Causes of Pain in the Upper Left Side of the Abdomen (Under the Left Ribs)

Quick overview

Pain in the upper left side of the abdomen (also called left upper quadrant pain) can come from the stomach, spleen, pancreas, left kidney, bowel, or even the chest wall/lungs. Most cases are digestive or muscle-related, but some causes are urgent.

Here’s the simplest way to think about it:

• After eating → often stomach irritation, reflux, trapped gas, or ulcer-type pain
• Constant and severe, with nausea/vomiting → consider pancreatitis or serious stomach inflammation
• With fever → infection becomes more likely (stomach, kidney, or lung)
• With shortness of breath or chest pressure → consider lung/heart causes
• After trauma (fall, sports hit, car accident) → the spleen must be taken seriously

A quick Houston reality check (seasonal context)

If you’re reading this in the middle of winter in Houston—especially around busy corridors like the Galleria/Uptown, Memorial, the Energy Corridor, Westchase, or Spring Branch—please know this: respiratory virus season increases coughing, chest wall strain, dehydration, and “viral stomach” symptoms that can mimic or worsen upper abdominal discomfort.

• In Texas, influenza activity has been elevated this season, with hospital lab positivity reported at 42.2% in a recent surveillance week.
• Nationally, CDC respiratory virus tracking has shown high overall acute respiratory illness activity with flu elevated and RSV elevated (and COVID-19 trends monitored alongside).
• Norovirus season typically peaks December to March, which matters because vomiting/diarrhea can cause significant upper abdominal cramping and irritation.

That doesn’t mean your pain is “just a virus.” It means your body may be under more strain than usual—so pattern and red flags matter.

Where is the upper left abdomen?

The upper left abdomen is the area under your left ribs and slightly toward the center.

Structures that can cause pain in upper left abdomen include:

• Stomach (reflux, gastritis, ulcer)
• Spleen (enlargement, injury)
• Pancreas (pancreatitis)
• Left kidney/urinary tract (stone, infection)
• Colon (trapped gas/constipation, inflammation)
• Lower left lung (pneumonia/pleurisy)
• Ribs and abdominal wall muscles (strain, costochondritis)
• Heart-related pain (sometimes felt in unusual places)

Because everything is close together, pain in the upper left side of the stomach doesn’t always mean the stomach is the cause.

Angina: When Chest Pain Turns Up Where You Least Expect

Let’s talk about angina—a classic heart signal that can throw you for a loop by showing up as upper left abdominal pain. Angina happens when your heart muscle isn’t getting enough oxygen-rich blood. Most people picture this as crushing chest pain, but here’s the curveball: angina can masquerade as vague discomfort not just in the chest, but also in places like the upper belly, left shoulder, back, or even jaw.

How does this tie into abdominal pain? The nerves serving your heart and your upper abdomen like to “share” pathways. That means irritation in your heart can be felt in your upper left abdomen, especially near the ribcage—often described as tightness, pressure, or a gnawing ache.

• Angina tends to show up when your heart’s working harder—like walking, climbing stairs, or after a big holiday meal.
• It doesn’t always feel like the classic “elephant on the chest”—sometimes it’s just a strange, unsettling pain under your left ribs (or even across your upper stomach).
• If the pain eases with rest and returns with exertion, consider angina as a possibility.

Angina is not a disease itself; it’s a warning flag for underlying issues like coronary artery disease. It’s your heart’s way of saying, “Hey, something’s not right down here.” If you notice these patterns—especially alongside shortness of breath, sweating, or nausea—a heart check-up needs to jump to the top of your list.

Can Appendicitis Cause Pain in the Upper Left Abdomen?

Let’s put one myth to bed: the appendix usually lives in the lower right side of your belly. That’s why appendicitis most often causes pain starting near your belly button before settling in that famous lower right spot.

But here’s the rare twist: unusual anatomy or referred pain can sometimes send discomfort into the upper left abdomen. This might occur if someone has a “wandering” appendix due to congenital differences, or rarely, if pain radiates in an atypical pattern across the abdomen.

Unless you’ve recently had abdominal surgery that altered your anatomy or know you have something called “situs inversus” (where organs are flipped like a mirror image), appendicitis isn’t the top suspect for upper left pain. Still, medicine loves its exceptions.

