Differential Diagnosis for a 47-year-old Male Patient with Prediabetes and Abdominal Pain
Single Most Likely Diagnosis
- Chronic Pancreatitis: This condition is a likely cause of abdominal pain and elevated lipase in a patient with prediabetes. The normal abdominal CT scan does not rule out chronic pancreatitis, as it may not show the characteristic changes of chronic pancreatitis, such as pancreatic calcifications or atrophy, especially in early stages.
Other Likely Diagnoses
- Acute Pancreatitis: Although the abdominal CT scan is normal, it's possible that the patient had a mild episode of acute pancreatitis that resolved by the time the CT scan was performed. The elevated lipase supports this diagnosis.
- Gallstone Disease: Gallstones can cause abdominal pain and elevated lipase, even if the CT scan is normal. The patient's prediabetes may increase the risk of gallstone disease.
- Peptic Ulcer Disease: Peptic ulcers can cause abdominal pain and may be associated with elevated lipase in some cases.
Do Not Miss Diagnoses
- Pancreatic Cancer: Although less likely, pancreatic cancer can cause abdominal pain, elevated lipase, and may not be visible on a normal abdominal CT scan, especially if it's a small tumor. This diagnosis is critical to consider due to its high mortality rate if left untreated.
- Intestinal Ischemia: This condition can cause abdominal pain and elevated lipase, and may not be visible on a CT scan if it's not an acute event. Intestinal ischemia is a medical emergency that requires prompt diagnosis and treatment.
Rare Diagnoses
- Hypertrophic Pyloric Stenosis: This rare condition can cause abdominal pain and elevated lipase, but it's more commonly seen in infants.
- Eosinophilic Pancreatitis: This rare condition is characterized by inflammation of the pancreas due to an eosinophilic infiltrate, and can cause abdominal pain and elevated lipase.
- Groove Pancreatitis: This rare condition is characterized by inflammation of the pancreatic groove, and can cause abdominal pain and elevated lipase.