Left upper quadrant pain

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 pubic hair into four quarters. The quarter on your left side closest to your ribs is your LUQ.

What organs are in my left upper quadrant?

Abdominal Quadrant Regions

OpenStax, CC BY 3.0, via Wikimedia Commons

The organs within your LUQ include:

• Spleen.

• Stomach.

• Part of the pancreas.

• Left kidney (at the back behind the other organs) and left adrenal gland.

• Upper part of the large bowel (colon).

• The aorta.

There are also the skin and nerves of that section.

What causes left upper quadrant pain?

Pain can come from any of the organs mentioned above, and these are the source for the most common causes. But the human body is never simple, so pain can also come from other areas of your body. This is called 'referred' pain. So this widens the possible causes of pain.

The following are some of the possibilities caused by the above organs. They are not in order of how common they are. Other causes are discussed later in this leaflet.

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. An enlarged spleen can also occur during infections such as glandular fever.

• If it bursts (ruptures) following an injury, such as in a road traffic accident or falling heavily onto handlebars of a bike. This causes a sudden severe pain shortly after significant injury to the tummy (abdomen).

• If you have sickle cell disease and are having a sickle cell crisis.

Problems with your guts (stomach and 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. The pain may feel like indigestion. Antacids may ease the pain for short periods of time. The pain can be severe and associated with vomiting. Some complications of stomach ulcers require emergency treatment. See the separate leaflet Stomach ulcer for more information.

• Indigestion (dyspepsia). You can get some pain in the upper part of your tummy associated with heartburn and acid reflux.

• 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).

• Diverticulitis. This is 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 (fever) and a change in your bowel habit.

• Crohn's disease and ulcerative colitis. These are long-term conditions which can cause pain anywhere in the tummy. They usually cause loose stools, sometimes with blood.

• 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.

• Irritable bowel syndrome. This tends to cause pain lower down but can give pain anywhere in the tummy, especially as it often causes bloating. It comes and goes and may be associated with diarrhoea and/or constipation.

Shingles

Sometimes people notice pain from shingles before the rash appears. The pain tends to be quite sharp or burning, and you may feel not quite right in yourself. A few days later a blistery rash appears. The LUQ is a common place for a shingles rash.

See the separate leaflet called Shingles (Herpes Zoster) for more information.

Kidney stones and infections

Problems with the kidney tend to give you pain more around the left-hand side of the LUQ, or in your back (loin), but the pain may spread and involve the front of the tummy (abdominal) area.

A kidney stone or infection can cause pain anywhere along your urinary tract. So this could be anywhere from the loin in your back, around to the front, the LUQ, or down to below your belly-button (umbilicus). It may severe, associated with a fever, pain when you wee, or you may pass urine more often than usual.

See the separate leaflets called Kidney infection (Pyelonephritis) and Kidney stones for more information.

Pain coming from the aorta

Your aorta is the main blood vessel of your body, carrying blood from your heart, and passing down 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. This is called an aortic aneurysm.

If it develops a leak, you can get a tummy pain which you may also feel in your back. Rarely, the aorta can develop a tear in a weakened area of the lining of the aorta. This is called an aortic dissection. If the aorta bursts (ruptures), you will get a very severe pain in your tummy, back or chest and feel very unwell indeed. Any pain which is suspected to come from the aorta is a medical emergency and needs immediate treatment.

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.

Cancers of the pancreas can also cause upper tummy pain although they can cause pain elsewhere such as the back, and, unfortunately, they often don't cause any symptoms until the person is very unwell with advanced cancer.

What are the other possible causes?

As well as the causes described above, many other conditions can cause LUQ pain. This list is not exhaustive.

• Problems with your heart. The heart is located near the LUQ and as a result heart problems can sometimes present with LUQ pain. Conditions include a heart attack (myocardial infarction), angina or pericarditis. Call an ambulance immediately if you think you are having a heart attack.

• Problems with your lungs. If there is an infection or condition affecting the lower part of your left lung or the diaphragm then you may feel pain in the LUQ. This includes pneumonia and pleurisy.

• Problems in your spine or back can be 'referred' so that you feel the pain around the front of your tummy (abdomen).

• 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, can give you tummy pain. You would also be very unwell with other symptoms.

• An unusual blood disorder called acute porphyria.

• Pain which is referred from the pelvis, which is below the belly-button (umbilicus). This can 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 sprains can affect the LUQ, particularly 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.

What causes 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. In early pregnancy it is important to consider ectopic pregnancy.

In pregnancy a common cause of discomfort is the pressure of the womb (uterus) pressing on other organs, and pressing them into the diaphragm. 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 causes 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:

• Constipation.

• Anxiety.

• Gastroenteritis.

• Mesenteric adenitis. In children with viral infections such as colds, glands within the tummy can 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.

• In addition, many of the adult causes listed above may cause LUQ pain in children.

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 fewer 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.

Should I see a doctor for upper left abdominal pain?

Yes, if you have a pain which doesn't settle, you will probably need to see a health professional to help work out the cause. See a doctor urgently if:

• Your pain is very severe.

• You have recently lost weight without trying or have lost your appetite.

• You are bringing up (vomiting) blood, or have blood in your poo (including a very dark coloured poo which can be caused by old blood high up in the gut).

• You have a high temperature with shaking (rigors).

• You feel short of breath.

• You are having difficulty swallowing food. You may feel food is getting "stuck" in your food pipe (oesophagus) when you swallow, or feel pain in your lower throat or chest when you swallow food.

How is left upper quadrant pain diagnosed?

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.

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.

You may be asked to provide a sample of urine, to rule out kidney problems. You may need further tests, depending on what they think is causing the pain.

You may have to have blood tests to check the function of some of your organs or look for inflammation or possible infection. The doctor may ask for a pregnancy test to check you are not pregnant. You may be asked to provide a poo (stool) sample to look for infection in the stomach.

What are the next steps?

Next it will depend on what has already been found by examining you and talking with you. 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. 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.

Treatment for left upper quadrant pain

This will depend on the cause of your pain. See the relevant leaflet for the condition with which you have been diagnosed.

What is the outlook?

Again this depends entirely on the cause of the pain. Your doctor should be able to give you an idea of the outlook (prognosis) once a diagnosis has become clear.