Causes of Upper Abdominal Pain and When to See a Doctor
- stomach, spleen, liver, and gallbladder
- parts of the pancreas, small intestine, and large intestine
- the muscular abdominal wall itself
Abdominal pain can also spread, or radiate, to or from other locations, such as the heart, lungs, or blood vessels. Problems with the kidneys, which are located in the back side of the abdominal cavity, can also result in upper abdominal pain.
This article presents an overview of pain in the upper abdomen, including minor to severe causes, symptoms, when to contact a doctor for treatment, and how doctors diagnose the cause of upper abdominal pain.
Abdominal pain, including upper abdominal pain, is a common reason for people to seek care in the emergency department (ED). This is according to a 2016 retrospective analysis of 5,340 admissions for acute abdominal pain to a large urban ED in Italy.
The definition of acute abdominal pain is pain lasting for 5 days. The Society for Academic Emergency Medicine notes that it is the most common condition in the ED. A common diagnosis is nonspecific abdominal pain, or abdominal pain that is not due to a specific cause. Renal colic from kidney stones is the other most common diagnosis.
There are different types of upper abdominal pain. For example, you may feel mild discomfort, a burning sensation, or a sharp pain. You may feel it in one specific area or throughout the upper abdomen. The pain may also move from one place to another. For example, you may feel pain that begins in your chest, such as from heartburn, but that moves to your upper abdomen.
The type and location of the pain can be important in diagnosing the possible cause. For example, pain from your pancreas or kidneys might start in your abdomen and then move to your back. Shingles, which can cause skin irritation, can also cause abdominal pain if the infection spreads there. Pain from heart attacks or pneumonia usually starts in your chest, but you may also feel this in your upper abdomen.
Any symptoms that occur along with upper abdominal pain, such as nausea or vomiting, can also help with diagnosis. Healthcare professionals perform a physical exam and ask about the nature and duration of the pain and any related symptoms. They may also order an abdominal ultrasound to help diagnose upper abdominal pain.
Seek immediate medical care (call 911) for severe upper abdominal pain that comes on suddenly, especially if it is accompanied by:
- an inability to have bowel movements
- bloody stool, vomiting blood, or abdominal rigidity, which refers to an abdomen that is very firm or hard
- breathing difficulties
- pain in the neck, chest, shoulders, or area between the shoulders
Abdominal pain during pregnancy also requires emergency attention.
Less severe pain that does not get better within a couple of days can also indicate a serious medical condition. If your upper abdominal pain is persistent or causes you concern, seek prompt medical care.
Acute upper abdominal pain is pain lasting for up to 5 days.
Digestive tract causes of upper abdominal pain
Digestive tract causes include:
- stomach flu
- food intolerance, such as lactose intolerance
- celiac disease
- gallbladder disease or gallstones
- gastroesophageal reflux disease
- inflammatory bowel disease
- irritable bowel syndrome
- liver disease, including hepatitis
- ulcers of the stomach or duodenum, which is the first section of the small intestine
Other causes of upper abdominal pain
Conditions involving other body systems that can cause upper abdominal pain include:
- muscle strain
- nerve compression
- kidney stones
- kidney infection
- shingles, which can sometimes cause pain on the left or right side of the abdomen
Serious or life threatening causes of upper abdominal pain
- aortic aneurysm
- bowel obstruction or bowel perforation
- chemical or heavy metal poisoning
- colonic volvulus
- intestinal ischemia
- heart attack
- preeclampsia, which can cause upper right abdominal pain
- sickle cell crisis
- significant abdominal trauma
Upper abdominal pain may occur along with other symptoms, including those involving the digestive tract or other body systems, such as the circulatory (cardiovascular) system.
Digestive tract symptoms that may occur along with upper abdominal pain
Gastrointestinal symptoms can include:
- indigestion, or dyspepsia
- bloody stool
- changes in bowel movements
- nausea with or without vomiting
Other symptoms that may occur along with upper abdominal pain
Upper abdominal pain may accompany symptoms related to other body systems. Such symptoms may include:
- abdominal muscle spasms
- body aches
- general ill feeling
- numbness or tingling
- unexpected weight loss
Potential complications of untreated upper abdominal pain due to serious conditions include:
Abdominal pain is a common complaint that can be due to a wide range of causes. Some of these are serious and require a professional medical evaluation to diagnose or rule out.
Contact a doctor or another healthcare practitioner for upper abdominal pain when you experience:
- abdominal pain bad enough to wake you up
- continuous discomfort for 24–48 hours
- mild pain or pain that comes and goes for more than a few days
Keep in mind that the need for medical attention can depend on the person’s age, health, and medical history.
Serious symptoms that might indicate a life threatening condition
In some cases, upper abdominal pain is a symptom of a serious condition. Seek immediate medical care (call 911) for any of the following symptoms:
- high fever
- severe or sharp abdominal pain that comes on suddenly
- an inability to have bowel movements, especially with vomiting
- a rapid heart rate
- respiratory or breathing problems
- chest pain, chest tightness, chest pressure, or palpitations
- rigidity of the abdomen
- trauma to the abdomen
- vomiting blood, rectal bleeding, or bloody stool
- changes in consciousness or alertness, such as passing out or becoming unresponsive
The diagnosis of upper abdominal pain involves a thorough physical examination, a review of your medical history, and possibly imaging and blood tests.
Imaging tests can include:
- abdominal ultrasound, which is a common imaging test for diagnosing abdominal pain
- CT scan
- upper gastrointestinal endoscopy, or esophagogastroduodenoscopy, which is a test to examine the lining of the esophagus, stomach, and first part of the small intestine
Questions for diagnosing the cause of upper abdominal pain
To diagnose your condition, some questions your doctor may ask include:
- Where do you feel the pain?
- Is the pain precise, or is it hard to pinpoint where it is?
- When did the pain start?
- Have you had pain like this before?
- How severe is the pain? (On a scale of 1–10, 10 is the worst pain you can imagine.)
- How would you describe your pain? Is it sharp or dull, constant, or intermittent?
- Does anything make the pain go away or make it worse?
- Have you been injured?
- Do you have any other symptoms?
- What medications are you taking?
- What is your medical history?
- Have you had surgery recently?
- Could you be pregnant?
The treatment of abdominal pain will depend on the cause. You can treat some causes at home. For non-serious causes, such as stomach flu, treatment includes resting and taking on fluids until your body clears the viral infection.
Some types of treatment, along with their causes, include:
- antacid medications for heartburn
- pain relief medications for muscle strains
- antibiotics for bacterial infections
- nerve blocks for severe pain from conditions such as pancreatitis
- oral or IV fluids for dehydration from vomiting
- surgery for correcting structural problems, such as hernia, or for treating certain conditions, such as stomach ulcer or kidney stones
Often, upper abdominal pain is not due to a serious cause and will go away on its own.
However, if you have persistent pain, unusual or sharp pain, or pain with other symptoms, take your concerns to your healthcare professional. In most cases, a doctor finds the cause, and treatment is successful.