Classic appendicitis clues—beyond shifting abdominal pain—involve:

• Loss of appetite
• Nausea and vomiting
• Indigestion or bloating
• Sometimes a low-grade fever

If your pain migrates or just doesn’t fit the standard patterns, it’s always worth mentioning these details to your doctor.

What is endocarditis—and how does it relate to upper left abdominal pain?

Endocarditis is an infection of the inside lining of the heart, most often caused by bacteria. While it primarily affects the heart, it can sometimes trigger discomfort in the upper left abdomen thanks to the close relationship between the heart and surrounding organs.

Here’s how:

• When endocarditis leads to heart problems—like heart failure—fluid can back up and cause swelling or pain in areas such as the upper abdomen.
• Tiny blood clots or infected growths (emboli) from the heart can travel elsewhere, sometimes causing spleen inflammation or irritation under the left ribs.

Common symptoms include:

• Persistent fever and chills
• Unexplained fatigue or weakness
• Shortness of breath, especially with activity
• New or worsening heart murmur

If you have upper left abdominal pain along with these symptoms—especially if you notice fever or feel generally unwell—it’s important to seek medical attention.

When should you worry about upper left abdominal pain?

You asked for guidance without telling people to call 911—so here is the clean, practical version:

Seek urgent evaluation now if you have upper left abdominal pain with any of the following:

• Chest pressure, squeezing, or discomfort (especially with sweating, nausea, shortness of breath, or lightheadedness)
• Trouble breathing, rapid breathing, or chest pain that worsens with a deep breath
• Severe, constant pain that is escalating (not “waves,” not improving)
• Fainting, severe weakness, confusion, or gray/clammy skin
• Vomiting blood, black/tarry stools, or signs of internal bleeding
• Fever + flank/back pain + urinary symptoms (possible kidney infection/obstruction)
• Pain after trauma (even if the hit felt “not that bad”)—especially if you feel dizzy or weak

If you’re unsure, it is appropriate to be checked in an emergency setting. A quick exam plus basic testing often clarifies whether something dangerous is happening.

How to interpret your pain pattern (the “ER doctor” way)

Most people don’t feel pain in medical categories. You feel it as real life:

1) Is it burning, gnawing, or sour—especially after meals?

This leans stomach-related: reflux, gastritis, ulcer-type irritation.

2) Is it crampy with bloating, and better after passing gas or a bowel movement?

This leans bowel-related: constipation, trapped gas, colonic spasm.

3) Is it sharp under the ribs and worse with twisting, coughing, or pressing on the area?

This leans musculoskeletal: abdominal wall strain, rib cartilage irritation.

4) Is it severe, deep, and radiating to the back—especially with nausea/vomiting?

This raises concern for pancreatitis.

5) Is it higher and toward the flank with urinary changes?

This raises concern for kidney stones or infection.

What sets apart the symptoms and causes among these conditions?

Even though pain in the upper left abdomen can feel similar regardless of the culprit, there are key differences in both what brings it on and what other clues ride along with it. Here’s how these causes diverge—think of it as matching the “pattern” and “partners in crime” to each potential suspect.

Heart Sources (Cardiac and Surrounding Structures):

• Heart attack or angina: Pain often feels like pressure or squeezing, not just in the chest but sometimes radiating to jaw, shoulders, or back. These typically show up with big warning signals like shortness of breath, cold sweats, nausea, or lightheadedness—especially if you have risk factors like age, smoking, or family history.
• Pericarditis: Pain here usually gets worse when lying flat and feels sharper, sometimes improving when you sit up. It may be accompanied by mild fever or a recent viral illness.
• Endocarditis (heart lining infection): Unlike sudden severe pain, this tends to cause fever, fatigue, and sometimes swelling or signs of heart failure over days to weeks.

Digestive Tract Causes:

• Heartburn / GERD: Burning or sour discomfort after meals or when lying down. May come with burping, sour taste, or cough—worse with spicy or fatty foods.
• Gastritis and Ulcer: Burning, gnawing pain, sometimes waking you at night or linked to certain foods and relieved with antacids. Nausea and vomiting may surface.
• Constipation or trapped gas: More cramping or bloating, tending to improve after a bowel movement or passing gas.
• Inflammatory bowel disease: Brings cramping pain plus chronic diarrhea, sometimes blood in stool or weight loss between flare-ups.
• Pancreatitis: Think deep, searing pain straight through to the back, usually with ongoing nausea and vomiting, often set off by fatty meals or alcohol.

