Differential Diagnosis
The patient's presentation is complex, with findings suggestive of gastrointestinal and urinary tract issues. Here's a breakdown of the differential diagnosis:
- Single Most Likely Diagnosis
- Peptic ulcer disease (PUD) with concurrent urinary tract infection (UTI): The CT abdomen suggests PUD or duodenal diverticulitis, and the urinalysis shows evidence of a UTI (bacteria, nitrite positive, leukocyte esterase positive, and blood in the urine).
- Other Likely Diagnoses
- Duodenal diverticulitis: Although less likely than PUD, the CT findings and the patient's presentation could still be consistent with this diagnosis.
- Nephrolithiasis (kidney stones): The CT mentions probable tiny stones in the bladder, which could be causing the hematuria and potentially contributing to the UTI.
- Anemia of chronic disease: The patient's low hemoglobin and hematocrit, along with elevated RDW, could indicate anemia of chronic disease, potentially related to the gastrointestinal issues or chronic infection.
- Do Not Miss Diagnoses
- Sepsis: Although the patient's procalcitonin is low, the elevated WBC count and presence of a UTI could indicate a risk for sepsis, which would be a medical emergency.
- Upper GI bleeding: The patient's anemia and the CT findings suggestive of PUD or duodenal diverticulitis raise the concern for upper GI bleeding, which could be life-threatening if not addressed promptly.
- Pyelonephritis: The UTI could potentially be ascending to the kidneys, causing pyelonephritis, which would require prompt antibiotic treatment.
- Rare Diagnoses
- Duodenal cancer: Although the CT does not specifically suggest this, duodenal diverticulitis can be associated with an increased risk of duodenal cancer, and the patient's age and presentation could potentially be consistent with this diagnosis.
- Malabsorptive disorders: The patient's anemia and gastrointestinal symptoms could potentially be related to a malabsorptive disorder, such as celiac disease or Crohn's disease, although this would be less likely given the acute presentation.