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dx.
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Left Upper Quadrant Pain
Resuscitation and Universal Approaches
Approach to Unresponsive Patient
Approach to Airway Obstruction And Stridor
Approach to Acute Respiratory Distress With Impending Failure
Approach to Peri-arrest Hypotension
Approach to Post Resuscitation Care After Rosc
Approach to Cardiac Arrest Rhythms, Pea, Asystole
Approach to Cardiac Arrest Rhythms, Vf, Pulseless Vt
Approach to Severe Agitation With Safety Risk
Approach to Procedural Sedation
Chest and Cardiovascular
Approach to Pacemaker And Icd Related Presentations
Approach to Acute Limb Ischemia And Leg Pain
Approach to Suspected Deep Vein Thrombosis Symptoms
Approach to Hypertension
Approach to Chest Pain
Approach to Palpitations And Tachyarrhythmia Symptoms
Approach to Bradycardia Symptoms
Approach to Syncope And Presyncope
Approach to Syncope With Neurologic Concern
Approach to Unilateral Leg Swelling
Approach to Bilateral Leg Swelling
Approach to Calf Pain And Swelling
Respiratory
Approach to Wheezing, Undifferentiated
Approach to Wheezing In Infants
Approach to Stridor And Upper Airway Symptoms
Approach to Dyspnea
Approach to Aspiration Event
Approach to Cough
Approach to Hemoptysis
Approach to Upper Respiratory Infection Symptoms
Approach to Suspected Pulmonary Embolism Presentation
Approach to Smoke Inhalation Concern
Approach to Smoke Exposure And Inhalational Injury
Abdominal and Gastrointestinal
Approach to Abdominal Distension
Approach to Abdominal Pain, Undifferentiated
Approach to Acute Abdominal Pain (general)
Approach to Suspected Incarcerated Or Strangulated Hernia
Approach to Pancreatitis Concern
Approach to Biliary Colic And Cholecystitis Concern
Approach to Appendicitis Concern
Approach to Diverticulitis Concern
Approach to Rectal Pain And Anorectal Complaints
Approach to Dysphagia And Food Bolus Impaction
Approach to Foreign Body Ingestion
Approach to Refractory Vomiting And Recurrent Vomiting Syndromes
Approach to Cannabis Associated Hyperemesis
Approach to Upper Gastrointestinal Bleeding Symptoms (melena)
Approach to Lower Gastrointestinal Bleeding And Hematochezia
Approach to Constipation And Obstipation
Approach to Diarrhea
Approach to Acute Hepatitis And Jaundice Concern
Approach to Right Upper Quadrant Pain
Approach to Epigastric Pain
Approach to Left Upper Quadrant Pain
Approach to Right Lower Quadrant Pain
Approach to Left Lower Quadrant Pain
Approach to Suprapubic Pain
Renal and Urinary
Approach to Oliguria And Anuria
Approach to Catheter Related Urinary Complaints
Approach to Dialysis Patient Presentations
Approach to Flank Pain And Renal Colic Concern
Approach to Urinary Retention
Approach to Hematuria
Approach to Scrotal Pain
Neurologic
Approach to Transient Neurologic Deficits
Approach to Acute Aphasia And Speech Disturbance
Approach to Acute Confusion And Delirium
Approach to Postictal State And Seizure Recurrence Concern
Approach to Seizure
Approach to Acute Vision Loss
Approach to New Tremor And Involuntary Movements
Approach to Headache
Approach to Vertigo
Approach to Acute Weakness Or Numbness
Approach to Gait Instability And Ataxia
Back and Neck
Approach to Atraumatic Back Pain
Approach to Sciatica And Radicular Back Pain
Approach to Back Pain With Neurologic Deficit, Cauda Equina Concern
Approach to Back Pain With Fever Or Immunosuppression, Spinal Infection Concern
Approach to Atraumatic Neck Pain
Approach to Neck Pain After Trauma
Approach to Neck Pain With Meningismus Concern
Approach to Acute Torticollis
Women's Health, Pregnancy, and GU
Approach to Vaginal Discharge
Approach to Hyperemesis Gravidarum Concern
Approach to Hypertensive Disorders Of Pregnancy Symptoms
Approach to Postpartum Hemorrhage Concern
Approach to Postpartum Infection Concern
Approach to Sexual Assault Medical Evaluation Overview
Approach to Pelvic Pain
Approach to Vaginal Bleeding, Nonpregnant
Approach to Vaginal Bleeding In Pregnancy
