Will pancreatitis cause left upper quadrant (LUQ) abdominal pain?

From the Guidelines

Yes, pancreatitis can cause left upper quadrant (LUQ) abdominal pain, though the pain is typically more prominent in the epigastric region (upper middle abdomen) and often radiates to the back. According to the United Kingdom guidelines for the management of acute pancreatitis by the British Society of Gastroenterology 1, a clinical history of upper abdominal pain and vomiting with features of epigastric or diffuse abdominal tenderness are common clinical findings. The pancreas is located behind the stomach with its head in the right upper quadrant and its body and tail extending into the left upper quadrant, which explains why inflammation can cause LUQ pain.

The pain results from local inflammation, release of digestive enzymes that damage surrounding tissues, and distension of the pancreatic capsule. Other symptoms that may accompany the LUQ pain include nausea, vomiting, fever, and abdominal tenderness. As noted in the guidelines 1, the clinical picture may be obscured in certain circumstances, such as in the postoperative period, and a diagnosis of acute pancreatitis is often unreliable if made on the clinical findings alone.

Key points to consider in the management of acute pancreatitis include:

• Diagnosis and assessment of severity
• Management according to disease severity with ongoing monitoring and assessment
• Detection and management of complications, particularly in the group predicted as severe
• Evaluation and treatment of aetiological factors in all patients, as outlined in the management guidelines 1. Treatment depends on the severity and cause but typically includes pain management, bowel rest, intravenous fluids, and addressing the underlying cause such as gallstones or alcohol use.

From the Research

Pancreatitis and Abdominal Pain

• Pancreatitis is an inflammatory process involving the pancreas that can cause abdominal pain, with the location of the pain varying depending on the type of pancreatitis 2.
• Acute pancreatitis typically presents with epigastric or right upper quadrant pain, while chronic pancreatitis can cause a broader range of symptoms, including abdominal pain in combination with signs of pancreatic endocrine and exocrine insufficiency 2.
• In some cases, acute pancreatitis can present with isolated left flank pain, which is a rare and potentially misleading symptom 3.

Location of Abdominal Pain in Pancreatitis

• The location of abdominal pain in pancreatitis can vary, but it is often felt in the upper abdomen, with radiation to the back and flank region 3, 4.
• Left upper quadrant (LUQ) abdominal pain is not typically mentioned as a common location for pancreatitis pain, but it is possible for the pain to radiate to this area in some cases 3.
• The pain associated with pancreatitis can be severe and may require opioid analgesics for management, with studies suggesting that opioids can be effective in reducing pain intensity and decreasing the need for supplementary analgesia 4, 5.

Diagnosis and Management of Pancreatitis

• The diagnosis of pancreatitis typically involves a combination of clinical evaluation, laboratory tests, and imaging studies, with the goal of identifying the underlying cause of the inflammation and guiding treatment 2, 6.
• The management of pancreatitis depends on the severity of the disease and may involve aggressive fluid resuscitation, pain control, and nutritional support, as well as specific treatments for underlying conditions such as hypertriglyceridemia 6.