Differential Diagnosis for 67y Male with Epigastric Pain
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD) or Peptic Ulcer Disease: The patient's age and symptom presentation (epigastric pain) are consistent with these common gastrointestinal disorders. Epigastric pain is a hallmark symptom of both conditions, and they are prevalent in the elderly population.
Other Likely Diagnoses
- Acute Cholecystitis: Inflammation of the gallbladder can cause epigastric pain, especially if the pain radiates to the right upper quadrant. The patient's age increases the likelihood of gallbladder disease.
- Acute Pancreatitis: This condition can cause severe epigastric pain that may radiate to the back. While it's not the most common cause, the patient's age and the acute onset of pain make it a plausible diagnosis.
- Myocardial Infarction (MI) with Atypical Presentation: Although less common, especially in men, MI can present with epigastric discomfort or pain, particularly in elderly patients.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition that can present with sudden, severe epigastric or back pain. Although rare, missing this diagnosis can be fatal, and the patient's age increases the risk.
- Esophageal Rupture or Perforation: A serious condition that requires immediate attention. It can present with severe epigastric or chest pain and is often associated with vomiting or difficulty swallowing.
- Mesenteric Ischemia: This condition involves insufficient blood flow to the intestines and can cause severe abdominal pain. It's more common in older adults and has a high mortality rate if not promptly treated.
Rare Diagnoses
- Gastric Cancer: Although less likely, gastric cancer can cause epigastric pain and should be considered, especially if the patient has risk factors such as a family history or certain dietary habits.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis are less common in new presentations at this age but could be considered if other symptoms like diarrhea, weight loss, or blood in stool are present.