Upper Abdominal Pain

Causes, Diagnosis & Treatment Of Upper Abdominal Pain 

What Is Upper Abdominal Pain?

Upper Abdominal Pain In A Middle Aged Man

The upper abdomen is a wide area which spans both flanks or loins on the sides to the centre of the body below the breast bone down to the level of the umbilicus. It is a very common site for pain in the abdomen. Indigestion, trapped wind, gastritis, reflux oesophageal disease (GORD), hiatus hernia, gallbladder diseases, stomach ulcer, pancreatitis and  kidney stones are common causes of pain in this part of the abdomen.

If you develop sudden onset severe upper abdominal pain, it is important to exclude the less common but potentially more serious causes of pains in the upper abdomen like a perforated ulcer of the duodenum, dissecting abdominal aortic aneurysm or even a heart attack - yes, a heart attack could cause upper abdominal pain in anyone above the age of forty who has risk factors for this condition.  

Causes Of Upper Abdominal Pain

Causes of pain in the upper part of the abdomen include:

  • Costochondritis
  • Peptic ulcer
  • Gastritis from alcohol consumption
  • Medications like aspirin, ibuprofen, calcium channel blockers, anti-inflammatory medications etc.
  • Liver disease
  • Fitz-Hugh-Curtis Syndrome
  • Infection involving the liver, kidney or spleen
  • Cholangitis
  • Infectious mononucleosis
  • Ruptured spleen
  • POEM syndrome
  • Rupture of the aorta as in abdominal aortic aneurysm
  • Swallowed air / trapped wind
  • Pain from slipped disc
  • Referred pain from the spine
  • Ureteric stones
  • Angina
  • Chance fracture
  • Heart attack
  • Herpes infection
  • Spleen Pain
  • Spasms of the oesophagus
  • Epigastric hernia
  • Bowel obstruction
  • Pneumonia
  • Pulmonary Embolism (blood clots in the lung)
  • Stomach cancer
  • Pancreatic cancer
  • Myofascial pain syndrome
  • Irritable bowel syndrome (usually more on the left lower abdomen)
  • And ... including problems with the muscles, bone or skin over this area.

We will now take a closer look at the more common causes of pains in the upper abdominal area.

Right Upper Abdominal Pain

The upper right abdomen contains the following organs:

  • Right half of the liver
  • Gallbladder
  • Right Kidney to the back
  • Right Ureter (tube that connects the kidney to the urine bladder)
  • Part of the large intestines (ascending colon)
  • Lower end of the right lung from behind within the thorax
  • Right adrenal gland
  • Lower bones of the rib cage
  • Muscles, skin and blood vessels within this area

Any injury or disease affecting any of the above organs or structure could cause pain in the upper right abdomen. Common conditions that cause right upper abdominal pain include:

Gall Bladder Disease

The gallbladder is a pear shaped sac which is just below the liver and it is the place where bile is stored in the body. Sometimes, stones form inside this sac causing obstruction and pain which leads to a condition called biliary colic. If the gallbladder becomes infected it causes a condition called cholecystitis.

Typically, the pain from biliary colic:

  • Is sudden 
  • Is severe with a dull ache in the right upper abdomen
  • Spreads through the right side to the back under the right shoulder blade
  • Comes in waves or is continuous but with periods of increased severity
  • Makes you feel sick or you actually vomit
  • Makes it difficult to sit or lie still because of the pain. Patients often roll around in bed or walk around seeking a position of comfort
  • Could be triggered by eating a heavy meal or fatty food like fries

Is that you? If so, you may have biliary colic. This condition though very painful, is not life-threatening. With good pain control, it settles within a few hours to 3 days. It is important that you seek medical attention to exclude other conditions that mimics biliary colic like kidney stones  or a heart attack.

In the long term, if stones are present in your gallbladder, it may require surgery to remove them. Read more on biliary colic here.

Kidney Stones

Kidney Stones

The kidney helps with the filtering of waste products from the blood in the form of urine. Sometimes, salts in the body accumulate to form stones. Small stones in the kidney less than 5mm can be passed down the ureter (the tube that connects the kidney to the bladder). In most cases such small stones get passed without notice or pain.