Approach to Pelvic Pain In Pregnancy
Approach to Post Procedure Or Post Abortion Complications Concern
Infectious Disease and Fever Syndromes
Approach to Fever In The Immunocompromised Patient
Approach to Fever With Rash
Approach to Animal Bites And Rabies Risk Assessment
Approach to Tick Exposure And Tick Borne Illness Concern
Approach to Sepsis Concern Without Clear Source
Approach to Soft Tissue Infection Concern
Approach to Abscess And Skin Infection Concern
Approach to Sore Throat
Approach to Sore Throat And Pharyngitis Symptoms
Approach to Meningitis
Approach to Envenomation And Bites
Allergy and Dermatology
Approach to Pruritus Without Rash
Approach to Contact Dermatitis And Eczema Flare
Approach to Herpes Zoster Concern
Approach to Drug Eruption Concern And Severe Cutaneous Reaction Red Flags
Approach to Urticaria
Approach to Angioedema Concern
Approach to Unexplained Bruising Or Bleeding Symptoms
Musculoskeletal and Extremities
Approach to Shoulder Pain
Approach to Elbow Pain
Approach to Wrist Pain
Approach to Hand Pain
Approach to Hip Pain
Approach to Knee Pain
Approach to Ankle Pain
Approach to Foot Pain
Approach to Cast Or Splint Complication Symptoms
Approach to Wound Check And Suture Related Visits
Approach to Joint Swelling And Monoarthritis
Approach to Suspected Septic Joint Presentation
Approach to Suspected Tendon Rupture Presentation
Approach to Limp Or Refusal To Bear Weight
Trauma and Wounds
Approach to Motor Vehicle Collision Evaluation
Approach to Chest Wall Trauma And Rib Injury
Approach to Blunt Abdominal Trauma Evaluation
Approach to Penetrating Trauma Evaluation
Approach to Pediatric Minor Head Trauma
Approach to Pediatric Head Trauma
Approach to Facial Lacerations And Dental Trauma
Approach to Hand Lacerations With Tendon Injury Concern
Approach to Puncture Wounds And Retained Foreign Body Concern
Approach to Electrical Injury
Approach to Burn Injury
Approach to Fall Evaluation
Approach to Assault And Interpersonal Violence Evaluation
Approach to Eye Trauma And Hyphema Concern
ENT, Eye, Dental
Approach to Dysphagia And Odynophagia
Approach to Throat Pain
Approach to Ear Pain
Approach to Foreign Body In Ear Or Nose
Approach to Vision Loss Complaint
Approach to Flashes And Floaters
Approach to Atraumatic Eye Pain
Approach to Red Eye
Approach to Dental Abscess Concern
Approach to Post Extraction Pain And Complications
Endocrine, Metabolic, and Abnormal Labs
Approach to Hyperglycemia
Approach to Hypoglycemia
Approach to Hyponatremia Symptoms
Approach to Hyperkalemia Symptoms
Approach to Hypokalemia Symptoms
Approach to Rhabdomyolysis Concern
Approach to Anticoagulation Related Abnormal Coagulation Studies
Approach to Acute Kidney Injury And Elevated Creatinine Referral
Approach to Symptomatic Anemia Concern
Toxicology and Behavioral
Approach to Undifferentiated Overdose
Approach to Opioid Toxicity
Approach to Opioid Withdrawal
Approach to Alcohol Intoxication
Approach to Alcohol Withdrawal
Approach to Stimulant Toxicity
Approach to Pediatric Ingestion
Approach to Carbon Monoxide Exposure
Approach to Inhalational Or Chemical Exposure
Approach to Suicidal Ideation And Self Harm Risk Assessment
Approach to Acute Psychosis And Mania Symptoms
Approach to Anxiety And Panic Symptoms
Approach to Capacity Assessment And Safe Disposition
Approach to Behavioral Escalation And Restraint Considerations
Pediatrics
Approach to Fever In The Neonate And Young Infant
Approach to Pediatric Fever By Age 0 To 28 Days
Approach to Pediatric Fever By Age 29 To 60 Days
Approach to Pediatric Fever By Age 2 To 24 Months
Approach to Pediatric Respiratory Distress
Approach to Croup And Stridor In Children
Approach to Pediatric Dehydration
Approach to Pediatric Abdominal Pain
Approach to Febrile Seizure
Approach to Rash In The Child
Approach to Poor Feeding And Lethargy In The Infant
Approach to Vomiting In The Child
Approach to Diarrhea In The Child
Approach to Pediatric Trauma Evaluation
Approach to Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern
