Differential Diagnosis for Abdominal Pain and Bloating in a 91 y/o Female
Single Most Likely Diagnosis
- Cholecystitis or Biliary Colic: Given the patient's age and the presence of mild bile duct dilation on CT scan, a gallbladder pathology is a strong consideration. The absence of liver function test abnormalities does not rule out biliary colic or early cholecystitis.
Other Likely Diagnoses
- Ovarian Cyst-Related Pain: The patient has a known left ovarian cyst, which could be causing the abdominal pain and bloating, especially if the cyst is large or has undergone torsion.
- Gastroesophageal Reflux Disease (GERD) or Peptic Ulcer Disease: Although the patient does not have nausea or vomiting, GERD or peptic ulcer disease could still cause abdominal pain and bloating, particularly in the context of her medical history.
- Diverticulitis: Given the patient's age, diverticulitis is a possible cause of abdominal pain, although the absence of changes in bowel habits and the lack of specific localization of pain to the left lower quadrant make it less likely.
Do Not Miss Diagnoses
- Bowel Obstruction: Although the patient does not have constipation or diarrhea, a partial bowel obstruction could still present with abdominal pain and bloating. This diagnosis is critical to consider due to its potential for serious complications if missed.
- Mesenteric Ischemia: This is a life-threatening condition that can present with abdominal pain out of proportion to physical examination findings. The patient's history of hypertension and hyperlipidemia increases her risk for vascular disease.
- Ovarian Torsion: While less common, ovarian torsion is a surgical emergency that can present with severe abdominal pain and requires prompt diagnosis and intervention.
Rare Diagnoses
- Hepatic Artery Aneurysm or Other Vascular Anomalies: These conditions are rare but could cause abdominal pain and bile duct dilation. They are more likely to be considered if other diagnoses are ruled out and the patient's condition worsens or does not improve with treatment.
- Intra-abdominal Malignancy: Although the patient has a known ovarian cyst, the possibility of another intra-abdominal malignancy causing her symptoms cannot be entirely ruled out without further investigation.