From the Research
The patient's normal ultrasound results, in combination with her anxiety and left upper quadrant pain, suggest that further evaluation should focus on non-abdominal causes of pain, such as musculoskeletal issues or functional abdominal pain, as recommended by the most recent guidelines 1. Given the normal ultrasound findings, which include a normal liver, gallbladder, bile ducts, pancreas, spleen, aorta, and kidneys, with no stones, lesions, fluid collections, or other concerning findings, it is reasonable to consider other causes for the patient's left upper quadrant (LUQ) pain. The patient's anxiety should also be addressed through clear communication about the normal findings, as anxiety can sometimes manifest as or exacerbate physical symptoms. Further evaluation might include:
- A trial of acid suppression therapy if gastritis is suspected
- Pain management for musculoskeletal causes
- Additional imaging if symptoms persist despite the reassuring ultrasound, with computed tomography with intravenous contrast media often chosen for generalized abdominal pain, left upper quadrant pain, and lower abdominal pain, as suggested by recent studies 1. It is also important to consider extra-abdominal causes of pain, such as respiratory infections and abdominal wall pain, as well as diagnoses specific to female patients, such as ectopic pregnancy, pelvic inflammatory disease, and adnexal torsion, although these may be less likely given the patient's presentation and normal ultrasound results. Overall, a comprehensive approach that takes into account the patient's symptoms, medical history, and normal ultrasound results is necessary to determine the cause of her LUQ pain and develop an effective treatment plan, with the most recent and highest quality study 1 guiding the evaluation and management of acute abdominal pain in adults.