Differential Diagnosis for 71-year-old Female with Acute Abdominal Pain
The patient's presentation of acute onset severe abdominal pain radiating to the hips, back, and shoulders, along with systemic symptoms such as headache, body aches, chills, nausea, vomiting, and diarrhea, suggests a serious underlying condition. The following differential diagnoses are considered:
Single Most Likely Diagnosis
- Acute Cholecystitis or Biliary Colic: The severe pain in the right upper quadrant and epigastric region, along with significant tenderness on palpation, points towards a gallbladder pathology. The patient's age and symptoms are consistent with acute cholecystitis, which is an inflammation of the gallbladder often caused by gallstones.
Other Likely Diagnoses
- Acute Pancreatitis: The severe abdominal pain radiating to the back, nausea, vomiting, and the location of pain in the epigastric region could also suggest acute pancreatitis. The patient's history of kidney stones increases the risk for pancreatitis if a stone were to obstruct the pancreatic duct.
- Peptic Ulcer Disease: Although less likely given the radiation of pain to the hips, back, and shoulders, peptic ulcer disease could present with severe epigastric pain and systemic symptoms like nausea and vomiting.
- Diverticulitis: While the pain is typically more left-sided, diverticulitis can present with severe abdominal pain, nausea, vomiting, and changes in bowel habits. The patient's age puts her in a higher risk category for diverticular disease.
Do Not Miss Diagnoses
- Appendicitis: Although the pain is not typically in the right lower quadrant as expected in appendicitis, atypical presentations can occur, especially in older adults. Missing appendicitis can lead to perforation and severe consequences.
- Myocardial Infarction: Abdominal pain can be a presenting symptom of a myocardial infarction, especially in women and older adults. The radiation of pain to the shoulders and the presence of systemic symptoms like nausea and vomiting make this a crucial diagnosis not to miss.
- Aortic Dissection: Severe, tearing abdominal or back pain can be a sign of an aortic dissection, a life-threatening condition that requires immediate intervention.
- Mesenteric Ischemia: This condition, which involves insufficient blood flow to the intestines, can present with severe abdominal pain out of proportion to physical examination findings, along with systemic symptoms.
Rare Diagnoses
- Porphyria: A group of disorders that can result in acute, severe abdominal pain, along with neurological and psychiatric symptoms. The presence of body aches, nausea, and vomiting could suggest this rare diagnosis, although it is less likely.
- Lead Poisoning: Can cause severe abdominal pain, along with systemic symptoms like nausea, vomiting, and body aches. However, this would be an unusual presentation without a clear history of lead exposure.