Upper Left and Right Abdominal Pain

Upper Abdominal Pain

Any abdominal pain can be so excruciating or unbearable  that the patient may  jump, shout or writhe in pain.  Usually the symptoms that accompany abdominal pain include: nausea, vomiting, chills and shivering, burning sensation, diarrhea, mild or severe fever. These symptoms and the location of the pain help in the correct diagnosis of upper abdominal pain.

The upper abdomen is located between the lower ribcage margins and the naval. It is further divided into upper left abdomen and upper right abdomen. Another way to describe it is the center of body from under the breast-bone to umbilicus and across to both sides of the torso.

Any pain in the upper abdomen region is termed as upper abdominal pain. Because of the numerous organs or structures in the upper abdomen it is difficult to diagnose the actual cause of pain. Any disorder or medical condition pertaining to these organs or structures can lead to upper abdominal pain. Sometimes a patient can experience upper abdominal pain due to organs or structures not located in the abdomen.  The illustration of abdominal quadrants can help you describe the location of the pain.

Abdominal quadrants pictures

Picture 1 : Upper left and right abdominal quadrants (highlighted)

Picture 2 : Upper left and right abdominal quadrants with abdominal organs (highlighted)

Source : wikimedia.org

Picture 3 : Upper right and left abdominal pain area (highlighted)

source : drshailja.com

Causes of Upper Abdominal Pain

Many of the  possible reasons for upper abdominal are listed here in alphabetical order:

• Angina
• Disorders related to muscles, skin or bones.
• Esophagus spasms
• Gallbladder disorders
• Gastritis
• Heart attack
• Herpes infection
• Indigestion
• Kidney stones and infections
• Liver disease and infections
• Pancreatitis
• Peptic ulcer
• Spleen infections
• Trapped wind
• Ureteric stones

The signs of various disorders along with symptoms of upper abdominal pain help diagnose the cause of the pain.

Upper Abdominal Pain During Pregnancy

It is not unusual for a woman to have upper abdominal pain during pregnancy. She may have many physiological and hormonal changes that increase the risk of  conditions which may cause  upper abdominal pain.

Various causes of abdominal pain in expectant mothers include :

• Miscarriage
• Urinary tract infection
• Constipation, very common in pregnant women.
• Gastritis
• Appendicitis
• Ectopic pregnancy
• Fibroids
• Labor pains
• Tumors related to ovaries
• Diabetes keto acidosis.
• Pre-eclampsia of pregnancy [7]

Upper Left Abdominal Pain

Abdominal pain in the upper left side is felt from the left nipple to the umbilicus. The pain can occur due to any disorders in any of the various organs or structures present in the upper left abdomen which include the following:

• Spleen
• Tail end of pancreas
• Parts of large intestines
• Part of bowel
• Some part of stomach
• Left lower ribs
• Left kidney
• Muscles, skins and bones
• The heart is located just above the upper left abdomen but can be responsible for an upper left abdominal pain.

Causes of Upper Left Abdominal Pain

Few of the medical conditions that give rise to upper left abdominal pain are given below:

• Any injury or infection linked to the spleen causes severe abdominal pain in the upper left side. At times, even a splenic tumor is also the cause for such a pain.
• Bowel cancer which affects the bowel’s left side results in a burning upper abdominal pain.
• Shingles or Herpes zoster.
• A pain in the upper left abdomen after a meal can be due to contaminated food resulting in food poisoning.
• Usually pancreatitis starts with an upper middle abdominal pain and if the pancreas tail gets affected, then the pain is felt even in the upper left abdomen.
• Pancreatic cancer is another pancreas disorder that leads to the pain.
• Left Kidney stones and left kidney infection
• Any viral infection in the lower left ribs.
• Stomach ulcer
• Disorders of left side of liver like cyst, tumor or hepatitis are some common causes of upper left abdominal pain.[4]
• Disease involving left adrenal gland
• A ruptured or leaked abdominal aortic aneurysm
• When the stomach twists upon itself, it results in gastric volvulus causing upper left abdominal pain.
• The other disorders or medical conditions apart from those mentioned above include:  pneumonia, trapped wind, transverse colon volvulus and heart problems.

Upper Right Abdominal Pain

The pain experienced from the right nipple to the umbilicus level is commonly known as upper right abdominal pain. The organs or structures found in this quadrant are:

• Liver
• Bowel’s upper part
• Right kidney
• Right lungs’ lower part
• Right kidney’s tubes (ureters)
• Right adrenal gland
• Muscles, skin and bones

Any problem related to these organs or structures lead to mild or severe right side abdominal pain. In some cases, the organs not present in the upper right quadrant too lead to pain in that part.

Causes of Upper Right Abdominal Pain

A pain in the upper right side of abdomen is less common. It can initiate due to various medical conditions or disorders of the organs located in the upper right abdomen. Some of these causes are as follows:

• Biliary colic starts a dull to severe pain in the upper right abdomen and is one of the most common causes.
• Similar to biliary colic, Cholecystitis, also causes upper abdominal pain on the right side.[5]
• Kidney stones or stones in ureters on the right side leads to abdominal pain in the upper right quadrant. This type of an upper right abdominal pain in men sometimes spreads to the penis tip.
• Inflammation of the right lung’s lower part leading to pneumonia.
• Some other less common causes of abdominal pain in the upper right side are constipation, irritable bowel syndrome, musculoskeletal pain and hepatitis

Diagnosing Upper Abdominal Pain

Determining the location and type of pain is the first step in diagnosing upper abdominal pain. When the abdomen is rigid and tender to touch it is a serious sign. If the abdomen is gently pressed and then released, it is a symptom that the patient needs Immediate medical care. [6]

In addition to a physical examination and medical history, blood and urine tests are commonly part of reaching a diagnosis. Endoscopy is often used to examine the interior of the digestive system to see if there are ulcers or gallstones or other problems. [ 9]

A ruptured spleen is a medical emergency that needs immediate attention and is likely to require surgery. [8]

Depending on the symptoms that come with the upper abdominal pain, your doctor will make the best diagnosis possible. Then a treatment plan can be set up.

Treatment for Upper Abdominal Pain

The treatments for both right and left sides of upper abdominal pain are similar and involve diagnosing the actual cause of pain as the first step. Sometimes simple pain killers are administered to a patient to provide temporary relief  until the various investigation tests are completed.  Quite often, 50% of cases,  specific reasons for upper abdominal pain are not clearly diagnosed. Consequently caution must be taken to administer the most appropriate treatments based upon the results of the various tests that have been give.

Medications like acetaminophen, cocodamol, tramadol, morphine injections, pethidine, ibuprofen, and codeine phosphate and morphine sulphate tablet are used along with other drugs to treat upper right abdominal pain.

References:

1. http://www.medicinenet.com/abdominal_pain/article.htm
2. http://en.wikipedia.org/wiki/Abdominal_pain
3. http://www.emedicinehealth.com/abdominal_pain_in_adults/article_em.htm
4. http://www.webmd.com/digestive-disorders/tc/cholecystitis-overview
5. http://www.nlm.nih.gov/medlineplus/ency/article/003136.htm
6. http://www.nlm.nih.gov/medlineplus/ency/article/000899.htm
7. http://www.mayoclinic.com/health/endoscopy/MY00138