Differential Diagnosis for Left Shoulder Pain with Epigastric Pain
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): The patient's symptoms of intermittent epigastric pain that occurs after meals and radiates to the left shoulder are consistent with GERD. The fact that the pain is intermittent and can be severe (7/10) supports this diagnosis.
Other Likely Diagnoses
- Peptic Ulcer Disease: The patient's epigastric pain and radiation to the left shoulder could also be indicative of a peptic ulcer. The intermittent nature of the pain and its relation to meals are consistent with this diagnosis.
- Functional Dyspepsia: This condition is characterized by recurrent epigastric pain or discomfort that is not explained by other conditions. The patient's symptoms of intermittent epigastric pain and radiation to the left shoulder could be consistent with functional dyspepsia.
- Musculoskeletal Pain: The patient's left shoulder pain could be related to musculoskeletal issues, such as strain or overuse. However, the radiation of pain from the abdomen to the shoulder suggests a gastrointestinal origin.
Do Not Miss Diagnoses
- Myocardial Infarction: Although the patient is young, it is essential to consider myocardial infarction as a possible cause of chest pain that radiates to the shoulder. The patient's mild hypertension increases his cardiovascular risk.
- Pulmonary Embolism: This is a life-threatening condition that can cause sudden onset of chest pain and shortness of breath. Although the patient's symptoms are intermittent, it is crucial to rule out pulmonary embolism.
- Pancreatitis: Acute or chronic pancreatitis can cause severe epigastric pain that radiates to the back or shoulder. The patient's symptoms of intermittent epigastric pain and radiation to the left shoulder could be consistent with pancreatitis.
Rare Diagnoses
- Gallbladder Disease: Gallstones or cholecystitis can cause epigastric pain that radiates to the right shoulder, but it is less common for the pain to radiate to the left shoulder.
- Sphincter of Oddi Dysfunction: This condition can cause recurrent epigastric pain and is often associated with biliary colic. However, it is a rare condition and would require further evaluation to diagnose.
- Esophageal Spasm: This condition can cause chest pain and radiation to the shoulder, but it is relatively rare and would require further evaluation to diagnose.