Differential Diagnosis for Left Upper Quadrant Pain in Pregnancy
Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): This condition is common in pregnancy due to increased intra-abdominal pressure and relaxation of the lower esophageal sphincter, leading to symptoms of heartburn and left upper quadrant pain.
Other Likely Diagnoses
- Peptic ulcer disease: Similar to GERD, the increased pressure and potential for gastric acid reflux can lead to peptic ulcers, causing pain in the left upper quadrant.
- Gallbladder disease: While more commonly associated with right upper quadrant pain, gallstones or cholecystitis can sometimes refer pain to the left upper quadrant, especially if there is associated pancreatitis.
- Splenic infarction or rupture: Although less common, these conditions can occur in pregnancy, especially with conditions like preeclampsia or trauma, leading to severe left upper quadrant pain.
- Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain that may be localized to the left upper quadrant, especially if the tail of the pancreas is involved.
Do Not Miss Diagnoses
- Ectopic pregnancy: Although typically presenting with right or left lower quadrant pain, an ectopic pregnancy can occasionally cause upper abdominal pain if the ectopic implantation site involves structures near the left upper quadrant or if there is significant internal bleeding.
- Placental abruption: This condition involves the premature separation of the placenta from the uterus and can cause severe abdominal pain, which might be referred to the left upper quadrant, along with vaginal bleeding.
- Pulmonary embolism: While primarily a respiratory condition, a pulmonary embolism can cause referred pain to the upper abdomen, including the left upper quadrant, especially if the embolism is large and causes significant strain on the heart.
Rare Diagnoses
- Splenic artery aneurysm rupture: This is a rare but potentially catastrophic condition that can occur in pregnancy, leading to severe left upper quadrant pain and hemodynamic instability.
- Gastric volvulus: A rare condition where the stomach twists abnormally, which can cause severe upper abdominal pain, including in the left upper quadrant.
- Diaphragmatic hernia: Although rare, a diaphragmatic hernia can cause upper abdominal pain and may be exacerbated by the increased intra-abdominal pressure of pregnancy.