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Nerve Pain Inner Upper Arm
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Left Upper Quadrant Pain
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The Information Standard
Dr Adrian Bonsall, 08 Jul 2017
This leaflet looks at pains which can develop in the upper part of the tummy (abdomen) on your left hand side. It deals with possible causes, how a diagnosis might be made and what the treatment might be.
In this article
- Arrow-downWhere is my left upper quadrant?
- Arrow-downWhat is in my left upper quadrant?
- Arrow-downWhat are the common causes of left upper quadrant pain?
- Arrow-downWhat are the common causes of left upper quadrant pain in pregnancy?
- Arrow-downWhat are the common causes of left upper quadrant pain in children?
- Arrow-downWhat else could it be?
- Arrow-downAre everybody's organs in the same place?
- Arrow-downWhat are the usual tests?
- Arrow-downWhat are the next steps?
- Arrow-downWhat treatment will I need?
- Arrow-downWhat is the outlook?
Left Upper Quadrant Pain
In this article
Where is my left upper quadrant?
The left upper quadrant (LUQ) is a section of your tummy (abdomen). Look down at your tummy, and mentally divide the area from the bottom of your ribs down to your pubes into four quarters. The quarter on your left side closest to your ribs is your LUQ.
By Blausen. com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.
What is in my left upper quadrant?
By Mariana Ruiz Villarreal, modified by Madhero88 [Public domain], via Wikimedia Commons
The organs within your LUQ include:
- Pancreas (a part of it – it crosses the midline).
- Left kidney (at the back behind the other organs) and left adrenal gland.
- Upper part of the large bowel (colon).
- A small part of your liver (most of it is on the right side, but a small part of it crosses over the midline into your LUQ).
And don’t forget the skin and nerves of that section.
What are the common causes of left upper quadrant pain?
There are a lot of possible causes for pain in the left upper quadrant (LUQ) area. The following are some of the possibilities, not in order of how common they are.
Problems with the spleen
Your spleen is just behind your stomach, under and behind the lower ribs on your left. Its main functions are to filter your blood, create new blood cells and store platelets. It is also a key part of your body’s immune system. It may cause pain:
- When it becomes enlarged, which can happen in certain blood-related cancers such as leukaemias and lymphomas. This tends to be a vague ache which may gradually get worse. It can also become enlarged during infections such as glandular fever, in which case a very mild pain would be associated with tiredness and repeated bouts of a sore throat and sometimes high temperature (fever).
- If it bursts (ruptures) following an injury, such as in a road traffic accident. This causes a sudden severe pain shortly after trauma to the tummy (abdomen.
- If it is damaged as part of a crisis in sickle cell disease.
Problems with your guts (bowels)
All sorts of common and uncommon problems to do with the upper and lower part of your guts can give you pain in this area. For example:
- Stomach ulcers. Stomach ulcers tend to give you pain in the middle of your tummy just under your ribs. The pain may be worse after eating or when you are lying down at night. Antacids may ease the pain. See separate leaflet called Stomach (Gastric) Ulcer for more information.
- Indigestion (dyspepsia). You can get some pain in the upper part of your tummy associated with heartburn and acid reflux. Again this tends to be worse lying flat or after meals. You may get some bloating. See separate leaflet called Indigestion (Dyspepsia) for more information.
- Gastroenteritis. Infections in your guts tend to cause pain all over your tummy, which is crampy and which is usually accompanied by diarrhoea and/or being sick (vomiting). See separate leaflet called Gastroenteritis in Adults for more information.
- Diverticulitis. This is an inflammation of a pouch or pouches which people who have diverticular disease have in their guts. Usually the pain from diverticulitis is lower in the abdomen, but sometimes it can be felt higher up. It usually comes with a temperature and an altered bowel habit. See separate leaflet called Diverticula (including Diverticulosis, Diverticular Disease and Diverticulitis) for more information.
- Crohn’s disease and ulcerative colitis. These are long-term conditions which can cause pain anywhere in the tummy at times. They usually cause loose stools, sometimes with blood. See separate leaflets called Crohn’s disease and Ulcerative Colitis for more information.
- Constipation. If your guts are full of poo, this can cause discomfort anywhere in your tummy. You will normally be aware that you are not opening your bowels as often, and that your poo is hard. See separate leaflet called Constipation in Adults for more information.
