Differential Diagnosis for Acute Abdominal Pain
The patient's presentation of acute abdominal pain, tenderness, and recent consumption of a meal from a fast food restaurant, combined with her medical history, suggests several potential diagnoses. These can be categorized as follows:
Single Most Likely Diagnosis
- Peptic Ulcer Disease (PUD): Given the patient's history of an ulcer "years ago" and the onset of pain after eating, which could be related to increased gastric acid production or irritation of a pre-existing ulcer site. The patient's diabetes might also contribute to gastrointestinal motility issues or increased susceptibility to ulcers.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Although more chronic in nature, an acute exacerbation could present with abdominal pain, especially after eating.
- Acute Cholecystitis: While less common in the absence of specific gallbladder disease history, the consumption of a potentially fatty meal could precipitate an attack in someone with gallstones.
- Acute Pancreatitis: Could be considered, especially if the meal was high in fat, though typically, there would be more specific symptoms like radiating back pain.
Do Not Miss Diagnoses
- Mesenteric Ischemia: Although less likely, this condition is critical and can be fatal if not promptly diagnosed and treated. The patient's age and history of diabetes increase her risk.
- Perforated Viscus: Any history of ulcer disease increases the risk of perforation, which is a surgical emergency.
- Appendicitis: While less common in this age group and without specific symptoms like migration of pain or localized tenderness, it cannot be entirely ruled out without further evaluation.
Rare Diagnoses
- Intestinal Obstruction: Without a history of abdominal surgery, this is less likely, but could still occur due to other causes like adhesions from previous inflammation or a tumor.
- Diverticulitis: More common in the lower abdomen and typically associated with changes in bowel habits, which this patient does not have.
- Eosinophilic Gastroenteritis: A rare condition that could present with abdominal pain after eating, but would be unusual without other symptoms like eosinophilia or atopic history.