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Upper Left Abdominal Pain

Pain in the upper left abdomen can be caused by a stomach ulcer, acute gastritis, a viral infection, or indigestion. But it may be an issue with your lungs, like pneumonia. If symptoms persist, talk to your doctor.
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Last updated September 29, 2021

Upper left abdominal pain quiz

Take a quiz to find out what's causing your pain.

Upper left abdominal pain quiz

Take a quiz to find out what's causing your pain.

Take upper left abdominal pain quiz

Pain in the upper left abdomen symptoms

Are you experiencing pain in your upper left abdomen? The abdomen can be separated into four quadrants, making it easier to pinpoint the source of your pain. However, it's quite likely that it will resolve on its own.

Upper left abdomen anatomy

The upper left part of the abdomen contains several structures including:

  • Pancreas
  • Spleen
  • Stomach
  • Diaphragm
  • Left lower rib cage
  • Left lower lung
  • Left lobe of the liver
  • Left kidney
  • Left adrenal gland
  • Upper left sections of the large intestine

Pain in the upper left abdomen is also called pain in the left upper quadrant, pain under the left ribcage, or pain in the left hypochondrium.

Common characteristics of pain in the upper left abdomen

The pain and tenderness you may be experiencing can likely be described by the following details:

  • Location: It will likely be beneath the lower edge of the rib cage, on the left side.
  • Sensitive: The pain will be evident on palpation (pressing) of the left upper abdomen.
  • Varied: The pain may range from mild and dull to severe and sharp.
  • Mobile: The pain may travel into the back at the same level, or to the left shoulder.
  • Worse when lying down

Other symptoms

You may also have a general ill feeling, as well as the following:

Who is most often affected?

People who are most likely to experience pain in the upper left abdomen include:

  • Men
  • Drinkers: Five or more alcoholic drinks per day can damage the pancreas
  • Anyone with high triglyceride levels
  • Anyone taking large amounts of prescription medication
  • Anyone using illicit drugs

When is it most likely to occur?

Pain may get worse after eating a large meal, especially one high in fat.

Is pain in the upper left abdomen serious?

Pain can vary in severity depending on the cause.

  • Moderately serious: Ongoing left-sided pain that does not clear up quickly with rest, or that has symptoms that continue to get worse is considered moderately serious.
  • Serious: Left-sided pain accompanied by shortness of breath, pain in the jaw or arm, lightheadedness, or fainting is considered serious.

Pain in the upper left abdomen causes and conditions

Causes of pain in the upper left abdomen can be varied. You should consult your physician for pain that doesn't resolve and to receive a definitive diagnosis.

Systemic infections

Several different types of systemic, or body-wide infections, can affect the upper left abdomen, such as those that are:

  • Viral
  • Bacterial
  • Parasitic
  • Fungal

Localized infections

A localized infection confined to one of the organs of the left upper quadrant can also occur.

  • Pancreatitis: This is inflammation of the pancreas.
  • Pneumonia or pericarditis: An infection of the lungs is known as pneumonia. An infection of the sac enclosing the heart is known as pericarditis.
  • Abscess (a pocket of infection): These are likely in the kidney.
  • Ulcer: This is an erosion in the stomach or duodenum.

Injury-related causes

Injury to the abdomen can lead to further damage such as internal bleeding. Injuries may be due to accidents, sports injuries, or medical procedures such as surgeries, biopsies, or endoscopic procedures. Specific injuries that may occur include:

  • Lower left rib fracture: The broken rib can puncture the lung, spleen, or kidney.
  • Collapsed lower left lung: A collapsed lung can cause significant pain.
  • Ruptured organ: The spleen is especially vulnerable. This is a medical emergency due to the internal bleeding that may occur.

Idiopathic conditions

These are caused by a combination of diet and exercise choices, along with heredity, allergies, and sometimes viral infections.

  • Autoimmune diseases: Lupus, for example, attacks the organs of the left upper quadrant causing damage and pain.
  • Metabolic disorders: These cause imbalances in the way the organs work, such as diabetes.
  • Left kidney: Mineral deposits ("stones") can cause severe pain.
  • Liver: Damage to the liver can cause enlargement of the spleen.
  • Stomach: Stomach acids can back up into the esophagus in diseases such as in gastroesophageal reflux disease (GERD).
  • Colon: Pain may come from the part of the colon lying under the left rib cage, caused by constipation or excess gas.

