Upper Abdominal Pain: Causes, Red Flags, and When to Seek Care

Anatomic Regions

• Epigastric: Stomach, pancreas, proximal duodenum, left liver lobe.
• Right upper quadrant (RUQ): Gallbladder, liver, hepatic flexure, right kidney.
• Left upper quadrant (LUQ): Spleen, stomach body, pancreatic tail, left kidney, splenic flexure.

Common Causes by Region

Epigastric

• Gastritis, peptic ulcer disease (PUD), functional dyspepsia.
• GERD (heartburn, regurgitation).
• Pancreatitis (epigastric → back, severe, vomiting).
• Early MI (atypical presentation).

RUQ

• Biliary colic / cholecystitis (fatty meal trigger, Murphy's sign).
• Hepatitis (viral, alcoholic, autoimmune).
• Liver congestion (heart failure).

LUQ

• Splenomegaly (infections, hematologic, portal HTN).
• Gastric pathology, diverticulitis (sigmoid can refer).

Generalized/Referred

• IBS (functional).
• Herpes zoster (dermatomal pain before rash).
• Pneumonia (lower lobe → referred abdominal pain).

Red Flags → Urgent Evaluation

• Severe, unremitting pain.
• Fever + abdominal pain.
• Hematemesis, melena, hematochezia.
• Jaundice.
• Inability to pass flatus/stool (obstruction).
• Pregnancy + pain (ectopic, abruption).
• Syncope, hypotension.

Diagnostic Approach

• History: Onset, character, radiation, triggers, alleviating factors.
• Exam: Tenderness, guarding, Murphy's, Rovsing's, Carnett's (wall vs. visceral).
• Labs: CBC, LFTs, lipase, amylase, electrolytes, lactate, pregnancy test, UA.
• Imaging: US (RUQ), CT (pancreas, general), EGD (upper GI).

Self-Care for Mild Indigestion

• Small, low-fat meals; avoid triggers (caffeine, alcohol, spicy, late eating).
• Antacids, alginate, PPI (OTC 14-day course).
• H. pylori test if recurrent.