Differential Diagnosis for 48-year-old Female with Nausea
The patient presents with nausea, urinary urgency and frequency, increased stooling, and intermittent back pain, without abdominal pain, fever, or vomiting. Considering her significant past medical history, the following differential diagnoses are possible:
- Single most likely diagnosis
- Gastroesophageal reflux disease (GERD) exacerbation: The patient's history of GERD, nausea, and increased stooling could be indicative of an exacerbation of her condition, possibly triggered by dietary factors or stress.
- Other Likely diagnoses
- Urinary tract infection (UTI): Despite the patient's concern about a UTI, her symptoms of urinary urgency and frequency, without fever or dysuria, might also be related to other conditions. However, given her age and sex, UTI remains a plausible diagnosis.
- Diabetic gastroparesis: The patient's diabetes could be contributing to her nausea and increased stooling, as gastroparesis is a known complication of diabetes.
- Anxiety-related gastrointestinal symptoms: The patient's history of anxiety could be exacerbating her gastrointestinal symptoms, including nausea and increased stooling.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial infarction (MI): Although the patient denies chest pain, women with MI often present with atypical symptoms, including nausea, vomiting, and back pain. Her history of hypertension, hyperlipidemia, and diabetes increases her cardiovascular risk.
- Pulmonary embolism (PE): The patient's history of asthma and A-fib increases her risk for PE, which can present with nausea, back pain, and respiratory symptoms.
- Diabetic ketoacidosis (DKA): Although the patient denies fever and vomiting, DKA can present with nausea, abdominal pain, and urinary frequency. Her diabetes and symptoms warrant consideration of this life-threatening condition.
- Rare diagnoses
- Addisonian crisis: The patient's nausea, vomiting, and back pain could be indicative of an Addisonian crisis, although this is a rare condition.
- Pancreatic cancer: The patient's new-onset nausea, increased stooling, and back pain could be indicative of a pancreatic malignancy, although this is a rare diagnosis.
- Thyroid storm: The patient's nausea, vomiting, and back pain could be indicative of a thyroid storm, although this is a rare condition, especially in the absence of other thyroid-related symptoms.