Drugs and medications

Many drugs can cause left upper quadrant pain and associated damage with chronic use. A few are listed here:

  • Aspirin: High doses can cause stomach bleeding and pain.
  • NSAIDs: These are non-steroidal anti-inflammatory drugs, such as ibuprofen.
  • Oral antibiotics
  • Opioids: Pain may be due to the side effect of chronic constipation.
  • Chemotherapy drugs
  • Cocaine

Cancer

Cancer is considered a rare cause of pain in the upper left abdomen.

  • Localized tumor: A cancerous growth anywhere in the left upper quadrant can cause pain. There may or may not be a lump in the vicinity of the pain.
  • Blood cancers: These will affect the entire body and cause symptoms in the organs of the left upper quadrant.

Upper left abdominal pain quiz

Take a quiz to find out what's causing your pain.

Take upper left abdominal pain quiz

Chronic pancreatitis

Chronic pancreatitis is an inflammation of the pancreas that does not improve, but slowly gets worse over time.

Causes include alcoholism; a blocked pancreatic duct; autoimmune disease, where the body's natural defenses turn against itself; and possible genetic factors.

Chronic pancreatitis is most common in men from age 30 to 40 with a history of alcoholism and a family history of the disease, but anyone can be affected.

Symptoms include severe pain in the back and abdomen, especially with eating; weight loss; nausea and vomiting; and diarrhea with oily-appearing, pale-colored stools.

The pancreas is vital for blood sugar control and for secreting certain digestive enzymes. If not treated, chronic pancreatitis can lead to permanent pancreatic damage, diabetes, malnutrition, and chronic pain.

Diagnosis is made through patient history, physical examination, and imaging such as x-ray, CT scan, or ultrasound.

Treatment involves pain management through both medication and surgical procedures. Lifestyle improvements through diet, exercise, and stress management can also be very helpful.

Rarity: Rare

Top Symptoms: fatigue, abdominal pain (stomach ache), nausea or vomiting, loss of appetite, abdominal pain that comes and goes

Urgency: Primary care doctor

Stomach ulcer

A peptic ulcer or gastric ulcer is an open sore that forms when inflammation occurs in the stomach lining.

This stomach inflammation is caused by the bacteria Helicobacter pylori (H. pylori) and by prolonged use of pain relievers such as ibuprofen or aspirin. Chronic inflammation allows acid to damage the stomach lining and an ulcer may form.

Smoking, drinking alcohol, stress, and spicy foods may aggravate ulcers, but do not cause them.

Symptoms include burning pain in the stomach; heartburn; nausea; and bloating.

The pain may be worse between meals or at night. Antacids will only work for a short time. There may be dark red blood in the vomit or stools.

Left untreated, ulcers may bleed and cause anemia. They may perforate the stomach and cause peritonitis (serious infection of the abdominal cavity.)

Diagnosis is made through physical examination and by testing breath and stool for H. pylori. Endoscopy is sometimes used.

Treatment involves a course of antibiotics to kill the bacteria, and medication to block excess acid and heal the stomach.

Rarity: Uncommon

Top Symptoms: fatigue, nausea, loss of appetite, moderate abdominal pain, abdominal cramps (stomach cramps)

Symptoms that never occur with stomach ulcer: pain in the lower left abdomen

Urgency: Primary care doctor

Normal abdominal pain

The complaint of abdominal pain and discomfort, with no apparent cause, is one of the most common in medicine. It is a primary reason for patients to visit a medical provider or the emergency room.

The cause of abdominal pain can be difficult to find, because it can just be a completely normal abdominal pain or come from many different sources: the digestive tract, the urinary tract, the pancreas, the gall bladder, or the gynecologic organs.

The pain may simply be caused by overly sensitive nerves in the gut. This hypersensitivity can occur after repeated abdominal injury and/or it may have an emotional cause due to fear of the pain itself.

Diagnosis is made through physical examination, patient history, and simply ruling out any other condition. CT scan is often requested, but can rarely find a specific cause. The benefits must be weighed against the risks of radiation.

Treatment first involves making any needed lifestyle improvements regarding diet, exercise, work, and sleep, in order to reduce stress. In some cases, counseling, hypnosis, mild pain relievers, and antidepressants are helpful.

Rarity: Common

Top Symptoms: abdominal pain (stomach ache), vaginal discharge, fever, nausea

Symptoms that always occur with normal abdominal pain: abdominal pain (stomach ache)

Symptoms that never occur with normal abdominal pain: fever, vomiting, diarrhea, nausea, severe abdominal pain, unintentional weight loss, vaginal discharge

Urgency: Self-treatment

Kidney stone

A kidney stone, also called renal lithiasis or nephrolithiasis, is a solid deposit that forms inside the kidney. Stones may form if the urine becomes too concentrated for any reason, allowing the minerals in it to crystallize.

