Differential Diagnosis for a 71-year-old Female with Diffuse Abdominal Pain
The patient's presentation of diffuse abdominal pain radiating to the back and shoulder blades, along with slight scleral icterus, suggests a range of possible diagnoses. Here is a categorized differential diagnosis:
Single Most Likely Diagnosis
- Pancreatitis: The radiation of pain to the back and the presence of scleral icterus (indicative of jaundice) are highly suggestive of pancreatitis, particularly when considering the patient's age and the nature of the pain. Pancreatitis can cause abdominal pain that radiates to the back and can lead to jaundice if there is bile duct obstruction.
Other Likely Diagnoses
- Cholecystitis: Inflammation of the gallbladder can cause abdominal pain, especially in the right upper quadrant, and can radiate to the back. The presence of jaundice could indicate a stone obstructing the common bile duct.
- Peptic Ulcer Disease: While peptic ulcers typically cause more localized pain, a perforated ulcer could lead to diffuse abdominal pain and potentially radiate to the back if the perforation irritates the diaphragm or surrounding structures.
- Biliary Colic: Pain from biliary colic can be severe and diffuse, especially if a gallstone is obstructing the bile duct, leading to jaundice.
Do Not Miss Diagnoses
- Aortic Dissection: Although less likely, aortic dissection is a life-threatening condition that can present with severe, tearing back pain that may radiate to the abdomen. The presence of back pain and the patient's age make this a critical diagnosis not to miss.
- Myocardial Infarction: Some myocardial infarctions, especially those involving the inferior wall of the heart, can present with abdominal pain or a sensation of discomfort that radiates to the back.
- Pulmonary Embolism: While typically presenting with respiratory symptoms, a pulmonary embolism can occasionally cause chest or abdominal pain that radiates to the back, especially if the embolism is large or involves the lung periphery.
Rare Diagnoses
- Hepatic Artery Aneurysm: A rare condition that could potentially cause abdominal pain and jaundice if the aneurysm ruptures or compresses nearby structures.
- Splenic Artery Aneurysm: Similar to a hepatic artery aneurysm, a splenic artery aneurysm could cause abdominal pain, though it is less likely to cause jaundice directly.
Recommended Laboratory Tests
- Complete Blood Count (CBC) to assess for signs of infection or inflammation
- Basic Metabolic Panel (BMP) to evaluate electrolytes and renal function
- Liver Function Tests (LFTs) to assess for liver injury or bile duct obstruction
- Lipase or amylase to diagnose pancreatitis
- Imaging studies such as ultrasound of the abdomen, CT scan of the abdomen with contrast, or an MRI of the abdomen may be necessary to further evaluate the patient's condition, especially to assess the pancreas, gallbladder, and bile ducts.
- ECG and troponin levels to rule out myocardial infarction
- D-dimer if pulmonary embolism is suspected, though it should be interpreted with caution in the elderly due to its low specificity.