Upper Abdominal Pain

Upper abdominal pain (in the area above the navel) can, clinically, herald diseases of very different organs depending on exactly where the pain is, its character and the symptoms that accompany it. For a proper assessment, the upper abdomen has to be divided anatomically into three main parts:

1. Pain in the Middle of the Upper Abdomen (Epigastric Region)

Pain felt in the middle area just below the rib cage. It usually arises from the stomach, the oesophagus and the duodenum.

• Gastritis and stomach ulcer: Usually causes a burning sensation. Ulcer pain may worsen when hungry or ease with eating.
• Reflux (GORD): Shows itself as burning behind the breastbone and bitter or sour fluid coming up into the mouth.
• Pancreatitis (inflammation of the pancreas): Usually begins very severely, like a stab, and typically spreads to the back in a band-like way.

2. Pain in the Right Upper Abdomen

Pain in this area mostly points to diseases of the gallbladder, the liver and the right kidney.

• Gallstones and inflammation of the gallbladder (cholecystitis): Severe pain, usually triggered after fatty or heavy meals, that begins under the right ribs and radiates to the right shoulder blade or the back. On examination, the breath catching when the doctor presses on the right upper abdomen (Murphy’s sign) is typical.
• Hepatitis (inflammation of the liver): Because the liver enlarges, it causes a dull feeling of tightness and pain in the right upper quadrant. Fatigue and yellowing of the whites of the eyes (jaundice) may often accompany it.

3. Pain in the Left Upper Abdomen

Pain under the left ribs may arise from the stomach, the spleen, the left kidney or the left corner of the large intestine.

• Spleen problems: Enlargement of the spleen (splenomegaly) or splenic infarction causes a stabbing pain and a feeling of fullness in the left upper abdomen.
• Disorders of the body of the stomach: Large stomach ulcers or gastritis can cause more pain on the left side.

Important Causes Outside the Digestive System (Referred Pain)

Upper abdominal pain is not always related to the digestive system. Some life-threatening conditions can disguise themselves as upper abdominal pain:

• Heart attack (myocardial infarction): Attacks affecting the lower wall of the heart in particular can begin only with severe pain, burning and a feeling of indigestion in the stomach area (epigastric). If left arm pain, a cold sweat and shortness of breath accompany it, it is an emergency.
• Lung infections (pneumonia/pleurisy): Pneumonia or inflammation of the lining of the lung at the base of the right or left lung can cause upper abdominal pain that stabs when breathing in.

When Should You See a Doctor Urgently? (Critical Signs)

If any of the following “red flag” symptoms accompanies upper abdominal pain, go to the emergency department without delay:

• Pain that begins suddenly and reaches its worst within minutes, tearing or stabbing.
• Yellowing of the eyes or skin (jaundice) together with the pain.
• Vomiting blood, or vomit that looks like coffee grounds.
• Black, tar-like, foul-smelling stools (a sign of bleeding in the stomach or bowel).
• High fever, shivering, a cold sweat or a feeling of fainting.
• A board-hard abdomen that is too tender to touch.