LUQ Pain
Diagnosis
Signs and
Symptoms
Diagnostic
tests
Can’t Miss and/or Surgical Emergencies
MI
Pancreatitis
Perforated peptic ulcer
Sudden onset,
rapid onset of steady, acute pain
could initially present as left upper quadrant
constant chest pain,
(sometimes localized to left upper pain, but should quickly spread to the
possible radiating left quadrant) with possible rebound
generalized abdomen and/or radiate to the
arm pain, severe pain tenderness and voluntary
shoulder. Potentially increased nausea
(sometimes localized abdominal guarding, pain can last and/or vomiting. Patients could have a
to the left upper
for days with possible band-like
history of ulcers and will generally present
thorax, sometimes
radiation to the back, relief on
with a rigid, “board-like” abdomen due to
diffuse) sometimes
bending forward.Usually nausea,
involuntary guarding. See column below
increased on exertion, vomiting, possible fever,
on peptic ulcers for further info.
lungs clear to
restlessness, agitation, and Check
auscultation and
for a history of alcoholism or
tympany on
gallstones.
percussion, look for
history of CV disease
EKG and cardiac
serum and urine tests for increased Abdominal X-ray (30-50 % false negative
enzymes, possibly
pancreatic enzymes (amylase,
for excess free abdominal air), CT, or
catheterization
lipase, and trypsin), increased
endoscopy
serum levels of pancreaticassociated protein or trypsinogen
activation peptide, CT to look for
pancreatic swelling or abscess, Xray to exclude other abdominal
causes, ultrasound (can help, but
not always useful because
pancreas can be blocked by
bowel).
Diagnosis
Signs and
Symptoms
Diagnostic tests
Other Possibilities
Splenic abscess
Splenic rupture
Gastritis/
or infarct
Gastropathy
Tenderness in the left Severe left upper Acute: acute
upper quadrant and
quadrant pain
onset, pain or
pleuritic chest pain,
(radiating,
gnawing in the
splenomegaly is often exacerbated on
upper
present, sometimes
movement),
abdomen,
with a palpable
pleuritic chest
nausea and
spleen tip, friction
pain, and left
vomiting.
rubs are sometimes
shoulder pain
Chronic: dull
heard, Oftentimes
(Kehr sign).
pain, loss of
underlying pathology Oftentimes fever, appetite/fullnes
present and
chills, nausea,
s after several
associated malaise
and vomiting.
bites of food,
and fever (strep, TB, History
or oftentimes
endocarditis, etc)/
associated with
asymptomatic.
more common with
peripheral
With both
immunocompromised embolism (atrial there is
patients. Often result fib,
oftentimes
of trauma.
hematological
blood in your
disorders, etc).
vomit or black
stools.
Gastric ulcer
Gastric cancer
pain (dull ache or
burning and knowing
pain, intermittent,
starts 2-3 hours
following a meal, or
in the middle of the
night while your
stomach is empty and
will disappear after
eating), weight loss,
painful to eat,
vomiting, no
increased pain on
palpation, heartburn,
vomiting blood,
bloody or dark tarry
stools
Pain is usually
mild and vague
in early stages,
but more severe
and constant
(persistent) as it
progresses.
Patient usually
presents with
weight loss,
persistent pain,
sometimes
nausea, occult
gastric bleeding,
bloody stool,
bloody vomit,
and anemia. A
palpable
abdominal mass
may be present
CT or Ultrasound and CT or
possibly a blood test Ultrasound
to determine a
possible underlying
infection
CT, X-ray (barium
contrast), stool test
and/or breath test for
H. pylori, , blood test
biopsy, endoscopy
Endoscopy,
biopsy, upper GI
series (barium
contrast), CT
Endoscopy, Xray, biopsy,
stool tests and
possible blood
studies
Other possibilities but not initially suspected as primary cause of LUQ pain:Renal pain (kidney stone), Empyema (bacterial
pleural effusions), Pneumonia, Pulmonary Infarct, pleuritis, Hiatus Hernia (normally epigastric pain), Herpes Zoster