- Irritable bowel syndrome. This tends to cause pain lower down but can give pain anywhere in the tummy, especially as it often causes bloating which can make you feel uncomfortable higher up. It comes and goes and may be associated with diarrhoea and/or constipation. See separate leaflet called Irritable Bowel Syndrome for more information.
In some cases you can get the pain from shingles before the rash appears. You may have pain for a few days before a blistery rash appears. The pain tends to be quite sharp or burning, and you may feel not quite right in yourself. The tummy is a common place for a shingles rash.
Other people find they continue to get a pain long after the shingles rash is gone. This is called postherpetic neuralgia (PHN).
Kidney stones and infections
Problems with the left kidney tend to give you pain more around the left-hand side of the abdomen, or in your back (loin), but the pain may spread and involve the front of the tummy area. Kidney stones can cause a severe pain (usually round the back) which occurs in spasms lasting from a few minutes to several hours. There may be also be blood in your wee. A kidney infection can cause pain anywhere along your urinary tract. So this could be anywhere from the loin in your back, round to the front, the LUQ, or down to the lower part of your tummy. It may be associated with a fever, pain when you wee, or going to the loo more frequently.
Pain coming from the aorta
Your aorta is the main blood vessel of your body, carrying blood from your heart, and passing through the middle of your tummy, taking blood down to your legs and elsewhere. In some people this can swell, making it more vulnerable to leaking or bursting. If it develops a leak, you can get a tummy pain which you may feel in your back. If it bursts (ruptures), you will get a very severe pain in your tummy, back or chest and feel very unwell indeed. This is a major medical emergency and needs instant treatment. See separate leaflet called Abdominal Aortic Aneurysm for more information.
Pain coming from the pancreas
Your pancreas is in the middle of the upper part of your tummy. Chemicals (enzymes) made by cells in the pancreas pass into the guts to help digest food. The hormones insulin and glucagon are also made in the pancreas and help to regulate the blood sugar level. It can become inflamed in the conditions acute pancreatitis and chronic pancreatitis, causing upper tummy pain, usually with feeling sick (nausea) and/or being sick (vomiting). The pain is usually in the centre of the upper part of your tummy, but can be felt on the left. In acute pancreatitis there is usually also a fever and you may feel very unwell in yourself. Tumours of the pancreas can also cause upper tummy pain.
What are the common causes of left upper quadrant pain in pregnancy?
Any of the above conditions can cause pain in the LUQ area, whether you are pregnant or not, so you should always get checked out. However, in pregnancy a common cause of discomfort is the sheer pressure of the womb pressing on other organs, and pressing them into the diaphragm. Also problems with indigestion tend to be common in pregnancy, again at least partly due to the pressure on the stomach. Urinary tract infections are also more common in pregnancy.
What are the common causes of left upper quadrant pain in children?
In young children it is often quite difficult for them to show exactly where the pain is. If this is the case, the field of options widens to almost any cause of tummy ache. In children common causes include:
- Mesenteric adenitis. In children with infections such as colds, glands within the tummy commonly become inflamed giving them tummy ache.
- Appendicitis. Usually this gives pain in the lower right part of the tummy, but if a child can’t show you exactly where the pain is, or if the appendix has burst (ruptured), appendicitis may be a possible diagnosis to consider.
- Pneumonia. Infections in the lower parts of the lungs can cause pain in the tummy.
What else could it be?
The more common causes are those which arise from an organ which is located in the left upper quadrant (LUQ). However, sometimes a pain is felt in the tummy (abdomen), which is due to a problem elsewhere. Either this is because it is close by, or because the pain is “referred” from another part of the body further away.
Pain coming from a problem in your lungs
Problems with the lower part of your lungs may feel as though the pain is in the upper part of your tummy. The lower part of your lungs and the upper part of your tummy are separated only by the sheet of muscle called the diaphragm. Problems which might cause pain include infections such as pneumonia or pleurisy. You would usually have other symptoms such as a cough, high temperature (fever), or pain on breathing.
Pain coming from a problem with your heart
Problems with your heart more usually cause a pain in your chest. However, again the chest and tummy cavities are very close together and sometimes it may feel more as though the pain is in your upper tummy. Heart problems which might do this include:
- Angina. Pain usually comes on as you exert yourself and settles when you rest.
