35yr old Rati presented to ED with sharp epigastric pain, radiating to her shoulder and back, associated with nausea and vomitting. Her pain score was 10/10, on examiniation, she has abdominal rigity and dimished bowel sounds. What are differential diagnoses based on Rati's presentation and assesement so far?
Question
35yr old Rati presented to ED with sharp epigastric pain, radiating to her shoulder and back, associated with nausea and vomitting. Her pain score was 10/10, on examiniation, she has abdominal rigity and dimished bowel sounds. What are differential diagnoses based on Rati's presentation and assesement so far?
Solution
Based on Rati's presentation and assessment, the following are potential differential diagnoses:
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Acute Pancreatitis: This is suggested by the sharp epigastric pain radiating to the back, nausea, and vomiting. The abdominal rigidity and diminished bowel sounds could be due to paralytic ileus, which is a common complication of pancreatitis.
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Peptic Ulcer Disease (PUD): PUD can present with sharp epigastric pain, nausea, and vomiting. The pain can sometimes radiate to the back. Abdominal rigidity may be present if there is perforation leading to peritonitis.
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Gallstone Disease (Cholecystitis or Biliary Colic): This can present with epigastric pain radiating to the right shoulder or back, nausea, and vomiting. Abdominal rigidity may be present if there is perforation or empyema.
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Myocardial Infarction (MI): Although less likely, MI can sometimes present with epigastric pain, nausea, and vomiting. The pain can radiate to the shoulder or back.
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Gastroenteritis: This can present with abdominal pain, nausea, and vomiting. However, it is less likely to cause sharp epigastric pain radiating to the back or shoulder.
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Aortic Dissection: This is a less common but serious condition that can present with sharp pain radiating to the back. However, it is less likely to cause nausea and vomiting.
These are just a few possibilities. Further diagnostic tests such as blood tests, imaging studies, and possibly endoscopy would be needed to confirm the diagnosis.
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