However, larger stones of about 5mm up to 7mm are more difficult to pass. They tend to get stuck in the ureter and in a bid to get rid of the stone, the ureter goes into a very strong contraction causing severe pain lasting a few minutes, then it relaxes and goes into contraction again. If the ureter is able to expel the stone, the pain eases, otherwise this process continues until the ureter either gives up, continually giving you pain and with the obstruction remaining. Infection could set in and the back flow of urine due to the obstruction will cause part of the kidney to distend in what is referred to as hydro-nephrosis.

Upper abdominal pain due to kidney stone tends to:

  • Be a sudden or gradual onset of pain
  • Be a pain that starts from either the right or left upper flank (loin) and moves downward and forward to the abdomen
  • Be a very severe pain (described as the most severe pain ever)
  • Comes in waves
  • Spread, in some male patient to a pain in the tip of the penis
  • Make the suffer pace around
  • Cause nausea or vomiting
  • Cause an associated fever and pain when passing urine
  • Increase the frequency of passing urine

If you suspect that this might be the cause of your right or left upper abdominal pain it is important to seek medical attention immediately to exclude an obstruction or infection of the kidney and ureter. This is because both of these infections have serious consequences including loss of kidney function, overwhelming infection and death.

Lower Lobe Pneumonia - Right Sided

Pneumonia is the inflammation or infection of the lung. Quite uncommonly, an infection affecting the lower part of the right lung could cause pain in the right upper abdomen.

Such pain will be a dull continuous ache which is worse on coughing. It will make the sufferer have shortness of breath, a cough with production of greenish or yellow phlegm or sputum and a high temperature. They will usually look quite unwell.

If you suspect that a lung infection may be the cause of your right upper abdominal pain, see your doctor urgently. It could be serious. This condition tends to be more common in children than in adults.

Other causes of right upper stomach pain here include:

Central Upper Abdominal Pain

The following organs that could be affected by central abdominal pain include:

  • Stomach
  • Lower part of the gullet or oesophagus
  • Pancreas
  • Middle part of the liver
  • Duodenum
  • Part of the Small Intestines
  • Part of the Large Intestines or Colon
  • The Blood vessels - especially the Aorta
  • Muscles on the floor of the abdomen
  • The lumbar bones of the spine

The more common causes of central upper abdominal pain include:

Gastritis

Gastritis is the inflammation of the inner wall or lining of the stomach. Some people refer to it as infection of the stomach. It is actually not an infection in over 90 percent of cases.

Anything from stress, binge drinking, cigarette smoking to medications like anti-inflammatory medicines (e.g. ibuprofen, diclofenac, aspirin) calcium channel blockers (e.g. amlodipine, nifedipine) nitrates (e.g. glycerine nitrite, isosorbide mono-nitrite), bisphosphonates, steroids and some types of antidepressants like fluoxetine, citalopram or any SSRI, could trigger gastritis.

The pain is typically:

  • In the upper abdomen between the sternum and umbilicus or sometimes under the sternum
  • Dull to sharp
  • Continuous
  • Not worsened by movement, though pressure to the site will worsen the pain
  • Makes the sufferer feel nausea or vomit
  • Spread through to the back
  • Relieved or gets worse with eating

Many other conditions that mimic gastritis include:

  • Stomach ulcer
  • Duodenal ulcer
  • H. pylori infection of the stomach
  • Functional dyspepsia
  • Hiatus hernia

The difference with gastritis is that it is often something that starts newly and once the offending cause is removed the pain settles within a few days.

Treatment may also include the use of medications like omeprazole, or lanzoprazole, anti-acids like gavsicon and pain killers.