There are several possible causes:

  • Not drinking enough water.
  • Family or personal history of kidney stones.
  • Diets high in protein, salt, or sugar.
  • Obesity.
  • Digestive diseases and conditions, including gastric bypass surgery.
  • Urinary tract infection.
  • Metabolic conditions and/or hereditary disorders.

Symptoms include severe pain in the side, back, and abdomen; pain on urination; urine that is pink, red, brown, and/or foul-smelling; nausea and vomiting; and sometimes fever and chills.

Diagnosis is made through blood test, urine test, and imaging.

For smaller stones, the patient may only need to drink extra water and take over-the-counter pain relievers. Medication may be given to help pass the stone. Larger stones may require the patient to be hospitalized for surgical procedures.

Prevention involves drinking more water and restricting certain foods, including animal protein, calcium, and salt. Sometimes prescription medications will be used.

Indigestion (dyspepsia)

Indigestion, also called upset stomach, dyspepsia, or functional dyspepsia, is not a disease but a collection of very common symptoms. Note: Heartburn is a separate condition.

Common causes are eating too much or too rapidly; greasy or spicy foods; overdoing caffeine, alcohol, or carbonated beverages; smoking; and anxiety. Some antibiotics, pain relievers, and vitamin/mineral supplements can cause indigestion.

The most common symptoms are pain, discomfort, and bloating in the upper abdomen soon after eating.

Indigestion that lasts longer than two weeks, and does not respond to simple treatment, may indicate a more serious condition. Upper abdominal pain that radiates to the jaw, neck, or arm is a medical emergency.

Diagnosis is made through patient history and physical examination. If the symptoms began suddenly, laboratory tests on blood, breath, and stool may be ordered. Upper endoscopy or abdominal x-ray may be done.

For functional dyspepsia – "ordinary" indigestion – treatment and prevention are the same. Eating five or six smaller meals per day with lighter, simpler food; managing stress; and finding alternatives for some medications will provide relief.

Rarity: Common

Top Symptoms: nausea, stomach bloating, dyspeptic symptoms, bloating after meals, vomiting

Symptoms that always occur with indigestion (dyspepsia): dyspeptic symptoms

Symptoms that never occur with indigestion (dyspepsia): vomiting (old) blood or passing tarry stools, rectal bleeding, bloody diarrhea, fever

Urgency: Self-treatment

Heart attack in a woman

Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat - called an arrhythmia - that causes a severe decrease in the pumping function of the heart.

Call 911 and seek emergency care immediately

Acute pancreatitis

Acute pancreatitis is the inflammation of the pancreas, which creates and releases insulin and glucagon to keep the sugar levels in your blood stable. It also creates the enzymes that digest your food in the small intestine. When these enzymes accidentally get activated in the pancreas, they digest the pancreas itself, causing pain and inflammation.

You should go to the ER. There, diagnosis is made by physical examination, imaging, and blood tests. Treatment typically involves intravenous (IV) fluids and medicines to control the pain.

Rarity: Rare

Top Symptoms: constant abdominal pain, nausea or vomiting, being severely ill, severe abdominal pain, fever

Symptoms that always occur with acute pancreatitis: constant abdominal pain

Urgency: Hospital emergency room

Acute gastritis

Gastritis means inflammation or irritation of the stomach lining, and is "acute" when it comes on suddenly and severely.

Common causes are infection with H. pylori bacteria in the stomach, which also causes ulcers; regular use of pain relievers; and overuse of alcohol. Smoking, stress, and autoimmune diseases such as Crohn's disease, Hashimoto's disease, and type 1 diabetes can all contribute to acute gastritis.

Symptoms of acute gastritis include sudden fullness and burning pain in the upper abdomen, and sometimes nausea and vomiting. If the symptoms last more than a week, or there are signs of blood in vomit or stool, medical care should be sought.

If not treated, gastritis can lead to stomach ulcers due to the presence of H. pylori.

Diagnosis for H. pylori is made through blood tests, breath tests, and stool sample tests. Upper endoscopy and/or barium swallow x-ray may also be used.

Treatment includes lifestyle changes concerning use of pain relievers, alcohol, and other stomach irritants; antibiotics to treat the H. pylori; and medications to reduce and/or neutralize stomach acid.

Upper left abdominal pain quiz

Take a quiz to find out what's causing your pain.

