Differential Diagnosis
The patient's presentation with a distended gallbladder, mild wall edema, and right upper and right lower quadrant pain after consuming a pork sandwich, in the context of a complex cardiac history, suggests a multifaceted differential diagnosis. The following categories outline potential diagnoses:
Single Most Likely Diagnosis
- Cholecystitis: The patient's symptoms of right upper quadrant pain, distended gallbladder, and mild wall edema after eating a fatty meal (pork sandwich) are classic for cholecystitis, likely due to a gallstone obstructing the cystic duct.
Other Likely Diagnoses
- Myocardial Infarction: Given the patient's history of coronary artery disease (double vessel disease with 100% occlusion of the I ostial branch of the LAD and 50% RCA occlusion), new onset or worsening of cardiac symptoms could indicate an acute myocardial infarction, especially with a reduced ejection fraction (EF of 30%).
- Congestive Heart Failure (CHF) Exacerbation: The patient's history of significant cardiac disease and reduced EF, combined with symptoms that could be indicative of fluid overload (distended gallbladder, mild wall edema), suggests a possible exacerbation of CHF.
- Gallstone Ileus: Although less common, the patient's symptoms and the consumption of a fatty meal could also suggest a gallstone ileus, where a gallstone obstructs the intestinal lumen, often at the ileocecal junction.
Do Not Miss Diagnoses
- Mesenteric Ischemia: This is a critical diagnosis not to miss due to its high mortality rate. The patient's abdominal pain and history of cardiac disease could be indicative of mesenteric ischemia, especially if there is an embolic source from the heart.
- Pulmonary Embolism: Given the patient's cardiac history and potential for decreased mobility, pulmonary embolism is a diagnosis that must be considered, as it can present with a wide range of symptoms, including abdominal pain if there is associated right heart strain.
- Cardiac Tamponade: Although less directly related to the gastrointestinal symptoms, the patient's cardiac history makes cardiac tamponade a condition that should not be overlooked, as it can present with hypotension, muffled heart sounds, and potentially abdominal symptoms due to increased venous pressure.
Rare Diagnoses
- Amyloidosis: This condition can involve the heart (restrictive cardiomyopathy) and gastrointestinal system (gastroparesis, intestinal pseudo-obstruction), but it is rare and would require specific diagnostic testing for confirmation.
- Sphincter of Oddi Dysfunction: This condition could cause biliary-type abdominal pain and might be considered if other diagnoses are ruled out, but it is less likely given the patient's overall clinical presentation.