Differential Diagnosis for Left Upper Quadrant Abdominal Pain
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): Given the patient's history of hypertension, high cholesterol, and gout, which are associated with obesity, a common risk factor for GERD, and the complaint of left upper quadrant pain, GERD is a plausible diagnosis. The pain can radiate to the left upper quadrant and is often exacerbated by lying down or eating large meals.
Other Likely Diagnoses
- Peptic Ulcer Disease: The patient's age and history of NSAID use for gout could contribute to the development of peptic ulcers, which can cause upper abdominal pain.
- Gallbladder Disease: Although the pain is in the left upper quadrant, gallbladder disease can sometimes refer pain to this area, especially if there is a stone or inflammation affecting the diaphragm.
- Pancreatitis: Given the patient's history of high cholesterol and gout, which can increase the risk of pancreatitis, especially if there are gallstones or hypertriglyceridemia, pancreatitis should be considered.
Do Not Miss Diagnoses
- Myocardial Infarction: Although the pain is described as left upper quadrant abdominal pain, myocardial infarctions can present with atypical pain, including epigastric or upper abdominal pain, especially in diabetic or older patients.
- Pulmonary Embolism: Can cause sudden onset of chest or upper abdominal pain, especially if the embolism involves the lung bases and irritates the diaphragm.
- Aortic Dissection: A life-threatening condition that can cause severe, tearing chest or abdominal pain, which may be referred to the left upper quadrant.
- Splenomegaly or Splenic Infarction: Given the left upper quadrant location of the pain, conditions affecting the spleen, such as splenomegaly due to portal hypertension or a splenic infarct, should not be missed.
Rare Diagnoses
- Gastric Cancer: Although less common, gastric cancer can cause upper abdominal pain and should be considered, especially if there are other symptoms like weight loss or difficulty swallowing.
- Splenic Artery Aneurysm: A rare condition that can cause left upper quadrant pain, especially if the aneurysm ruptures.
- Diaphragmatic Hernia: Can cause upper abdominal pain or discomfort, especially if there is herniation of abdominal contents into the thoracic cavity.