Indigestion (Dyspepsia)

Indigestion or dyspepsia is an umbrella word for a group of gut conditions that causes upper abdominal pain after eating. Other associated symptoms alongside pain with indigestion include:

  • Feeling bloated in the upper abdomen
  • Belching or burping
  • Nausea and vomiting
  • Feeling easily satisfied after eating a small portion of meal
  • Fullness of the upper abdomen

Most causes of indigestion or pains in the upper abdomen after food are not very serious. The pains often include:

  • Functional dyspepsia - where no cause of central upper abdominal pain after eating can be found
  • GORD (or GERD in North America)
  • Gastritis
  • Helicobacter pylori infection - uncomplicated stage
  • Hiatus hernia

The serious and indeed worrying causes of central upper abdominal pain associated with eating are:

  • Stomach ulcer
  • Duodenal ulcer
  • Stomach cancer
  • Barret oesophagitis
  • Gastric outlet obstruction

If you are 55 years or older and have a recent bout of upper abdominal pain, it is important you see your doctor as soon as possible. Also, if you are of any age and suffer with upper abdominal pain, with associated weight loss, poor appetite, difficulty in swallowing, vomiting, vomiting blood or passing dark coloured stool, it is advised that you see your doctor.

Acute Pancreatitis

Pancreatitis refers to the inflammation of this organ, the pancreas

Lying deep under our stomach is a comma shaped organ called the pancreas. It helps in producing a number of chemicals (enzymes) that help the digestion of carbohydrates, proteins and fat. It is also where the important hormone, insulin, is produced.

If for any reason it gets inflamed, it causes a condition called pancreatitis (excessive alcohol consumption and gallstones are the most common causes of pancreatitis).

Pancreatitis causes:

  • A very severe, continuous central upper abdominal pain that progressively gets worse over a few hours
  • Pain which spreads through to the middle of the back
  • Pain which eases on leaning forward or lying on the side with the knee bend towards the chest and tends to get worse on lying flat
  • Pain which is followed by retching and vomiting
  • Fever and yellow discolouration of the white of the eyes

Pancreatitis is a serious condition that needs medical assessment and treatment. It will usually involve admission into hospital, use of intravenous fluids, very strong pain killers and antibiotics if required. Rarely, surgery may be needed.

Other causes of central upper abdominal pain are discussed here

Left Upper Abdominal Pain

Pain in the left upper abdomen is not as common as pain in other parts of the abdomen.

The major organ found in this part of the abdomen is the spleen which rarely is a source of the problem, except if involved in some uncommon infection, blood disorders like ITP, reduced blood flow or gets trapped and ruptures during trauma.

Other organs found on the left upper abdomen include:

  • Left part of the liver
  • Tail of the pancreas as it stretches left-wards
  • Left kidney
  • Left adrenal gland
  • Left ureter
  • Left part of the large bowel (left end of the transverse colon and the descending colon)
  • Blood vessels, lymph nodes, left lower ribs, muscles and skin over the left upper abdomen.

Common causes of left upper stomach pains include:

Costochondritis

This is inflammation of the lower ribs, at the point where the cartilage joins the bone. It often follows episodes of colds and cough or after a surgical operation. Typically, the sufferer experiences moderate to severe upper abdominal pain around the ribs, worse on breathing in, coughing or on application of direct pressure to the region.

Read more on costochondritis and other mimickers of this condition here.

Constipation

If you have a left upper tummy pain following a few days of not opening your bowels, constipation may be the cause.

With the pain often comes:

  • Feeling of bloating
  • Farting more than usual
  • Reduced appetite
  • Passage of small infrequent stools

Trial of laxatives like movicol, senna or ducolax may help.

Trapped Wind

Trapped wind is a very common cause of pain in the left upper abdomen. It often causes a nagging pain with associated bloating and loud "stomach noises", called borborygmi. Trapped wind could cause very severe stomach pain and tends to follow consumption of certain kinds of foods, eating in a hurry, or as a complication of constipation, food intolerance and some other conditions.

You can read more on trapped wind here.

Other causes of left upper stomach pain include:


Reference

In A Page Signs & Symptoms By: Scott Kahan (Franklin Square Hospital) and Ellen Smith (Harrisburg Family Practice) Apr 2004 ISBN: 9781405103688.

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