Differential Diagnosis for Upper Abdominal Pain
The patient presents with upper abdominal pain and tenderness that worsens at night, interrupting sleep, along with diffuse tenderness lasting for years and sensations of hot and cold. Given the normal results from the CT scan, CBC, CMP, amylase, and HBA1C, the following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Irritable Bowel Syndrome (IBS): This condition is characterized by chronic abdominal pain, changes in bowel movements, and is often worse at night. The normal laboratory and imaging results support this diagnosis, as IBS is a functional disorder without clear structural abnormalities.
- Other Likely Diagnoses
- Functional Dyspepsia: Similar to IBS, functional dyspepsia involves chronic upper abdominal pain or discomfort not explained by other conditions, which could fit the patient's symptoms.
- Gastroparesis: This condition involves delayed stomach emptying, which can cause abdominal pain, nausea, and vomiting, and could potentially worsen at night.
- Chronic Pancreatitis: Although the amylase level is normal, chronic pancreatitis can cause recurrent or persistent abdominal pain, and some patients may have normal pancreatic enzyme levels.
- Do Not Miss Diagnoses
- Peptic Ulcer Disease: Although less likely given the normal laboratory results, peptic ulcers can cause severe abdominal pain that worsens at night and can lead to serious complications if not treated.
- Gastric Cancer: This is a critical diagnosis not to miss, as it can present with nonspecific abdominal symptoms, including pain and weight loss, and is more common in certain populations.
- Pancreatic Cancer: Similar to gastric cancer, pancreatic cancer can present with vague abdominal symptoms and is crucial to diagnose early due to its poor prognosis.
- Rare Diagnoses
- Eosinophilic Gastroenteritis: A rare condition characterized by eosinophilic infiltration of the gastrointestinal tract, leading to abdominal pain, nausea, and vomiting.
- Abdominal Migraine: A condition that presents with recurrent episodes of severe abdominal pain, often accompanied by other migraine symptoms, and can be difficult to diagnose.
- Porphyrias: A group of rare genetic disorders that can cause acute episodes of severe abdominal pain, among other symptoms, and are important to consider in patients with chronic, unexplained abdominal pain.