History of Present Illness (HPI)
The patient is a 33-year-old female presenting with epigastric pain that has been ongoing for the last few days. She reports that the pain is exacerbated by eating, particularly spicy food and fast food, and is relieved by movement. She denies any exertional dyspnea, diaphoresis, or chest pain. The patient also denies vomiting blood.
Differential Diagnosis
- Single Most Likely Diagnosis
- Peptic Ulcer Disease (PUD): The patient's symptoms of epigastric pain that worsens after eating and improves with movement are consistent with PUD. The consumption of spicy food and fast food may have contributed to the development of a peptic ulcer.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): The patient's symptoms of epigastric pain that worsens after eating could also be consistent with GERD. However, the absence of symptoms such as heartburn and regurgitation makes this diagnosis less likely.
- Functional Dyspepsia: This condition is characterized by recurring epigastric pain or discomfort that is not explained by other pathologic conditions. The patient's symptoms of epigastric pain that worsens after eating could be consistent with functional dyspepsia.
- Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although the patient denies chest pain, ACS can present with epigastric pain, especially in women. It is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Pancreatitis: The patient's symptoms of epigastric pain that worsens after eating could be consistent with pancreatitis. Although the patient denies vomiting blood, pancreatitis can present with a range of symptoms, and it is crucial to consider this diagnosis.
- Rare Diagnoses
- Gastric Cancer: Although rare in a 33-year-old female, gastric cancer can present with epigastric pain and worsening symptoms after eating. It is essential to consider this diagnosis, especially if the patient's symptoms persist or worsen over time.
- Zollinger-Ellison Syndrome: This rare condition is characterized by excessive gastric acid production, leading to peptic ulcers and epigastric pain. Although rare, it is essential to consider this diagnosis if the patient's symptoms are severe or persistent.