Differential Diagnosis for Elevated LDH in a Patient with Episodic Nausea and No Cancer History
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): Elevated LDH can be seen in conditions that cause tissue damage or cell turnover. GERD, which can cause episodic nausea, may lead to esophageal mucosal damage, resulting in elevated LDH levels.
Other Likely Diagnoses
- Peptic Ulcer Disease: Similar to GERD, peptic ulcers can cause gastric mucosal damage, leading to elevated LDH levels. Episodic nausea can be a symptom of peptic ulcer disease.
- Gastritis: Gastritis, especially when caused by Helicobacter pylori infection, can lead to gastric mucosal inflammation and damage, resulting in elevated LDH levels.
- Pancreatitis: Although pancreatitis typically presents with abdominal pain, episodic nausea can be a symptom. Elevated LDH can be seen due to pancreatic tissue damage.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although less likely, pulmonary embolism can cause elevated LDH due to lung tissue damage. It is a life-threatening condition that requires prompt diagnosis and treatment. Nausea can be a symptom, especially if the patient is experiencing significant distress.
- Cardiac Ischemia/Infarction: Elevated LDH can be seen in myocardial infarction due to cardiac tissue damage. Episodic nausea can be a symptom, especially in women or patients with atypical presentations.
Rare Diagnoses
- Celiac Disease: Celiac disease can cause small intestinal damage, leading to elevated LDH levels. Episodic nausea can be a symptom, especially if the patient is experiencing malabsorption.
- Inflammatory Bowel Disease (IBD): IBD, including Crohn's disease and ulcerative colitis, can cause intestinal inflammation and damage, resulting in elevated LDH levels. Episodic nausea can be a symptom, especially during disease flares.
- Hemolytic Anemia: Hemolytic anemia can cause elevated LDH due to red blood cell destruction. Although less likely, it is a rare diagnosis that should be considered, especially if the patient has other symptoms such as jaundice or fatigue.