Left upper quadrant abdominal pain - Revision history

Danbot: Expanded with EM-focused content: anatomy, red flags, must-not-miss diagnoses, evaluation strategy, management

2026-03-20T23:42:13Z

Expanded with EM-focused content: anatomy, red flags, must-not-miss diagnoses, evaluation strategy, management

← Older revision		Revision as of 23:42, 20 March 2026
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	~~<languages/>~~
	~~<translate>~~

	==Background==		==Background==
			*This page outlines the general approach to adult left upper quadrant (LUQ) pain
	*This page outlines the general approach to adult LUQ pain		*LUQ contains: spleen, stomach, left kidney, splenic flexure of colon, tail of pancreas, and left adrenal gland
			*Key EM considerations: splenic pathology (rupture, infarct, abscess), gastric/peptic ulcer disease, pancreatitis, renal pathology
	</~~translate>~~		*Remember referred pain sources: left lower lobe pneumonia, MI, pericarditis
	{{Abdominal pain location}}		{{Abdominal pain location}}
	~~<translate>~~

			==Clinical Features==
			===History===
			*Onset, character, radiation, timing, severity
			*Associated symptoms: nausea/vomiting, fever, hematochezia/melena, pleuritic chest pain
			*Recent trauma (splenic injury)
			*History of blood dyscrasias, anticoagulation, mononucleosis (splenic enlargement)
			*Alcohol use, gallstones (pancreatitis)
			*NSAID use, H. pylori history (peptic ulcer disease)
			*History of atrial fibrillation or hypercoagulable state (splenic infarct)

	==~~Clinical Features~~==		===Physical Exam===
			*LUQ tenderness, guarding, peritoneal signs
			*Kehr sign: left shoulder pain from diaphragmatic irritation (splenic injury, ruptured spleen)
			*Splenomegaly
			*Epigastric tenderness radiating to back (pancreatitis)
			*CVA tenderness (pyelonephritis, nephrolithiasis)

			===Red Flags===
			*Hemodynamic instability with LUQ pain (splenic rupture, ruptured AAA)
			*Kehr sign (hemoperitoneum)
			*Recent trauma + LUQ pain (delayed splenic rupture can occur weeks after injury)
			*LUQ pain + atrial fibrillation (splenic artery embolism/infarct)

	==Differential Diagnosis==		==Differential Diagnosis==

	~~</translate>~~
	{{DDX LUQ}}		{{DDX LUQ}}
	~~<translate>~~


	==~~Workup~~==		===Must Not Miss===
			*'''[[Splenic rupture]]''' (traumatic or spontaneous)
			*'''Splenic infarct''' (embolic, sickle cell crisis)
			*'''[[Myocardial infarction]]''' (referred pain — always consider in older patients)
			*'''Left lower lobe [[pneumonia]]''' (referred to LUQ)

	*CBC		==Evaluation==
	*Chem		===Laboratory===
	*[[~~Special:MyLanguage/LFTs\|~~LFTs]]		*[[CBC]], [[BMP]]
	*Lipase		*[[LFTs]], lipase
	*Coags		*[[Urinalysis]]
	*[[~~Special:MyLanguage/Urinalysis\|~~Urinalysis]]		*Urine pregnancy test (females of reproductive age)
	*Urine pregnancy (females)		*[[Lactate]] if concern for mesenteric ischemia or sepsis
	*?[[~~Special:MyLanguage/ECG\|ECG~~]] (if ~~>50~~ or ~~at risk for cardiac disease)~~		*[[Troponin]], [[ECG]] if cardiac cause considered (age >40 or risk factors)
	*?[[~~Special:MyLanguage/RUQ US\|RUQ US~~]]		*Coagulation studies if anticoagulated or concern for splenic hemorrhage
	*?[[~~Special:MyLanguage/CXR\|CXR~~]]
	**Consider if ~~at risk~~ for ~~perforated ulcer~~

			===Imaging===
			*[[CT abdomen pelvis]] with IV contrast: most useful for LUQ pathology (splenic infarct, abscess, mass, pancreatitis, renal pathology)
			*[[POCUS]]/[[FAST exam]]: evaluate for free fluid (splenic rupture)
			*[[CXR]]: if concern for pneumonia or free air (perforated ulcer)
			*[[RUQ US]]: if concern for biliary/hepatic pathology

	==Management==		==Management==

	*Treat underlying disease process		*Treat underlying disease process
	*Consider GI cocktail ~~([[Special:MyLanguage~~/~~Bismuth subsalicylate\|Maalox]] Plus/[[Special:MyLanguage/Lidocaine\|Lidocaine]] Viscous 2%/Donnatol)~~		*IV fluids and analgesia
			*Consider GI cocktail if gastritis/peptic ulcer suspected
			*Emergent surgical consultation for splenic rupture
			*Hematology consultation for splenic infarction

	==Disposition==		==Disposition==
			*Based on underlying diagnosis
	*~~Disposition per underlying disease process~~		*Admit: splenic pathology, pancreatitis requiring IV management, mesenteric ischemia, MI
			*Discharge: mild gastritis, stable renal colic, musculoskeletal pain with clear follow-up

	==See Also==		==See Also==
			*[[Abdominal Pain]]
	*[[~~Special:MyLanguage/Abdominal Pain\|~~Abdominal Pain]]		*[[Abdominal Pain (Peds)]]
	*[[~~Special:MyLanguage/Abdominal Pain (Peds)\|~~Abdominal Pain (Peds)]]


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
	~~</translate>~~

Ostermayer: Prepared the page for translation

2026-01-04T23:17:32Z

Prepared the page for translation

← Older revision		Revision as of 23:17, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*This page outlines the general approach to adult LUQ pain		*This page outlines the general approach to adult LUQ pain