Urinary Tract and Kidney:

• Kidney Stones: Sudden, sharp, and severe pain—often waxing and waning (colicky)—possibly radiating to your back or groin, sometimes with visible blood in urine, nausea, or vomiting.
• Kidney infection: Upper side pain plus fever, chills, and sometimes burning when urinating.

Spleen and Blood Disorders:

• Enlarged spleen: Dull discomfort or sense of fullness/pain, not usually stabbing but more persistent, sometimes noticed with other symptoms like easy bruising or infections.

Musculoskeletal and Chest Wall:

• Costochondritis or muscle strain: Sharp, well-localized pain that worsens when pressing on the area, twisting, coughing, or deep breaths.
• Broken ribs: Localized pain after trauma, made worse by breathing, moving, or coughing.

Lung and Pleura:

• Pneumonia: Aching pain coupled with cough, fever, and often shortness of breath. Deep breathing may make it worse.
• Pleurisy: Stabbing pain that gets worse with breaths or coughing, often after a viral infection.
• Collapsed lung: Sudden, severe stabbing pain with impossible-to-ignore shortness of breath—may see blue lips/fingers in severe cases.

Others:

• Appendicitis (rarely left-sided): Usually right lower pain, but very rarely, if your anatomy is unusual, it could mimic left-sided discomfort—look for nausea, loss of appetite, and progression over hours.

Each of these conditions brings its own “signature”—be it the character of pain (sharp, burning, deep), the timing (meals, movement, sudden onset), or the company it keeps (fever, nausea, breath trouble, etc.). Knowing these patterns is what helps doctors (and sharp readers) sort minor annoyances from something more menacing.

Major causes of upper left abdominal pain

Digestive system causes

These are frequent reasons for upper left side abdominal pain and stomach discomfort upper left side.

Indigestion, reflux, and GERD

Often felt as burning or pressure in the upper abdomen or lower chest, sometimes with burping or sour taste.

Heartburn is the classic name for this discomfort—a burning sensation that typically shows up after eating, especially if you then lie down or bend over. It happens when stomach acid sneaks up into the esophagus, causing that familiar warmth or pressure. If these symptoms are more severe or frequent, you may be dealing with gastroesophageal reflux disease (GERD), which is common and can affect anyone.

Clues that fit:

• Worse after eating or lying down
• Acid taste, belching, chest/upper belly burning

Other signals can include a sour or bitter taste in the mouth, a feeling like food is coming back up, or even mild chest pain. While occasional heartburn is common, persistent symptoms—especially if they disrupt sleep or are accompanied by difficulty swallowing—deserve a closer look from your healthcare provider.

Gastritis (stomach lining irritation)

Gastritis can cause pain in the upper part of the belly, nausea, and sometimes vomiting.

Clues that fit:

• Upper abdominal tenderness
• Nausea, reduced appetite
• Symptoms after irritating foods or heavy meals

Peptic ulcer disease

Ulcers can cause a gnawing or burning pain—sometimes worse at night or when your stomach is empty, sometimes triggered by meals.

Clues that fit:

• Recurrent upper belly pain
• Nausea, early fullness
• Any sign of GI bleeding warrants urgent evaluation

Trapped gas and constipation

Gas and stool can “hang up” near the splenic flexure (left upper colon), creating abdominal pain top left side that feels sharp, full, or crampy.

Clues that fit:

• Bloating
• Pain improves after passing gas or bowel movement
• Irregular bowel habits

Inflammatory bowel disease (IBD)

IBD is a broad term for chronic conditions like Crohn’s disease and ulcerative colitis, where the digestive tract gets inflamed—sometimes stubbornly so. Either can cause pain and cramping in the upper left abdomen, especially if inflammation involves the colon near the splenic flexure (where your colon takes a sharp turn beneath the ribs on the left).

