black or bloody stools
-- fever, chills or night sweats
-- abdominal distention or tenderness
-- shortness of breath or difficulty breathing
-- dizziness, lightheadedness or fainting
Reviewed and revised by: Tina M. St. John, M.D.
A ruptured spleen is a life-threatening cause of left upper quadrant abdominal pain. The spleen is located on the left side of the abdomen, just beneath the rib cage. The spleen wards off infection, filters metabolic waste products and produces red and white blood cells. Because of its location, the spleen is susceptible to injury. Blunt-force trauma to the spleen, which can rupture the spleen, may be caused by a motor vehicle accident, physical assault or a sports-related injury. Common signs and symptoms associated with a ruptured spleen include pain and tenderness in the left upper abdominal quadrant. Because a ruptured spleen can cause extensive internal bleeding, a person with this condition may also experience reduced blood pressure, lightheadedness and confusion. A ruptured spleen is a medical emergency.
- American Family Physician: Evaluation of Acute Abdominal Pain in Adults
- Family Practice Notebook: Left Upper Quadrant Abdominal Pain
- Patient.info Professional Reference: Left Upper Quadrant Pain
- Surgery: Basic Science and Clinical Evidence; Jeffrey A. Norton, et al.
- Learning Surgery: The Surgery Clerkship Manual; Stephen F. Lowry
- Differential Diagnosis in Primary Care, 4th Edition; R. Douglas Collins