Differential Diagnosis for Epigastric Pain in a Chronic Drinker
Single Most Likely Diagnosis
- Alcoholic Pancreatitis: This is the most likely diagnosis given the patient's history of chronic drinking, epigastric pain, and nausea/vomiting. Alcoholic pancreatitis is a common complication of chronic alcohol abuse, and the patient's symptoms are consistent with this diagnosis.
Other Likely Diagnoses
- Alcoholic Hepatitis: As mentioned, this condition shares many symptoms with pancreatitis, including epigastric pain and nausea/vomiting. The patient's history of chronic drinking also supports this diagnosis.
- Gastritis: Chronic alcohol abuse can also lead to gastritis, which can cause epigastric pain and nausea/vomiting. This diagnosis is also likely given the patient's symptoms and history.
Do Not Miss Diagnoses
- Peptic Ulcer Disease: Although less likely, peptic ulcer disease can cause severe epigastric pain and nausea/vomiting. If missed, it can lead to life-threatening complications such as bleeding or perforation.
- Cholecystitis: Inflammation of the gallbladder can also cause epigastric pain and nausea/vomiting. If not diagnosed promptly, it can lead to serious complications such as gangrene or perforation.
- Myocardial Infarction: Although the patient's symptoms are more suggestive of a gastrointestinal issue, myocardial infarction can sometimes present with epigastric pain, especially in women or diabetic patients. Missing this diagnosis can be fatal.
Rare Diagnoses
- Pancreatic Cancer: Although rare, pancreatic cancer can cause epigastric pain and nausea/vomiting. This diagnosis is less likely in a patient with a history of chronic drinking, but it should still be considered, especially if the patient has other risk factors such as smoking or a family history of pancreatic cancer.
- Hepatic Artery Aneurysm: This is a rare but life-threatening condition that can cause epigastric pain and nausea/vomiting. It is more likely in patients with a history of liver disease or portal hypertension.