Clues that fit:

• Recurring abdominal pain, often with cramping
• Diarrhea (sometimes urgent, sometimes mixed with blood or mucus)
• Episodes of fatigue or weight loss
• May come with other “autoimmune” symptoms—joint aches, skin changes, or eye irritation

If you have a known diagnosis and pain is new or severe, or if there’s persistent blood in the stool, it’s not something to brush off.

Enlarged spleen (splenomegaly)

The spleen lives just under the left upper ribs, quietly filtering your blood and helping with immune defenses. Infections, chronic liver diseases (think cirrhosis), or certain blood disorders can all lead to spleen enlargement.

Clues that fit:

• Constant or “full” sensation in the left upper abdomen
• May radiate to the left shoulder (Kehr’s sign)
• Sometimes associated with fatigue, easy bruising, or infections

A noticeably enlarged spleen deserves attention—especially if you have fevers, unexplained weight loss, or recent infection.

Irritable Bowel Syndrome (IBS)

IBS is surprisingly common and can cause upper left abdominal discomfort, though it often wanders around the belly like a restless housecat. The pain tends to be crampy—sometimes sharp, sometimes achy—and frequently comes along with bloating.

Clues that fit:

• Recurrent episodes of abdominal pain, often relieved by passing gas or having a bowel movement
• Alternating episodes of diarrhea and constipation (sometimes one, sometimes the other)
• Feeling gassy, bloated, or full after eating
• No signs of fever, weight loss, or blood in stool (red flags mean it’s something else)

IBS symptoms often flare up during times of stress or after eating certain trigger foods (looking at you, beans and artificial sweeteners). While it’s uncomfortable, IBS itself doesn’t cause inflammation or permanent harm to the intestines—though the rollercoaster symptoms can be a pain, literally and figuratively.

Viral gastroenteritis (“stomach bug”)

This is especially relevant during winter months when norovirus peaks.

Clues that fit:

• Nausea, vomiting, diarrhea
• Cramping abdominal pain
• Sick contacts, daycare/school exposure, recent travel

Pancreatic causes

Pancreatitis

Pancreatitis typically causes pain in the upper left side or middle of the abdomen, often worse after eating and sometimes radiating to the back.

Clues that fit:

• Severe, constant pain (not mild cramps)
• Nausea/vomiting
• Worse lying flat; may feel better leaning forward
• Feels “deep,” not surface-level

Pancreatitis is not something to “wait out.” It deserves evaluation.

Spleen-related causes

Enlarged spleen (splenomegaly)

An enlarged spleen can cause pain or fullness in the left upper belly and may make you feel full quickly.

Clues that fit:

• Fullness under left ribs
• Feeling full after small meals
• Sometimes follows infections

Splenic injury or rupture

After trauma, left-sided pain can signal spleen injury. This can be dangerous even if symptoms start “later.”

Clues that fit:

• Pain after a hit to the abdomen/ribs
• Dizziness, weakness, shoulder-tip pain, worsening pain

Kidney and urinary causes

Kidney stones

Kidney stones can cause intense pain (often in the back/side) and may come with blood in urine, nausea/vomiting, or urinary urgency.

Kidney infection (pyelonephritis)

Often includes fever, chills, and flank pain, sometimes with nausea and urinary symptoms. This is urgent.

Lung and chest wall causes

Pneumonia or pleurisy

A lower lung infection can sometimes feel like upper abdominal pain, especially when breathing deeply or coughing.

Pleurisy is inflammation of the lining around your lungs and the inside of your chest wall. This can cause sharp, sometimes stabbing pain that gets worse with deep breaths, coughing, or movement. You might also notice fever or a persistent cough along with the pain.

Clues that fit:

• Fever, cough, shortness of breath
• Pain worse with deep breath
• Pain may be sharp and can sometimes be felt in the upper abdomen, chest, or even shoulder
• May be accompanied by a recent viral infection or illness

If chest pain is accompanied by trouble breathing, high fever, or you feel generally unwell, it’s best to seek medical attention.

Pulmonary embolism (blood clot in the lung)

This is less common but serious: sudden shortness of breath, rapid breathing, and chest pain often worse with breathing are classic warning signs.

