What is the diagnosis for a 75-year-old female with acute abdominal pain, tenderness, and a history of diabetes and peptic ulcer (ulcer) disease, presenting shortly after eating at a fast food restaurant with her grandchildren?

Differential Diagnosis for Acute Abdominal Pain in a 75-year-old Female

Single Most Likely Diagnosis

• Acute Cholecystitis: Given the patient's age, history of an ulcer, and the onset of pain after eating, acute cholecystitis is a strong consideration. The gallbladder's ability to function can decrease with age, and the consumption of a fatty meal can trigger a gallbladder attack.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD) or Peptic Ulcer Disease: The patient's history of an ulcer and the onset of pain after eating suggest that GERD or a recurrent peptic ulcer could be the cause of her symptoms.
• Diverticulitis: Although less common in this age group without a history of abdominal surgery or changes in bowel habits, diverticulitis is still a possibility, especially if the patient has a history of diverticulosis.
• Intestinal Obstruction: Without a history of abdominal surgery, this is less likely, but it could still occur due to other causes such as adhesions or tumors.

Do Not Miss Diagnoses

• Myocardial Infarction: Abdominal pain can be a presenting symptom of a myocardial infarction, especially in women and the elderly. It is crucial to consider this diagnosis due to its high mortality rate if missed.
• Aortic Dissection: Severe, tearing abdominal pain can be a symptom of an aortic dissection, which is a life-threatening condition requiring immediate intervention.
• Mesenteric Ischemia: This condition, which involves a lack of blood flow to the intestines, can present with acute abdominal pain and is more common in older adults. It has a high mortality rate if not promptly diagnosed and treated.
• Pancreatitis: Although the patient does not have a clear history of pancreatitis risk factors (e.g., gallstones, alcohol use), it is still a possibility and should be considered due to its potential severity.

Rare Diagnoses

• Inflammatory Bowel Disease (IBD): While IBD can occur at any age, it is less common in the elderly without a prior history of the disease.
• Abdominal Aortic Aneurysm (AAA) Rupture: Although AAA is more common in men, it can still occur in women, especially those with a history of smoking or hypertension. A ruptured AAA would present with severe abdominal pain and is a life-threatening emergency.
• Ectopic Pregnancy: Extremely unlikely in a 75-year-old female, but technically possible in the context of assisted reproductive technology or other rare circumstances.