Differential Diagnosis for Epigastric Pain Radiating to Back with Nausea
- Single Most Likely Diagnosis
- Peptic Ulcer Disease: This is a common cause of epigastric pain that can radiate to the back, often accompanied by nausea and vomiting. The pain is typically worsened by food and improved by antacids.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): GERD can cause epigastric pain that radiates to the back, along with nausea and regurgitation of food. Symptoms are often worsened by lying down or eating large meals.
- Pancreatitis: Acute pancreatitis can cause severe epigastric pain that radiates to the back, accompanied by nausea and vomiting. The pain is often constant and may be worsened by eating.
- Cholecystitis: Inflammation of the gallbladder can cause epigastric pain that radiates to the right upper back, along with nausea and vomiting. The pain is often worsened by fatty foods.
- Do Not Miss Diagnoses
- Myocardial Infarction: Although less common, myocardial infarction (heart attack) can present with epigastric pain radiating to the back, especially in women or diabetic patients. It is crucial to consider this diagnosis due to its high mortality rate if missed.
- Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain that radiates to the back, along with nausea and vomiting. This is a medical emergency that requires immediate attention.
- Esophageal Rupture: A rupture of the esophagus can cause severe chest pain that radiates to the back, along with nausea and vomiting. This is a rare but life-threatening condition that requires prompt diagnosis and treatment.
- Rare Diagnoses
- Gastric Cancer: Although rare, gastric cancer can cause epigastric pain that radiates to the back, along with nausea and vomiting. This diagnosis should be considered in patients with risk factors such as a family history or previous gastric surgery.
- Pancreatic Cancer: Pancreatic cancer can cause epigastric pain that radiates to the back, along with nausea and vomiting. This diagnosis should be considered in patients with risk factors such as smoking or a family history.
- Splenic Infarction: A blockage of the splenic artery can cause severe left upper quadrant pain that radiates to the back, along with nausea and vomiting. This is a rare condition that requires prompt diagnosis and treatment.