Differential Diagnosis for Left Upper Quadrant Pain
The differential diagnosis for left upper quadrant pain can be organized into the following categories:
- Single Most Likely Diagnosis
- Gastritis or peptic ulcer disease: This is often the most common cause of left upper quadrant pain, as the stomach is located in this region and inflammation or ulcers can cause significant discomfort.
- Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD): Similar to gastritis, GERD can cause pain in the left upper quadrant due to the reflux of stomach acid into the esophagus.
- Pancreatitis: Although the pancreas is a midline organ, its tail extends into the left upper quadrant, and inflammation of the pancreas can cause pain in this area.
- Splenic infarction or rupture: The spleen is located in the left upper quadrant, and conditions affecting the spleen, such as infarction or rupture, can cause severe pain.
- Left kidney stone or pyelonephritis: The left kidney is also located in the upper quadrant, and conditions such as kidney stones or infection can cause pain in this area.
- Do Not Miss Diagnoses
- Aortic dissection: Although less common, aortic dissection is a life-threatening condition that can cause severe pain in the left upper quadrant, and it is essential to consider this diagnosis to avoid missing it.
- Pulmonary embolism: While pulmonary embolism typically causes chest pain, it can also cause referred pain in the left upper quadrant, especially if the embolism is located in the upper lobes of the lung.
- Cardiac ischemia or infarction: Cardiac conditions such as ischemia or infarction can cause pain in the left upper quadrant, especially if the condition affects the lateral or posterior walls of the heart.
- Rare Diagnoses
- Left diaphragmatic hernia: A rare condition where the diaphragm is herniated, allowing abdominal contents to enter the thoracic cavity and causing pain in the left upper quadrant.
- Intestinal obstruction or volvulus: Although rare, intestinal obstruction or volvulus can cause severe pain in the left upper quadrant, especially if the obstruction or volvulus involves the stomach or small intestine.
- Left upper quadrant tumors (e.g., gastric, pancreatic, or splenic tumors): Various tumors can cause pain in the left upper quadrant, although these are relatively rare compared to other causes of pain in this region.