Take upper left abdominal pain quiz

Pain in the upper left abdomen treatments and relief

As long as you have not suffered a severe injury, treatment for pain in the upper left abdomen can begin at home. If symptoms persist, you should consult your physician for further medical treatment.

At-home treatments

Several at-home remedies can begin to alleviate some of your symptoms and possibly prevent them from worsening.

  • Stop drinking alcohol and stop smoking: Your medical provider can give you referrals for specialists.
  • Improve diet: Avoid high-fat foods, sugar, and carbonated drinks. Try to work in more nutrient-rich fruits, vegetables, and whole grains.
  • Drink water: Several glasses of water per day will help to flush out toxins and improve your metabolism.

Medical treatments

You should consult your physician to discuss treatment options for chronic, ongoing symptoms. He or she may also be able to adjust or substitute your medicines.

When it is an emergency

Experiencing the following symptoms in addition to your abdominal pain signal an emergency.

  • Worsening symptoms and intensifying pain: Hospitalization and/or surgery may be needed right away.
  • Pain and shortness of breath when inhaling
  • Heart attack symptoms: These include pain in the left chest, arm, jaw, or neck, as well as a cold sweat, shortness of breath, and lightheadedness or fainting.

FAQs about pain in the upper left abdomen

Does diabetes cause pain in the upper left abdomen?

The pancreas is located in the upper left quadrant. Pancreatitis is inflammation of the pancreas, which can lead to diabetes when it is severe or long-standing [1,3]. This causes pain and sometimes the inability to produce insulin.

Is pain in the upper left abdomen connected to, or a warning of, a heart attack?

The heart is technically located in the chest, not the upper abdomen, but it can be hard to tell the difference if a heart attack is occurring. Heart attacks involve other symptoms such as pain in the arm, jaw, or neck, along with a cold sweat, shortness of breath, or nausea and vomiting [6].

Is pain in the upper left abdomen connected to, or a warning of, an aortic aneurysm?

An aortic aneurysm is a bulging in the wall of the aorta, the largest artery in the body that runs straight down from the heart. There may be pain almost anywhere in the back and/or abdomen, though it will most often be felt lower in the back at about the level of the navel [7,8].

Is pain in the upper left abdomen a sign of an abnormal pregnancy?

An ectopic pregnancy, in which the fetus is growing inside a fallopian tube instead of inside the uterus, first causes internal bleeding. This irritates the nerves and causes pain into the upper abdomen and shoulders. There will also be signs of very early pregnancy and sudden, severe pain if the tube begins to rupture (a life-threatening medical emergency).

Is pain in the upper left abdomen part of a normal pregnancy?

A normal pregnancy can cause some conditions that lead to pain in the upper left abdomen. Constipation is a common one, as is heartburn [9]. However, a complication of pregnancy, called pre-eclampsia, can cause general upper abdominal pain and high blood pressure. Pre-eclampsia is considered an emergency [10].

Questions your doctor may ask about pain in the upper left abdomen

  • Have you experienced any nausea?
  • Any fever today or during the last week?
  • Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
  • How would you describe the nature of your abdominal pain?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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References

  1. Phillips MM. Acute Pancreatitis. U.S. National Library of Medicine: MedlinePlus. Updated October 26, 2017. MedlinePlus Link
  2. How Lupus Affects the Gastrointestinal System. The National Resource Center on Lupus. Updated July 12, 2013. NRCL Link
  3. Wolosin JD, Edelman SV. Diabetes and the Gastrointestinal Tract. Clinical Diabetes. 2000;18(4). Clinical Diabetes Link
  4. Russell RI. Non-Steroidal Anti-Inflammatory Drugs and Gastrointestinal Damage - Problems and Solutions. Postgraduate Medical Journal. 2001;77:82-88. BMJ Journals Link
  5. Answers About Aspirin. Harvard Medical School: Harvard Health Publishing. Published January 2014. Harvard Health Publishing Link
  6. Warning Signs of a Heart Attack. American Heart Association. Updated June 30, 2016. AHA Link
  7. Abdominal Aortic Aneurysm. Johns Hopkins Medicine. Johns Hopkins Medicine Link
  8. Abdominal Aortic Aneurysm. NHS inform. Updated October 11, 2018. NHS inform Link
  9. Ectopic Pregnancy. American Pregnancy Association. Updated July 20, 2017. American Pregnancy Association Link
  10. Signs & Symptoms. Preeclampsia Foundation Link. Updated March 29, 2016. Preeclampsia Foundation Link