Differential Diagnosis for Left Upper Abdominal Pain, Nausea, and Vomiting

Single Most Likely Diagnosis

• Gastritis: This is often the most common cause of left upper abdominal pain, nausea, and vomiting, especially if the pain is related to eating or if the patient has a history of NSAID use or alcohol consumption.

Other Likely Diagnoses

• Peptic Ulcer Disease: Similar to gastritis, peptic ulcers can cause pain in the left upper abdomen, especially if the ulcer is located in the stomach (gastric ulcer).
• Gastroesophageal Reflux Disease (GERD): While GERD typically causes heartburn, it can also lead to nausea and vomiting, and sometimes the pain can be felt in the upper abdomen.
• Pancreatitis: Although pancreatitis typically causes mid-abdominal pain, it can sometimes be felt in the left upper quadrant, especially if the tail of the pancreas is involved.
• Splenic Infarction or Rupture: Conditions affecting the spleen can cause left upper quadrant pain and may be accompanied by nausea and vomiting.

Do Not Miss Diagnoses

• Myocardial Infarction: Although myocardial infarctions typically cause chest pain, they can sometimes present with abdominal pain, nausea, and vomiting, especially in women or diabetic patients.
• Pulmonary Embolism: Similar to myocardial infarction, pulmonary embolism can present atypically with abdominal pain and nausea, especially if the embolism is large.
• Aortic Dissection: This is a life-threatening condition that can cause severe abdominal or back pain and may be accompanied by nausea and vomiting.
• Mesenteric Ischemia: This condition involves insufficient blood flow to the intestines and can cause severe abdominal pain out of proportion to the physical examination, along with nausea and vomiting.

Rare Diagnoses

• Left Upper Quadrant Hernia: Although rare, hernias in the left upper quadrant can cause intermittent pain, nausea, and vomiting, especially if the hernia becomes incarcerated or strangulated.
• Splenic Artery Aneurysm: This is a rare condition that can cause left upper quadrant pain and may rupture, leading to severe consequences.
• Gastric Cancer: While not typically presenting with acute nausea and vomiting, gastric cancer can cause chronic symptoms and should be considered in the differential diagnosis, especially in older patients or those with risk factors.