Differential Diagnosis for 17-year-old Female with Worsening Stomach Pain
Single Most Likely Diagnosis
- Functional Dyspepsia: This is a common condition characterized by recurring or persistent upper abdominal pain or discomfort that is not explained by other medical conditions. The patient's history of ongoing stomach issues and worsening symptoms over 4 days, especially with eating, aligns with this diagnosis. The absence of fever, vomiting, and blood in stool also supports this possibility.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): The patient's symptoms of worsening stomach pain with eating and a feeling of nausea could be indicative of GERD, especially if she experiences heartburn or regurgitation, which are common symptoms.
- Irritable Bowel Syndrome (IBS): Although the patient does not report changes in bowel habits, IBS can sometimes present with predominant abdominal pain. The absence of blood in stool and the nature of her pain could still fit within the spectrum of IBS.
- Peptic Ulcer Disease: The patient's inability to eat due to worsening discomfort could suggest a peptic ulcer, especially if she has been experiencing pain localized to the upper abdomen.
Do Not Miss Diagnoses
- Appendicitis: Although the patient's pain is generalized and not localized to the right lower quadrant, appendicitis can present atypically, especially in young females. It's crucial to consider this diagnosis due to its potential for severe complications if missed.
- Ectopic Pregnancy: Given the patient's age, an ectopic pregnancy must be considered, even though she does not report missing a menstrual period or other suggestive symptoms. A pregnancy test should be performed to rule out this life-threatening condition.
- Intestinal Obstruction: The patient's inability to eat and reports of nausea could suggest an intestinal obstruction, which is a medical emergency requiring prompt diagnosis and treatment.
Rare Diagnoses
- Inflammatory Bowel Disease (Crohn's Disease or Ulcerative Colitis): While less likely given the acute presentation, inflammatory bowel diseases can cause significant abdominal pain, nausea, and changes in bowel habits. These conditions are important to consider, especially if the patient has a family history or other systemic symptoms.
- Gastric Volvulus: A rare condition where the stomach twists upon itself, which can cause severe abdominal pain and nausea. This condition requires immediate medical attention.
- Pancreatitis: Although the patient does not report specific risk factors like gallstones or alcohol use, pancreatitis can cause severe abdominal pain and should be considered, especially if she has elevated pancreatic enzymes.