- A heart attack (myocardial infarction). Pain is sudden and crushing. There may also be pain in the left arm or jaw, and you may feel generally very unwell and/or short of breath. Call an ambulance immediately if you think you are having a heart attack.
- Pericarditis. This is an inflammation of the surrounding sac of the heart. More typically it gives you chest pain, usually with a fever.
Problems in your spine or back can be “referred” so that you feel the pain around the front. Pain may also be referred from problems in the pelvis, which is below the tummy. This might include conditions such as infections (pelvic inflammatory disease) or ovarian cysts. Again the pain in the LUQ area would usually be accompanied by one or more typical symptoms of these conditions.
Muscle pulls and sprains can also affect you in the tummy area, after an unusual exercise or activity. If this is the case, moving that particular muscle would make the pain worse, whereas if you lie completely still it wouldn’t hurt.
Medical illnesses causing pain
Medical illnesses which occasionally may cause pain in the upper part of the tummy include:
- A serious complication of type 1 diabetes, called diabetic ketoacidosis. This makes you very unwell generally, but occasionally tummy pain can be one of the symptoms.
- A complication of a condition called Addison’s disease, called an Addisonian crisis, occasionally can give you tummy pain. Again you would be unwell in other ways other than the pain.
- Sepsis. This is infection which has spread through your body, and again, in addition to pain you would be very unwell.
- An unusual blood disorder called acute porphyria.
Tumours in any of the organs within the LUQ area may cause a pain. This includes cancers of the stomach, kidney, upper colon, and pancreas. As mentioned previously, enlargement of the spleen due to lymphomas or leukaemias can also cause pain.
These lists of possible causes are by no means exhaustive and there are many other conditions which can occasionally cause pain in the LUQ area.
Are everybody’s organs in the same place?
Very rarely, it is possible to have organs the opposite way round to the usual arrangement. This occurs in less than 1 in 10,000 people and is called situs inversus. If you were one of these few then all the causes which affect most people in the right upper quadrant (RUQ) could give you pains on the left.
What are the usual tests?
Your doctor will narrow the (enormous) field of possible diagnoses by talking to you and by examining you. They may be able to find the cause simply from doing so. For example, if they find the typical rash of shingles, you will need no further tests to find the cause. If they find your spleen to be enlarged this suggests the problem is related to your spleen or blood. If examination is normal, that already rules out quite a few possible diagnoses. The doctor will certainly need to feel your tummy (abdomen) in the area you have the pain, but may also need to examine other parts too, such as the rest of your tummy and your chest.
- Check the function of your pancreas, liver and kidneys.
- Rule out any inflammation or infection in your system.
- Screen for lymphomas and leukaemias and to look for anaemia.
- Check your sugar level.
What are the next steps?
Next it will depend on what examination and the tests above have suggested. In some cases no further tests will be needed – if, for example, your doctor is confident you have indigestion, or constipation or shingles.
If a heart or lung problem is suspected, a heart tracing (electrocardiogram, or ECG) and/or chest X-ray might be required. If a problem with your stomach or upper bowel is suspected, you may need an examination with a tube with a camera put down into your stomach (an endoscopy). A computerised tomography (CT) scan or an ultrasound scan may be helpful to look at your spleen, pancreas or kidneys. In some cases an X-ray of the tummy may be useful. Further tests include other “scopes” (such as a colonoscopy or endoscopic retrograde cholangiopancreatography (ERCP) and other scans (such as a magnetic resonance imaging (MRI) scan).
Nobody will need all these tests, and some people may not need any.
What treatment will I need?
There is no single answer to this until you know what the cause of your pain is. See the relevant leaflet for the condition with which you have been diagnosed. Treatments for a few of the causes of left upper quadrant (LUQ) pain are briefly discussed below.
- Shingles. The pain and rash settle on their own in time, but some people may be advised to take an antiviral tablet to help speed this process up.
- Kidney infections are treated with antibiotics. Mild infections can be treated with antibiotics at home. If you are very unwell you may need admission to hospital for antibiotics and fluids through a drip (intravenously).
- Kidney stones. Small kidney stones pass on their own eventually, in which case you will need to drink plenty of fluids and take strong painkillers. Larger kidney stones may need one of a number of procedures done to break them up or remove them altogether.
