What could be causing left upper quadrant abdominal pain that worsens with palpation (pressing down)?

Left Upper Quadrant Abdominal Pain with Palpation Tenderness

You need immediate CT abdomen/pelvis with IV contrast to identify the cause of your left-sided stomach pain, as this symptom can represent serious conditions including splenic rupture, gastric perforation, or pancreatitis that require urgent intervention. 1

Immediate Life-Threatening Concerns to Assess

Your symptoms require urgent evaluation for several potentially dangerous conditions:

• Splenic pathology (rupture, hematoma, or infarction) presents with left upper quadrant pain that worsens with palpation and can cause referred left shoulder pain (Kehr's sign) from diaphragmatic irritation 1
• Gastric perforation causes sudden severe pain with peritoneal signs and requires emergent surgery 1
• Pancreatitis typically causes epigastric pain radiating to the back but can present with left upper quadrant tenderness 1
• Check your vital signs immediately—hypotension, rapid heart rate, or altered mental status indicate possible internal bleeding requiring emergency surgery 1

Critical Warning Signs Requiring Emergency Care

Seek immediate emergency department evaluation if you have:

• Left shoulder pain accompanying your abdominal pain (suggests blood or fluid irritating the diaphragm) 1
• Lightheadedness, dizziness, or feeling faint (suggests blood loss) 1
• Rigid abdomen, severe tenderness throughout, or inability to move without pain (peritonitis) 1
• Recent trauma to the abdomen or left chest wall 1
• Fever with severe pain (suggests infection or abscess) 2

Diagnostic Approach

CT abdomen/pelvis with IV contrast is the diagnostic test of choice, with 98% accuracy for evaluating upper abdominal pathology and detecting complications 2, 1:

• CT identifies splenic hematoma, laceration, infarction, abscess, pancreatic inflammation, gastric perforation, and alternative diagnoses 1
• IV contrast improves detection of bowel wall pathology, vascular issues, and fluid collections 2
• Do not rely on clinical assessment alone—misdiagnosis rates range from 34-68% without imaging 2, 1

Plain radiography is inadequate for initial evaluation as it only detects large-volume free air or obstruction and misses most serious pathology 2

Differential Diagnosis by Location and Character

Left Upper Quadrant Causes:

• Splenic rupture/hematoma: Pain with palpation, possible left shoulder pain, hemodynamic instability 1
• Splenic infarction: Acute pain in patients with atrial fibrillation, endocarditis, or clotting disorders 1
• Gastric perforation: Sudden severe pain, peritonitis, free air on CT 1
• Pancreatitis: Epigastric/left upper quadrant pain radiating to back, elevated lipase 1

Left Kidney/Urologic:

• Pyelonephritis: Fever, flank tenderness, urinary symptoms 1
• Renal colic: Pain radiating to flank and groin, hematuria 1

Cardiac:

• Acute coronary syndrome: Can present as upper abdominal pain—requires ECG and troponin 1

Common Pitfalls to Avoid

• Do not delay imaging if you have left shoulder pain with abdominal pain—this combination suggests serious intra-abdominal pathology 1
• Do not take NSAIDs (ibuprofen, naproxen) until bleeding sources are excluded, as they worsen hemorrhage 1
• Do not assume it's minor based on pain alone—delayed splenic rupture can occur hours to days after initial injury 1
• Do not discharge yourself from care without definitive imaging if pain persists 1

When to Seek Emergency Care vs. Urgent Outpatient Evaluation

Go to Emergency Department NOW if:

• Severe pain (especially if sudden onset) 1
• Any left shoulder pain with abdominal pain 1
• Lightheadedness, dizziness, or rapid heart rate 1
• Rigid abdomen or severe tenderness 1
• Recent trauma 1
• Fever with severe pain 2

Seek urgent outpatient evaluation (within 24 hours) if:

• Mild-moderate pain without warning signs 2
• No fever, no shoulder pain, stable vital signs 2
• Pain improving rather than worsening 2

However, given that you describe a "popping" sensation with palpation, this warrants immediate evaluation to rule out splenic or gastric pathology. 1