Approach to Lethargy And Altered Mental Status In The Child
Environmental and Exposure
Approach to Heat Illness
Approach to Hypothermia And Cold Exposure
Approach to Frostbite Concern
Approach to Drowning And Submersion Injury
Left Upper Quadrant Pain
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Procedures
Calculators
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ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
History
HPI overview
Core history elements
▶
Chief concern
Symptom onset context
Pattern and trajectory
Baseline status
Prior episodes
OPQRST
OPQRST framework
▶
Onset
▶
Sudden
Gradual
Provocation and palliation
▶
Worse with inspiration
Worse with movement
Worse after meals
Relief with antacids
Relief with leaning forward
Quality
▶
Sharp
Dull
Burning
Tearing
Region and radiation
▶
Left upper quadrant
Left shoulder
Back
Chest
Severity
▶
Mild
Moderate
Severe
Timing
▶
Constant
Intermittent
Postprandial
Exertional
Associated symptoms
Symptom associations
▶
Fever
Nausea
Vomiting
Hematemesis
Melena
Diarrhea
Constipation
Chest pain
Dyspnea
Cough
Pleuritic pain
Syncope
Dysuria
Flank pain
Context and triggers
Trigger review
▶
Blunt abdominal trauma
Recent vomiting or retching
Recent endoscopy
Heavy lifting
Recent infection
Recent travel
Special populations
Population modifiers
▶
Pregnancy status
Older adult frailty
Immunocompromised status
Anticoagulant use
Alarm Features
Immediate threats
Resuscitation triggers
▶
Hypotension
Shock index greater than 1
Altered mental status
Respiratory distress
Ongoing hematemesis
Large volume melena
High risk historical features
Time critical history signals
▶
Sudden severe pain at onset
Syncope with pain
Recent significant trauma
Known aneurysm
Anticoagulation with new pain
Recent MI or stent
High risk exam features
Exam danger findings
▶
Peritonitis
Rigid abdomen
Rebound tenderness
Focal neurologic deficit
New murmur
Unequal pulses
Vital sign danger thresholds
Physiologic danger patterns
▶
Systolic BP less than 90 mmHg
Heart rate greater than 120 per minute
Respiratory rate greater than 24 per minute
Oxygen saturation less than 92 percent on room air
Temperature 38.5 C or higher
Medications
Current and recent meds
Medication exposure
▶
Anticoagulants
Antiplatelets
NSAIDs
Steroids
GLP 1 receptor agonists
Opioids
Recent antibiotics
OTC and supplements
Non prescription exposures
▶
Bismuth
Antacids
Iron supplements
Herbal supplements
Therapy contraindications
Key contraindication checks
▶
NSAID avoidance in suspected GI bleed
QT prolonging drug combinations
Contrast precautions
Metformin with acute kidney injury concern
Diet
Recent intake and triggers
Dietary pattern
▶
Recent heavy meal
High fat intake
Poor oral intake
Dehydration indicators
Alcohol and caffeine
Exposures
▶
Alcohol binge
Daily alcohol use
Energy drinks
High caffeine intake
Review of Systems
GI and constitutional
GI and systemic symptoms
▶
Weight loss
Anorexia
Early satiety
Night sweats
Jaundice
Cardiopulmonary
Chest and lung symptoms
▶
Exertional chest pain
Orthopnea
Pleuritic pain
Hemoptysis
Neuro and vascular
Neurovascular symptoms
▶
Syncope
Focal weakness
Visual changes
New severe headache
Collateral History and Family History
Collateral and reliability
Source and reliability
▶
Family or caregiver history
EMS report
Prior records availability
Family history
Heritable and early disease
▶
Early coronary artery disease
Aortic aneurysm or dissection
Inherited hemolytic disorders
Inflammatory bowel disease
Risk Factors
Vascular and cardiac risks
Atherosclerotic risk
▶
Hypertension
Diabetes mellitus type 2 (E11.9)
Tobacco use
Dyslipidemia
Bleeding and splenic risks
Hemorrhage predisposition
▶
Anticoagulation
Thrombocytopenia
Cirrhosis
Portal hypertension
Infection and thrombosis risks
Infection and clot risks
▶
Asplenia
Sickle cell disease (D57.1)
Recent immobilization
Active malignancy
Exposure risks
Exposure profile
▶
Recent travel
Sick contacts
Animal exposure
Differential Diagnosis
Life threatening
Cannot miss diagnoses
▶
Acute coronary syndrome (I21.9)