Collapsed lung (pneumothorax)

A collapsed lung, known medically as pneumothorax, happens when air leaks into the space between your lung and chest wall. This buildup of air places pressure on the lung, causing it to partially or completely collapse—which makes it tough to breathe deeply.

Clues that fit:

• Sudden, sharp, stabbing chest pain
• Difficulty taking a full breath
• Rapid heart rate
• Low blood pressure or lightheadedness
• Bluish lips or skin (from low oxygen)

A pneumothorax often strikes suddenly and deserves emergency evaluation, especially if you notice severe shortness of breath or feeling faint.

Pericarditis

Pericarditis is inflammation of the thin sac (pericardium) that surrounds your heart. When this protective membrane becomes irritated and swollen, it can produce pain that may be felt in the upper abdomen or lower chest, sometimes mimicking heart attack or pneumonia.

Clues that fit:

• Sharp, stabbing chest or upper abdominal pain—often worse with deep breaths, coughing, or lying flat
• Relief when sitting up or leaning forward
• Pain may spread to the neck, shoulder, or back
• Possibly a recent viral infection or illness

There are a few main types of pericarditis, defined by how long symptoms last:

• Acute: Lasts less than 3 weeks, with a sudden onset.
• Subacute: Develops over weeks or months after an illness, injury, or chest infection.
• Incessant: Symptoms persist for 4–6 weeks without remission.
• Recurrent: Returns after a symptom-free period (usually after 4–6 weeks).
• Chronic: Persists for more than 3 months.

Recognizing pericarditis is important because, while many cases improve on their own, some require prompt treatment. If you notice severe pain with these features—especially if other heart or lung symptoms are present—it’s smart to get checked out.

Musculoskeletal causes

Abdominal wall strain / intercostal muscle strain

This is one of the most common causes of upper left sided abdominal pain after coughing, lifting, twisting, or workouts.

Clues that fit:

• Sharp pain upper left abdomen when moving
• Reproducible pain when you press on a specific spot
• Worse with coughing or twisting

Rib cartilage irritation (costochondral-type pain)

Pain near the ribs that worsens with breathing/movement can be musculoskeletal and can mimic deeper problems. One common culprit is costochondritis—an inflammation of the cartilage where your ribs meet your breastbone. This can cause sharp or aching pain in the upper and middle rib area, sometimes on either side of the breastbone.

Clues that fit:

• Pain that gets worse with deep breaths, coughing, or moving your upper body
• Tenderness when pressing on the affected area of the chest wall
• Discomfort may intensify when lying down

Costochondral pain can feel alarming (and sometimes similar to heart-related pain), but it’s typically harmless and responds to rest and anti-inflammatories. If you’re unsure or the pain is severe, it’s always safest to check in with a healthcare provider.

Broken ribs and referred upper left abdominal pain

A broken rib—often after a blow to the chest, fall, or accident—can trigger pain not just right at the site, but also in the upper left abdomen. The ribs on your left side curve over and protect the upper part of your abdomen, so a fracture here can send sharp, localized pain to this region. People with weaker bones (like in osteoporosis) may even suffer a break from milder injuries.

Clues that fit:

• Sharp or stabbing pain after chest trauma or forceful impact
• Pain is worse with deep breaths, coughing, or sneezing
• Localized tenderness over a rib, sometimes with visible bruising

If you suspect a rib injury—especially after trauma—seek care, as occasionally rib fractures can affect underlying organs.

Nerve/skin causes

Shingles

Shingles can start as burning pain on one side before a rash appears.
If you notice tingling/burning in a stripe-like pattern and then a rash, don’t ignore it.

Special situations people ask about

Upper left abdomen pain female / in women

Most causes are the same for everyone: stomach, bowel, muscles, kidney. What changes is the context—pregnancy, anemia risk, and how heart symptoms can sometimes be subtler.

If you searched this phrase specifically: woman pain in upper left side of stomach, the key is not the label—it’s the pattern. If pain is paired with chest discomfort, shortness of breath, faintness, or unusual sweating, take it seriously.

Upper left abdominal pain in pregnancy

Many cases are reflux, gas, constipation, or muscle strain from posture changes—but pregnancy is a reason to have a lower threshold for evaluation if pain is severe, persistent, or paired with vomiting, fever, or bleeding.