- A stomach ulcer and indigestion are usually treated with acid-suppressing medication.
- Gastroenteritis usually doesn’t need any treatment, other than drinking plenty of fluid to compensate for all that is being lost. Occasionally when germs (bacteria) which can be treated with antibiotics are causing the infection an antibiotic may help.
- Ruptured spleens are usually removed with an operation (a splenectomy). You can survive without your spleen, but you do need to take certain precautions, as your spleen is important for your immune system. These include having certain immunisations and in some people taking regular antibiotics.
- If the spleen is enlarged by Lymphoma or leukaemia, treatment is usually with chemotherapy.
- Pneumonia is treated with antibiotics.
What is the outlook?
Again this depends entirely on the cause of the pain. Some conditions settle very quickly on their own (for example, gastroenteritis), or with the help of antibiotics (for example, a kidney infection). Others can be cured with treatment, such as stomach ulcers. Some can rumble on for a long time, such as postherpetic neuralgia (PHN). Your doctor should be able to give you an idea of the outlook (prognosis) once a diagnosis has become clear.
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Upper Abdominal Pain During Pregnancy
An ectopic pregnancy occurs when the embryo implants itself outside the uterine cavity. In most cases of ectopic pregnancy, the implantation occurs inside the fallopian tubes. However, it can also occur in cervix, ovaries or abdominal area. If unnoticed, there could be bleeding and other complications due to the rupturing of the area of ectopic pregnancy. This condition poses a threat to the life of the woman and calls for immediate medical intervention.
Many women miscarry in the first few months of the pregnancy. If a woman feels sharp pain in her abdomen followed by weakness and passing of blood, consult a doctor immediately.
One of the key causes of this pain is preeclampsia which occurs during the second or third trimester. It takes place when the pregnant woman is suffering from hypertension or high blood pressure along with the passage of significant traces of protein in the urine. This disorder leads to changes in the blood vessels, due to which certain organs of the body including the brain, kidney and liver can get affected. It may also adversely impact the placenta.
HELLP syndrome is a disorder which usually occurs during the last three months of pregnancy. The full form of HELLP syndrome is ‘Hemolysis, elevated liver enzymes, and low platelet count’. A woman is most likely to experience severe pain and tenderness on the upper right side of the abdomen. HELLP syndrome can lead to the development of preeclampsia, because the former can increase blood pressure levels and protein in the urine. Pregnant women may also suffer from blood clots as well as anemia due to HELLP syndrome.
Sometimes, a woman may feel contractions in the second and third trimester of pregnancy. These are not ‘near birth’ contractions, and are the result of tightening of the uterine muscles for a very short duration. They usually disappear in some time; but if they persist, it is advisable to consult your doctor.
If the cervix of a pregnant woman gets dilated or she starts to have contractions before completing 37 weeks, one of the symptoms will be severe pain in the upper part of abdomen. This symptom will be an indication of a preterm labor and will require immediate medical attention.
Usually, this condition gives rise to pain and discomfort in the lower abdomen and pelvic area, but if the infection spreads towards the kidneys, one can experience pain and discomfort in the upper abdomen as well.
The gallbladder is a small organ which stores bile (a digestive juice which aids in breaking down fats) in the body secreted by liver. Therefore, it plays an important role in the digestion of fat. However, during pregnancy, this organ does not work so effectively, and the bile can solidify to form gallstones or cholelithiasis.
A woman may also feel acute pain in the upper side of her stomach during pregnancy because of inflamed appendix caused by the enlargement of uterus. Unfortunately, it is difficult to detect appendix problems during pregnancy. It can be fatal if not treated in time. Hence, if you feel any kind of pain in your stomach, it is better to bring it to your doctor’s attention right away.
When the fetus grows in size, the ribs also increase, so as to help the baby to fit in the mother’s tummy. It is natural for the mother to experience pain in that area due to this bodily change.
Excessive gas and bloating due to improper or slow digestion during pregnancy can cause such a pain. The extra pressure exerted by the uterus on stomach and intestines is also one of the causes of pain in the upper part of the stomach.
A pregnant woman’s digestive tract takes more time to process food which results in constipation leading to pain in the abdomen.
This Buzzle article is for informative purposes only, and should not be used as a replacement for expert medical advice.
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