▶
Epigastric or LUQ discomfort equivalent
Risk increased with exertional symptoms
Aortic dissection (I71.00)
▶
Sudden severe pain
Pulse deficit
Neurologic symptoms
Ruptured abdominal aortic aneurysm (I71.3)
▶
Hypotension
Syncope
Back or flank radiation
Splenic rupture
▶
Trauma history
Left shoulder pain
Hypotension
Upper GI bleed (K92.2)
▶
Hematemesis
Melena
NSAID exposure
Perforated viscus (K63.1)
▶
Peritonitis
Free air on imaging
Pulmonary embolism (I26.99)
▶
Pleuritic pain
Dyspnea
Tension pneumothorax (J93.0)
▶
Sudden dyspnea
Unilateral absent breath sounds
Common
High frequency etiologies
▶
Gastritis or peptic ulcer disease (K29.70)
▶
Postprandial pain
NSAID exposure
Acute pancreatitis (K85.9)
▶
Epigastric or LUQ pain
Radiation to back
Left lower lobe pneumonia (J18.9)
▶
Fever
Cough
Nephrolithiasis (N20.0)
▶
Flank radiation
Hematuria
Constipation
▶
Reduced bowel movements
Distension
Musculoskeletal pain
▶
Reproducible with palpation
Worse with movement
Less common
Lower probability considerations
▶
Splenic infarct
▶
Atrial fibrillation
Hypercoagulable state
Splenic abscess
▶
Prolonged fever
Immunocompromised state
Gastric volvulus
▶
Severe retching
Inability to pass NG tube
Herpes zoster
▶
Dermatomal pain
Rash timing lag
Mesenteric ischemia (K55.9)
▶
Pain out of proportion
Elevated lactate
Inflammatory bowel disease flare (K50.90)
▶
Diarrhea
Weight loss
Past Medical History
Relevant diagnoses and events
Baseline conditions
▶
Coronary artery disease (I25.10)
Heart failure (I50.9)
Atrial fibrillation (I48.91)
Chronic kidney disease (N18.9)
Chronic liver disease
Prior procedures and devices
Procedure history
▶
Prior abdominal surgery
Prior endoscopy
Coronary stent
Pacemaker or ICD
Prior similar episodes
Episode pattern
▶
Prior pancreatitis
Prior peptic ulcer disease
Prior kidney stones
Physical Exam
Initial appearance and vitals
Global assessment
▶
Toxic appearance
Diaphoresis
Perfusion
Orthostatic vitals when stable
Abdomen
Abdominal exam cluster
▶
Focal LUQ tenderness
Rebound tenderness
Guarding
Distension
Bowel sounds
Cardiopulmonary
Heart and lung exam
▶
New murmur
Crackles
Decreased breath sounds
Chest wall tenderness
Vascular and neuro
Vascular and neurologic screen
▶
Pulse symmetry
Blood pressure in both arms when concern
Focal deficits
Limb ischemia signs
Skin and zoster check
Skin findings
▶
Dermatomal rash
Ecchymosis
Lab Studies
Core labs
Initial lab set
▶
CBC
Electrolytes
Creatinine
Glucose
Liver enzymes
Bilirubin
Lipase
Venous blood gas if ill
Hemorrhage and coagulation
Bleeding evaluation
▶
INR
PTT
Type and screen
Type and crossmatch if unstable
Cardiac testing
Cardiac risk labs
▶
Troponin with serial strategy
BNP when heart failure concern
Infection and ischemia clues
Adjunct tests
▶
Lactate
Blood cultures when febrile and septic concern
Urinalysis
Pregnancy test when applicable
Interpretation pitfalls
Common pitfalls
▶
Normal early lipase in very early pancreatitis
Lactate may be normal early in mesenteric ischemia
Imaging
Scoring Systems
When scores influence imaging choice
▶
PERC for PE exclusion
Wells score for PE pretest probability
HEART score for chest pain risk
MRI
MRI considerations
▶
Alternative when CT contraindicated
Limited role in acute unstable abdominal pain
MRCP when biliary obstruction concern and stable
CT
CT pathways
▶
CT angiography chest abdomen pelvis for dissection concern
CT abdomen pelvis with IV contrast for perforation or ischemia concern
CT abdomen pelvis without contrast for renal colic when stable
Ultrasound
Ultrasound use cases
▶
POCUS FAST when trauma or hemorrhage concern
POCUS abdominal aorta screening when hypotension and rupture concern
Left pleural effusion assessment
Splenic size and free fluid support findings
Special Tests
Bedside and procedural
Bedside diagnostics
▶
Rectal exam when GI bleed concern
Nasogastric aspirate local protocol dependent
Point of care hemoglobin local protocol dependent
Respiratory focused tests
Pulmonary adjuncts
▶
Peak flow when asthma mimic suspected