Abdominal pain upper left side male

Again, causes are usually the same. The key difference is risk profile (work strain, heavy lifting, dehydration patterns, and kidney stones in some populations). If pain is severe, persistent, or paired with urinary symptoms, get checked.

Pain in upper left side and back

This pattern can point to the pancreas, kidney/urinary tract, or sometimes musculoskeletal causes. The deciding factors are severity, persistence, vomiting, fever, and urinary symptoms.

What to do next

If your symptoms are mild and improving

Focus on what an ER doctor listens for first:

• Hydration
• Rest
• Small, bland meals
• Avoid heavy/fatty meals if pain is meal-triggered
• Watch for any escalation or red flags

If symptoms are persistent (over 24–48 hours), recurrent, or disruptive

You should be evaluated—because imaging and labs answer what guessing cannot.

How doctors evaluate upper left abdominal pain

In the ER, we’re trying to answer: Is this dangerous today? Then: What’s the most likely cause?

You can expect:

• A focused history: timing, triggers, foods, vomiting/diarrhea, urinary symptoms, trauma, fever, pregnancy status
• Exam: tenderness location, guarding, rib/chest wall reproducibility
• Testing depending on symptoms:
• Bloodwork (infection, anemia, pancreatic markers)
• Urine testing (infection, blood)
• EKG when chest/heart symptoms are possible
• Imaging (ultrasound, CT, sometimes chest X-ray)

Frequently Asked Questions

Most upper left abdominal pain is not life-threatening—but the job is to separate “common and manageable” from “rare but dangerous.” The fastest way to do that is pattern recognition plus timely evaluation when red flags are present.

If you’re in Houston and you need an in-person evaluation for persistent or concerning upper abdominal pain, Post Oak ER can assess abdominal pain with appropriate testing and imaging, while keeping the focus on clear answers and patient-first care.

Reference List

MedlinePlus. (n.d.). Pneumonia. https://medlineplus.gov/pneumonia.html

Texas Department of State Health Services. (2025). Texas Respiratory Virus Surveillance | MMWR Week 52, 2025 [PDF]. https://www.dshs.texas.gov/sites/default/files/IDCU/disease/respiratory_virus_surveillance/2025/2025-week52-trvsreport.pdf

Centers for Disease Control and Prevention. (2026, January 9). Respiratory Virus Activity Levels. https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

Centers for Disease Control and Prevention. (n.d.). FluView: Weekly U.S. Influenza Surveillance Report. https://www.cdc.gov/fluview/index.html

Centers for Disease Control and Prevention. (2025). Weekly U.S. Influenza Surveillance Report (2025 Week 52). https://www.cdc.gov/fluview/surveillance/2025-week-52.html

Centers for Disease Control and Prevention. (2025). NoroSTAT Data. https://www.cdc.gov/norovirus/php/reporting/norostat-data.html

Centers for Disease Control and Prevention. (2025, November 25). NoroSTAT Surveillance Network. https://www.cdc.gov/norovirus/php/reporting/norostat.html

Centers for Disease Control and Prevention. (2024, April 24). How Norovirus Spreads. https://www.cdc.gov/norovirus/causes/index.html

Centers for Disease Control and Prevention. (n.d.). Norovirus (Overview). https://www.cdc.gov/norovirus/index.html

MedlinePlus. (n.d.). Gastritis (Medical Encyclopedia). https://medlineplus.gov/ency/article/001150.htm

MedlinePlus. (n.d.). Acute Pancreatitis (Medical Encyclopedia). https://medlineplus.gov/ency/article/000287.htm

MedlinePlus. (n.d.). Kidney Stones. https://medlineplus.gov/kidneystones.html

Mayo Clinic Staff. (n.d.). Enlarged Spleen (Splenomegaly) – Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/enlarged-spleen/symptoms-causes/syc-20354326

Centers for Disease Control and Prevention. (2024, October 24). About Heart Attack Symptoms, Risk, and Recovery. https://www.cdc.gov/heart-disease/about/heart-attack.html

MedlinePlus. (n.d.). Pulmonary Embolism. https://medlineplus.gov/pulmonaryembolism.html

MedlinePlus. (n.d.). Shingles (Medical Encyclopedia). https://medlineplus.gov/ency/article/000858.htm