Differential Diagnosis
The patient presents with abdominal fluid and bulging on both sides since March, despite weight loss, and experiences pressure in the abdomen when sitting. The patient's father passed away from pancreatic cancer. The patient's appetite and bowel movements are normal.
Single most likely diagnosis
- Ascites: The patient's complaint of abdominal fluid and bulging on both sides, along with abdominal pressure when sitting, is highly suggestive of ascites. The weight loss could be related to various underlying causes, but the presence of ascites is a key finding that points towards liver disease, heart failure, or other conditions leading to fluid accumulation in the abdomen.
Other Likely diagnoses
- Liver Cirrhosis: Given the ascites and the fact that the patient has lost weight, liver cirrhosis is a plausible diagnosis. The patient's normal appetite and bowel movements do not rule out cirrhosis, as these symptoms can be absent in early or compensated stages of the disease.
- Congestive Heart Failure (CHF): CHF can cause ascites due to fluid overload and increased venous pressure. Although the patient's weight loss might seem counterintuitive, it can occur in CHF due to various factors, including decreased appetite and increased energy expenditure.
- Peritoneal Carcinomatosis: Given the family history of pancreatic cancer, the possibility of abdominal carcinomatosis, either primary or metastatic, should be considered. However, the normal appetite and bowel movements make this less likely compared to ascites or cirrhosis.
Do Not Miss diagnoses
- Pancreatic Cancer: Although the patient's symptoms and normal appetite and bowel movements might not strongly suggest pancreatic cancer, the family history of pancreatic cancer makes it a diagnosis that cannot be missed. Pancreatic cancer can present with weight loss and abdominal symptoms, and the presence of ascites could be a sign of advanced disease.
- Ovarian Cancer: Similar to pancreatic cancer, ovarian cancer can present with ascites and abdominal symptoms. It is a diagnosis that should not be missed, especially in women, due to its potential for late presentation and poor prognosis if not caught early.
Rare diagnoses
- Tuberculous Peritonitis: This is a rare condition in many parts of the world but can cause ascites and abdominal symptoms. It would be considered if the patient has risk factors for tuberculosis or if other diagnoses are ruled out.
- Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can cause ascites and abdominal symptoms. It is a rare diagnosis but should be considered in the differential, especially if other causes are excluded.