			</translate>
	{{Abdominal pain location}}		{{Abdominal pain location}}
			<translate>


	==Clinical Features==		==Clinical Features==


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{DDX LUQ}}		{{DDX LUQ}}
			<translate>


	==Workup==		==Workup==

	*CBC		*CBC
	*Chem		*Chem
	*[[LFTs]]		*[[Special:MyLanguage/LFTs\|LFTs]]
	*Lipase		*Lipase
	*Coags		*Coags
	*[[Urinalysis]]		*[[Special:MyLanguage/Urinalysis\|Urinalysis]]
	*Urine pregnancy (females)		*Urine pregnancy (females)
	*?[[ECG]] (if >50 or at risk for cardiac disease)		*?[[Special:MyLanguage/ECG\|ECG]] (if >50 or at risk for cardiac disease)
	*?[[RUQ US]]		*?[[Special:MyLanguage/RUQ US\|RUQ US]]
	*?[[CXR]]		*?[[Special:MyLanguage/CXR\|CXR]]
	**Consider if at risk for perforated ulcer		**Consider if at risk for perforated ulcer


	==Management==		==Management==

	*Treat underlying disease process		*Treat underlying disease process
	*Consider GI cocktail ([[Bismuth subsalicylate\|Maalox]] Plus/[[Lidocaine]] Viscous 2%/Donnatol)		*Consider GI cocktail ([[Special:MyLanguage/Bismuth subsalicylate\|Maalox]] Plus/[[Special:MyLanguage/Lidocaine\|Lidocaine]] Viscous 2%/Donnatol)


	==Disposition==		==Disposition==

	*Disposition per underlying disease process		*Disposition per underlying disease process


	==See Also==		==See Also==
	*[[Abdominal Pain]]
	*[[Abdominal Pain (Peds)]]		*[[Special:MyLanguage/Abdominal Pain\|Abdominal Pain]]
			*[[Special:MyLanguage/Abdominal Pain (Peds)\|Abdominal Pain (Peds)]]


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
			</translate>

Rossdonaldson1: /* Background */

2024-01-31T22:38:13Z

Background

← Older revision		Revision as of 22:38, 31 January 2024
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	==Background==		==Background==
	*This page outlines the general approach to adult LUQ pain		*This page outlines the general approach to adult LUQ pain

			{{Abdominal pain location}}

	==Clinical Features==		==Clinical Features==

ClaireLewis at 15:23, 14 September 2019

2019-09-14T15:23:12Z

← Older revision		Revision as of 15:23, 14 September 2019
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	*CBC		*CBC
	*Chem		*Chem
	*LFTs		*[[LFTs]]
	*Lipase		*Lipase
	*Coags		*Coags
	*[[Urinalysis]]		*[[Urinalysis]]
	*Urine pregnancy (females)		*Urine pregnancy (females)
	*?ECG (if >50 or at risk for cardiac disease)		*?[[ECG]] (if >50 or at risk for cardiac disease)
	*?[[RUQ US]]		*?[[RUQ US]]
	*?CXR		*?[[CXR]]
	**Consider if at risk for perforated ulcer		**Consider if at risk for perforated ulcer

	==Management==		==Management==
	*Treat underlying disease process		*Treat underlying disease process
	*Consider GI cocktail (Maalox Plus/Lidocaine Viscous 2%/Donnatol)		*Consider GI cocktail ([[Bismuth subsalicylate\|Maalox]] Plus/[[Lidocaine]] Viscous 2%/Donnatol)

	==Disposition==		==Disposition==

Ktanner777: /* Management */

2017-10-09T06:07:16Z

Management

← Older revision		Revision as of 06:07, 9 October 2017
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	==Management==		==Management==
	*Treat underlying disease process		*Treat underlying disease process
	*Consider GI cocktail		*Consider GI cocktail (Maalox Plus/Lidocaine Viscous 2%/Donnatol)

	==Disposition==		==Disposition==

ClaireLewis: /* References */

2016-10-29T17:06:57Z

References

← Older revision		Revision as of 17:06, 29 October 2016
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	[[Category:GI]]		[[Category:GI]]
			[[Category:Symptoms]]

Rossdonaldson1: Text replacement - "UA" to "Urinalysis"

2016-10-02T18:03:39Z

Text replacement - "*UA" to "*Urinalysis"

← Older revision		Revision as of 18:03, 2 October 2016
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	*Lipase		*Lipase
	*Coags		*Coags
	*UA		*[[Urinalysis]]
	*Urine pregnancy (females)		*Urine pregnancy (females)
	*?ECG (if >50 or at risk for cardiac disease)		*?ECG (if >50 or at risk for cardiac disease)

Neil.m.young: Text replacement - "==Sources==" to "==References=="

2016-06-26T21:35:43Z

Text replacement - "==Sources==" to "==References=="

← Older revision		Revision as of 21:35, 26 June 2016
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	==External Links==		==External Links==

	==~~Sources~~==		==References==
	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]

Rossdonaldson1: Rossdonaldson1 moved page Left upper quadrant pain to Left upper quadrant abdominal pain

2015-01-28T20:20:05Z

Rossdonaldson1 moved page Left upper quadrant pain to Left upper quadrant abdominal pain

← Older revision	Revision as of 20:20, 28 January 2015
(No difference)

Rossdonaldson1: /* Differential Diagnosis */

2014-10-27T04:57:33Z

Differential Diagnosis

← Older revision		Revision as of 04:57, 27 October 2014
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{DDX LUQ}}

	==Workup==		==Workup==