D dimer only in low to intermediate PE risk
ECG
Indications and timing
ECG triggers
▶
Any upper abdominal pain with cardiac risk
Diaphoresis
Dyspnea
Syncope
High risk patterns
ECG danger findings
▶
STEMI criteria
New ischemic ST depression
New T wave inversion in contiguous leads
Ventricular arrhythmia
Serial strategy
Repetition logic
▶
Repeat in 15 to 30 minutes if ongoing concern
Repeat with new symptoms or hemodynamic change
Assessment
Problem representation
Working synthesis
▶
Hemodynamic status category
Peritonitis present or absent
Cardiac and vascular risk context
Risk stratification
High risk flags
▶
Shock physiology
Active bleeding features
Suspected vascular catastrophe
Complications to exclude
Complication screen
▶
Pancreatitis complications
Perforation
Sepsis
ACS equivalent
Plan
First 5 minutes
Immediate stabilization
▶
Cardiac monitor
Pulse oximetry
Two large bore IVs if unstable
Oxygen if saturation less than 92 percent
Massive transfusion activation local protocol dependent
Diagnostic sequencing
Test prioritization
▶
ECG within 10 minutes when cardiac concern
Bedside ultrasound in unstable patient
CTA when dissection concern and stable enough
Analgesia and antiemetics
Symptom control options
▶
Acetaminophen PO 1000 mg once
Hydromorphone IV 0.5 mg
Titrate every 10 minutes as needed
Ondansetron IV 4 mg
Avoid NSAIDs in suspected GI bleed or renal injury
Condition directed therapy
Targeted treatments
▶
Suspected GI bleed
▶
Pantoprazole IV 80 mg bolus
Then 8 mg per hour infusion local protocol dependent
Suspected pancreatitis
▶
Balanced crystalloid bolus 10 mL per kg if hypovolemic
Avoid routine antibiotics unless infected necrosis concern
Suspected ACS
▶
Aspirin PO 160 mg chewable if no contraindication
Nitrates contraindicated with hypotension or RV infarct concern
Reassessment loop
Recheck cadence
▶
Pain score after each intervention
Vitals every 15 minutes if unstable
Abdominal exam repeat after analgesia
Escalate level of care for deterioration
Disposition
ICU and monitored care
Higher acuity criteria
▶
Ongoing hypotension after fluids
Vasopressor requirement
Active GI bleeding with transfusion need
Suspected dissection
Inpatient admission
Admission indications
▶
Pancreatitis with organ dysfunction
Pneumonia with hypoxia
Splenic injury
Uncontrolled pain or vomiting
Observation pathway
Observation candidates
▶
Low risk chest pain pathway eligible
Stable renal colic with pain control
Discharge criteria
Copy
Safe discharge requirements
▶
Stable vitals
Pain controlled with oral meds
Oral intake tolerated
No peritonitis
Reliable follow up
Discharge Instructions
Copy discharge instructions
Copy
Diagnosis summary
▶
Left upper abdominal pain evaluation today did not show an emergency cause on the tests performed
Some conditions can evolve over time and may not show early on initial testing
Medications
▶
Use acetaminophen as directed on the label
Avoid NSAIDs if you have stomach bleeding risk or kidney problems
Take prescribed nausea medicine only as directed
Activity
▶
Avoid heavy lifting until symptoms improve
Hydration with frequent small sips
Follow up
▶
Primary care or clinic follow up within 24 to 72 hours
Return sooner if symptoms worsen
Return to ED now for
▶
Fainting
Chest pain
Trouble breathing
Vomiting blood
Black stools
Fever with worsening pain
New severe sudden pain
Weakness on one side
Inability to keep fluids down
References
Key sources
Evidence base
▶
American College of Cardiology and American Heart Association guideline for acute coronary syndromes 2025
American Heart Association scientific statement on aortic dissection evaluation and management 2022
American College of Gastroenterology guideline for upper gastrointestinal and ulcer bleeding 2021
American College of Gastroenterology guideline for acute pancreatitis 2024
ACEP clinical policy for suspected pulmonary embolism evaluation 2018
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
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Left Upper Quadrant Pain