LEFT UPPER QUADRANT PAIN

For all abdominal pain, anatomy is the key to recalling the many causes of pain in the left upper quadrant (LUQ) by visualizing the structures layer by layer. In the first layer are the skin, abdominal wall, and ribs; in the second layer, the spleen, colon, and stomach; and in the third layer, the pancreas, adrenal gland, kidney, aorta, and spine. Now it is possible to cross-index the organs with the various etiologies contained in the mnemonic VINDICATE (Table 8). The following discussion emphasizes the most important of these.

ABDOMINAL PAIN, LUQ

1. Abdominal wall and ribs. Pain will occur most commonly from herpes zoster, contusion, hernia, rib fracture, or metastatic tumor.
2. Spleen. Painful splenic infarcts are not unusual in subacute bacterial endocarditis, polycythemia, sickle cell anemia, leukemia, periarteritis nodosa, and other autoimmune disorders. A ruptured spleen is an important consideration in abdominal injuries, particularly those in children and in patients with infectious mononucleosis.
3. Stomach. Acute gaseous distention of the stomach in gastritis, pneumonia, and pyloric obstruction is a common cause of LUQ pain. Gastric carcinoma that extends beyond the wall of the stomach may cause pain. Episodic obstruction of the stomach in the “cascade stomach” should be considered in the differential diagnosis. Herniation of the stomach through the diaphragm occasionally causes LUQ pain.
4. Colon. An inflamed diverticulum or an inflamed splenic flexure from granulomatous colitis may cause pain in the LUQ. Less commonly, the colon develops a perforating or constricting carcinoma in this area, which obstructs the bowel. A mesenteric infarct of the colon, as well as gas or impacted feces in the splenic flexure, may also cause LUQ pain.
5. Pancreas. Acute pancreatitis, pancreatic pseudocyst, and carcinoma of the pancreas may cause LUQ pain.
6. Adrenal gland. Adrenal infarction from emboli or Waterhouse–Friderichsen syndrome may cause pain, but neoplasms rarely do until they have become massive.
7. Kidney. Renal infarct, renal calculus, acute pyelonephritis, and nephroptosis with a Dietl crisis may cause LUQ pain. Perinephric abscess must also be considered.
8. Aorta. Dissecting or atherosclerotic aneurysms of the aorta may cause LUQ pain, especially when they occlude a feeding artery to one of the structures there.
9. Spine. Herniated disc, tuberculosis, multiple myeloma, osteoarthritis, tabes dorsalis, spinal cord tumor, and anything else that may compress or irritate the intercostal nerve roots can cause LUQ pain.

Approach to the Diagnosis

The presence or absence of other symptoms and signs will be most helpful in the diagnosis. In acute cases, a surgeon is consulted and a flat plate of the abdomen, CBC, urinalysis, arid perhaps a serum amylase level should be done. If necessary, a CT scan of the abdomen is also done. Gastroscopy and colonoscopy may be desirable before other x-rays are done. In chronic cases, however, an upper GI series, barium enema, and stool examination for blood, ova, and parasites are indicated.

Other Useful Tests

1. Four-quadrant peritoneal tap (ruptured spleen)
2. Quantitative urine amylase
3. IVP (renal calculus)
4. Stool for occult blood (carcinoma, diverticulitis)
5. Gallium scan (diverticulitis, etc.)
6. X-ray of thoracolumbar spine (radiculopathy)
7. Small-bowel series (Meckel diverticulum)
8. Laparoscopy (ruptured viscus or peritonitis)
9. Aortogram (dissecting aneurysm)
10. Lymphangiogram (retroperitoneal sarcoma)
11. Exploratory laparotomy

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Upper back pain

Read excerpts from these other book chapters related to Upper back pain:

Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

More About Causes of Upper back pain

• Back to symptom: Upper back pain: Introduction (review 20 causes)
• Next Book Extract About Upper back pain: RIGHT UPPER QUADRANT PAIN (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Upper back pain

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

 » Next page: RIGHT UPPER QUADRANT PAIN (Differential Diagnosis in Primary Care)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• RIGHT UPPER QUADRANT PAIN (Differential Diagnosis in Primary Care)
• Back pain (Handbook of Signs & Symptoms (Third Edition))
• Back Pain (A Pocket Manual of Differential Diagnosis)
• Back pain (Professional Guide to Signs & Symptoms (Fifth Edition))
• Low Back Pain (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

Tools & Services:

• Bookmark this page
• Take a survey relating to Upper back pain
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City